Canada’s publicly-funded, single-payer healthcare system is known as one of the best in the world. With it, the health of each Canadian and permanent resident is insured. Under our healthcare system, each visit to the doctor is publicly paid for—there’s no need to worry about copayments or paying out-of-pocket.

For nearly half a million people in Canada, however, this isn’t the case. Canada, as a signatory of several UN conventions, affirms the human right to good health. Yet, in spite of this, a 2016 report by the Wellesley Institute estimates that up to 500 000 people in Canada don’t have access to health coverage.

Who we’re not looking out for

Immigration status is the single biggest obstacle to accessing health insurance in Canada. It’s estimated that there may be more than 500 000 undocumented residents in Canada, which means they don’t have authorization to live in Canada. Many undocumented residents arrive in Canada through legal means, but their immigration status may have changed. A report by the City of Toronto Medical Officer of Health cites expired visas, denied refugee claims, and sponsorship breakdowns as typical reasons for people losing their immigration status.

CBC Radio followed the story of Grace, who legally came to Canada in 2001. Before Grace could complete the immigration process, she lost her job. Over the past 18 years, Grace has worked under the table jobs, the same ones that are highly susceptible to exploitative practices. In 2012, Grace had to get a pacemaker and ended up having to pay tens of thousands of dollars out-of-pocket. Last August, she received news of a breast tumour, with treatment likely to cost more than $10 000.

In 2015, more than 200 000 temporary workers, international students, and newly-arrived permanent residents lacked access to provincial healthcare. More than 20 years ago, temporary residents and international students had provincial health coverage. Then, in 1994, the provincial government imposed a three-month wait period for newly-arrived residents and removed health coverage for temporary residents and students. The three-month wait period, which prevents health coverage until the individual has been in the province for three months, also applies to Canadian citizens if they’ve been out of the country for 212 days.

Luma, a 4-year-old Canadian citizen, had left the country with her mother to visit family in the Middle East. Due to armed conflicts, Luma and her mother were unable to return home and their three week visit became longer than seven months. Upon arriving back in Canada, Luma’s face had been infected and when Luma’s mother took her to the hospital, she was denied coverage.

When asked about abolishing the three-month wait period in 2011, the provincial government cited that the policy saves $90 million a year and there were no plans to change it. However, as the Wellesley Institute points out, the amount saved wasn’t transparently calculated and it fails to consider the higher costs needed to treat people who become sicker over the three-month period. It also excludes any cost associated with untreated infectious diseases that can spread to communities during that time.

The wait period also affects nearly 120 000 temporary foreign workers (TFWs) in Ontario. Although TFWs pay the same taxes most ordinary Canadians do, they arrive in the country without health coverage for three months. Some may never get health coverage, as some workers can have multiple job contracts a year, with each one allowing them to work for less than three months at a time. Canadian citizens that are homeless and/or have mental health conditions also make up part of the population of uninsured people. Often times, these individuals aren’t able to provide the documents needed to identify themselves and subsequently lose healthcare coverage because of it.

What’s being done

At the moment, there are several healthcare services that uninsured people can access. The Canadian Centre for Refugee and Immigrant Healthcare (CCIRH), located in Scarborough, was Canada’s first medical clinic dedicated solely to supporting refugees and immigrants. Ever since 1999, the CCIRH has had more than 50 000 visits, 31% of which are from uninsured people. The CCIRH estimates that due to the efforts of their organization, they’ve saved over $24 200 000 in healthcare and research costs.

Scattered throughout the province, community health centres offer primary healthcare for all individuals in their community, including the uninsured. They’re non-profit organizations that receive some provincial funding.

In addition, there are clinics available where a health card is optional. To name a couple, the Toronto District School Board offers pediatric and optometry clinics for newcomers and Women’s College Hospital runs the Bay Centre for Birth Control.

On the federal level, the government supports incoming refugees through the Interim Federal Health Program (IFHP), which covers basic healthcare costs for refugees coming to Canada.

To address the issue of missing identification documents, the Ministry of Health and Long-Term Care has offered identification clinics in the past. Today, some community health centres have replaced these clinics, offering to provide assistance with obtaining the documents needed to get healthcare coverage.

Most of these services are limited by lack of funding, however. Community health centres are typically at capacity and have certain requirements that new patients need to meet. Clinics such as the CCIRH lack the necessary funds to operate at full capacity. Dr. Caulford, who works at the CCRIH clinic, has said “[Funding] runs out about five months into the year … we’re going on fumes for about seven months.”

The IFHP has its own set of problems. In 2012, the Conservative government made significant cuts to the program, leaving many refugees without health coverage. Protests organized by healthcare providers erupted throughout the country. Although the cuts have since been reversed, there’s been confusion about the state of the program. In order to be paid by the program for seeing refugee patients, healthcare practitioners need to enrol with the program. Some clinics continue to deny services for refugees as they’re under the assumption that IFHP coverage hasn’t been restored. Even when practitioners are registered with IFHP, there have been complaints about the lack of information about what services are covered.

What can be done

It’s clear a lot can be done to improve the healthcare coverage of uninsured people in Canada. A good start would be reforming the three-month wait policy.

Groups have been lobbying for the elimination of the three-month wait period, stating the cruel irony of denying healthcare coverage. “You could say it’s even fraudulent to invite people to Ontario and then say to them when they get here, ‘By the way, don’t get sick for a few months’”, said Dr. Bob Gardner from the Wellesley Institute.

The wait period can…discourage people with infectious diseases from getting treatment

The wait period can also discourage people with infectious diseases from getting treatment, leaving cases of infectious disease unseen by public health officials. The current provincial government is more than aware of this. This March, in response to the COVID-19 pandemic, the Government of Ontario announced that the three-month wait period will be waived and the cost of COVID-19 related services would be covered for uninsured people.

Luma eventually got treated for her infection, all thanks to volunteer healthcare providers. As one of the wealthiest countries in the world, however, there shouldn’t be a need to rely on volunteers to treat people that offer so much to our country, both socially and economically. At what point does someone become “Canadian enough” to have their right to good health?