Introduction
The Wellesley Institute is a non-profit and non-partisan institute that works on research and policy to improve health and health equity across the Greater Toronto Area (GTA). This includes using research to inform policy development to ensure health is advanced and health and wellness are shared equally by all. Our work has shown that a healthy workforce is critical for the wellbeing of individuals, families, and communities. This brief provides feedback to the government of Ontario’s Portable Benefits Advisory Panel on the development of a portable benefits strategy, with a focus on advancing equity and ensuring all workers have what they need to be healthy and thrive.
In 2021, the Ontario Workforce Recovery Advisory Committee’s report on the future of work recommended that the Ontario government appoint an expert to design and test the feasibility of a portable benefits program, which would support worker mobility by tying benefits to workers rather than employers[1]. Early this year the Ontario government announced their intention to develop a strategy for delivering portable benefits to help close the gap in access to extended medical insurance, dental care, and other workplace benefits. To deliver on this, they established an expert panel to advise on the design and implementation of the program, with a final report and recommendations expected in 2023[2].
Issue
Workers’ access to benefits are largely determined by the form of employment their employer provides—or is allowed to provide under the law. Standard employment, meaning jobs that are full-time, permanent, and subject to labour law, often provide health benefits through a mix of private and public insurance plans[3]. However, opportunities for standard employment have declined due to a significant shift towards precarious employment, which consists of non-standard, insecure income-earning activities that are often poorly paid and protected[4].
Approximately 30-32 per cent of Ontario workers are considered vulnerable and precariously employed[5]. The expansion of precarious work is largely concentrated in service industries including food and accommodation, personal care, and caregiving[6]. These sectors employ a disproportionately large number of racialized people, women, newcomers, and students in part-time, temporary, and precarious positions that do not provide adequate income or workplace protections to support good health.
Workers outside of standard employment are less likely to have access to employer-provided benefits and most do not meet the criteria for other government social security programs like Employment Insurance, Canada Pension Plan (CPP), and workplace injury compensation through WSIB[7]. Past analysis of Statistics Canada data by the Wellesley Institute found that one-third of paid employees in Ontario did not have access to employer-provided medical or dental benefits, with low-income workers having lower levels of coverage compared to high-income earners[8].
Inequities in access to benefits have been exacerbated by the COVID-19 pandemic and the current cost-of-living crisis, both of which have negatively affected the health of low-income, racialized, and other marginalized populations. For example, a recent survey data of Ontario food bank users showed that more employed people are turning to food banks than before, with close to half (45 per cent) not having any employer-provided benefits[9]. This poses serious threats to workers’ well-being and Ontario’s overall health system. Going forward, it will be critical to help these vulnerable groups and ensure that coverage provided through the portable benefits program reaches those who need it the most.
Implications for Health and Health Equity
Research shows that income is significantly linked to health outcomes and quality of life. Low-income workers without benefits are far too often forced to pay out-of-pocket to receive necessary uninsured health services such as prescription drugs, vision and dental care, and mental health care[10]. Workers with limited income and resources are put into difficult situations where they must choose between addressing their health needs and other necessary costs like food and housing[11]. A recent Canadian study found that low income, financial insecurity, and lack of drug coverage are linked to individuals not being able to take necessary prescription drugs (cost-related non-adherence to medications), which contributes to poorer health over time and has implications for our already strained health care system and further exacerbates health inequities[12].
A GTA-based study found that precarious work can lead to heightened anxiety and stress, diminished social and community connections, and impacts the ability to manage household expenses including housing, food, health and personal care, and transportation[13]. Other research has also found that racialized populations, persons with disabilities, newcomers, and older adults and youth are over-represented in part-time and precarious employment, and thus have less access to important benefits that promote good health[14].
Wellesley Institute’s Thriving in the City for families: A framework for income and health report from 2017 identified the goods, resources, and services households in the GTA need to live a healthy life—including health benefits. Estimates found that a single person living in the GTA needs to earn between $46,186 and $55,432 after tax to Thrive. In a 2021 follow-up report Wellesley calculated that a GTA family of two parents and two children needs between $103,032 and $136,428. It is important to note that these amounts have not been updated for inflation, which is almost 7 per cent this year. Further demonstrating the importance of benefits is the health-based Thriving at Work framework which recognizes that adequate income and access to benefits like retirement savings and extended health care is needed for workers to live a full and healthy life.
Recommendations
Having access to basic workplace benefits is critical for sustaining workers’ health, wellbeing, and household economic security. However, more than that is needed for workers to live a Thriving life. The current model of benefits delivery in Ontario is inadequate and widens health and social inequities between those with sufficient resources and those without.
Wellesley’s vision for health benefits is that everyone making less than a Thriving income gets what they need to Thrive—to live a healthy, meaningful life. While increasing income and addressing other categories such as health care and retirement savings will help move some individuals closer to Thriving, Wellesley recommends that the government’s strategy guarantee every worker below the Thriving income receives full and adequate necessary health benefits. Thriving in the City for Families estimated that if workers were provided with comprehensive health benefits this would close the gap by over $5,000 in 2017 for typical GTA families—moving them much closer to what they need.
