On February 9th, the Wellesley Institute and the Health Network for Uninsured Clients held a full day symposium which brought together settlement workers, researchers, policy makers, politicians, funders, and a range of health care providers to discuss current research, practice and policy opportunities to improve access to health care for uninsured clients and to realize the universal right to health of all Ontario residents.
Public health care insurance provides important access to a spectrum of care that spans from preventative care to keep us healthy through to emergency care to help us when we’re sick or injured. But despite our universal health care system, many people in Ontario do not have public health care coverage and are left without access to essential health care or face the possibility of having to pay out-of-pocket for care.
People become uninsured for a wide variety of reasons, including:
- People who have lost their identification are often eligible but denied OHIP coverage. This can be particularly difficult for people who are homeless and/or experiencing severe mental health challenges.
- New immigrants, returning Canadians and Canadians moving between provinces have to wait three months for OHIP coverage. In 2014, over 80 000 newcomers were denied health care in their first three months because of this policy.
- Cuts to the Interim Federal Health program (IFH) in 2012 reduced and/or eliminated refugee and refugee claimant’s access to basic health care, medication and mental health support.
- Temporary visa holders such as visitors and students do not have public health care coverage.
- An estimated 200,000-500,000 people live, work and go to school in Canada without status due to expired visas, denied refugee claims and failed sponsorships. Without status, individuals and families are unable to access care through public health insurance programs.
People without access to public health insurance often face delayed and inconsistent care, worsened health conditions and large out-of-pocket expenses. Uninsured clients’ experiences are further shaped by income, precarious and unsafe work conditions, and experiences of discrimination and oppression.
Many Successes to Celebrate
The symposium aimed to build on successes in policy, practice and research, and to identify emerging opportunities to improve access to care for people who are uninsured. Important progress has been made in recent months and years at the local, provincial and federal levels.
Of particular importance was recent progress on the Interim Federal Health Program. Arif Virani, MP for Parkdale-High Park and Parliamentary Secretary to the Minister of Immigration, Refugees and Citizenship, began the day by reiterating the new federal government’s commitment to providing immediate health care access to Syrian refugees through the IFH program and to reinstating IFH for all refugees. This is a major step forward as the IFH cuts had health impacts for refugee claimants in Canada. The restoration of IFH for all refugees and claimants provides the foundation for all refugees to receive the basic health care services that they need to get off to a healthy start in Canada.
There have also been significant steps forward in improving access to care in Toronto and Ontario. In January 2015, midwives secured additional funding from the Ministry of Health and Long-Term Care to provide care to uninsured clients throughout their pregnancy including necessary lab tests, ultrasounds and physician referrals. This ensures that pregnant clients have access to the full range of services required for a healthy birth.
In 2013, City of Toronto declared itself a Sanctuary City and in doing so committed to providing access to city services for all Torontonians regardless of status. This policy is being rolled out across the city and has the potential to ensure that all Torontonians have access to services that support good health. Also at the local level, the Toronto Central Local Health Integration Network (TCLHIN) continues to work with community health centres to provide care to uninsured clients and with hospitals to harmonize and reduce fees for uninsured clients. The TCLHIN is also building a health equity roadmap that holds promise in addressing the health care needs of uninsured and other vulnerable populations.
Now is the Time
Strong coalitions of service providers, policy makers and researchers have led to these recent policy changes. We have made good progress, but more needs to be done as considerable gaps persist in access to health care.
Symposium speakers and participants identified a number of local, provincial and federal opportunities to build on recent successes and take advantage of new windows of opportunity. Locally, Toronto hospitals should follow through on their commitment to harmonize fees for uninsured clients with OHIP rates so that vulnerable uninsured clients are not charged above standard rates. Ending the three month wait period for OHIP would be an important first step to ensuring that provincial policy recognizes all residents’ right to health and the expansion of OHIP-level coverage to all Ontarians. Finally, federal immigration reform and regularization of status is needed to ensure that there are ways for individuals and families to obtain status, settle and integrate into communities, schools and jobs without fear of status precarity and lack of public health care coverage.
The symposium was an opportunity to pause, to reconnect across organizations and sectors, to celebrate recent successes, to highlight persistent gaps, to reaffirm our commitment to the right to health for all Toronto and Ontario residents, and to plan for continued and collective action to improve access to care for some of the most vulnerable Torontonians.
For a summary of the day’s online conversation see below, and to see the full conversation, follow #uninsuredcdn and @wellesleyWI on Twitter.