Wellesley does not take a position on how this should be achieved, but the government has the option to:
- Encourage employers to offer these benefits to everyone they pay (including down their supply chains). This would reduce the need of government top-ups.
- Directly provide this benefit where it is missing, as is currently done through OHIP+.
- Provide benefits through universal programs. This would reduce gaps in coverage by ensuring all Ontario residents have equal access to publicly-provided services without having to meet narrow eligibility criteria.
Whichever method is chosen, we strongly urge the use and public sharing of Health Equity Impact Assessments to ensure that a health equity lens is consistently used in the development and implementation of the portable benefits strategy so disparities are identified early, and policymakers can promote more equitable delivery of the program[15].
There are two additional points we urge the government to bear in mind.
First, the government can pay or regulate now, or it can pay later. If individuals do not have access to the benefits they need they will get sicker and have reduced wellbeing. With this portable benefits strategy the government has an opportunity to provide supports for people to thrive and to grow our economy. Investing in and supporting people will generate wealth for all.
Second, Ontario is a society. We elect governments to lead us, but they have the responsibility to structure markets and government services (which really belong to us all) to get everyone what they need—in this case, benefits, but more broadly, what we need to live a happy, healthy, meaningful life. This vision may not be achieved overnight, but the government should provide the public with measurable targets that it intends to achieve that will mean it is reached in short order.
Ensuring every Ontarian has either the income or the benefits they need to access all necessary health services is the smart thing to do and the right thing to do, and the government of Ontario should design and deliver portable benefits program that will bring a better future for Ontario in which everyone in need can thrive.
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References
[1]. Ontario Workforce Recovery Advisory Committee. (2021). The Future of Work in Ontario. https://www.ontario.ca/files/2022-06/mltsd-owrac-future-of-work-in-ontario-november-2021-en-2021-12-09.pdf
[2]. Government of Ontario. (2022). Consultation: Portable Benefits Program. https://www.ontario.ca/page/consultation-portable-benefits-program
[3]. Standing Committee on Human Resources, Skills and Social Development and the Status of Persons with Disabilities. (2019). Precarious Work: Understanding the changing nature of work in Canada. https://www.ourcommons.ca/Content/Committee/421/HUMA/Reports/RP10553151/humarp19/humarp19-e.pdf
[4]. United Nations. (2021). Policy Brief: Digitally enabled new forms of work and policy implications for labour regulation frameworks and social protection systems. https://www.un.org/development/desa/dpad/publication/un-desa-policy-brief-113-digitally-enabled-new-forms-of-work-and-policy-implications-for-labour-regulation-frameworks-and-social-protection-systems
[5]. Government of Ontario. (2017). The Changing Workplaces Review: An Agenda for Workplace Rights. https://files.ontario.ca/books/mol_changing_workplace_report_eng_2_0.pdf
[6]. Noack, A. M. & Vosko, L. F. (2011). Precarious Jobs in Ontario: Mapping Dimensions of Labour Market Insecurity by Workers’ Social Location and Context. Law Commission of Ontario. https://www.lco-cdo.org/wp-content/uploads/2012/01/vulnerable-workers-call-for-papers-noack-vosko.pdf
[7]. Hennessy, T. & Tranjan, R. (2018). No Safe Harbour. Canadian Centre for Policy Alternatives. https://policyalternatives.ca/sites/default/files/uploads/publications/National%20Office%2C%20Ontario%20Office/2018/08/No%20Safe%20Harbour.pdf
[8]. Barnes, S., Abban, V., & Weiss, A. (2015). Low Wages, No Benefits. Wellesley Institute. https://www.wellesleyinstitute.com/wp-content/uploads/2015/02/Low-Wages-No-Benefits-Wellesley-Institute-Feb-2015.pdf
[9]. Daily Bread Food Bank & North York Harvest Food Bank. (2022). Who’s Hungry Report 2022. https://www.dailybread.ca/wp-content/uploads/2022/11/DB-WhosHungryReport-2022-Digital-1.pdf
[10]. Busby, C. & Muthukumaran, R. (2016). Precarious Positions: Policy Options to Mitigate Risks in Non-standard Employment. C.D. Howe Institute. https://www.cdhowe.org/sites/default/files/attachments/research_papers/mixed/Commentary%20462_0.pdf
[11]. Daily Bread Food Bank & North York Harvest Food Bank. (2022). Who’s Hungry Report 2022.
[12]. Holbrook, A.M., Wang, M., Lee, M. et al. (2021). Cost-related medication nonadherence in Canada: a systematic review of prevalence, predictors, and clinical impact. Syst Rev 10, 11. https://doi.org/10.1186/s13643-020-01558-5
[13]. United Way Toronto. (2013). It’s More than Poverty. https://www.unitedwaygt.org/wp-content/uploads/2021/10/more-than-poverty-report.pdf
[14]. Colour of Poverty. (2019). Racialized Poverty in Employment. https://colourofpoverty.ca/wp-content/uploads/2019/03/cop-coc-fact-sheet-5-racialized-poverty-in-employment-2.pdf
[15]. Wellesley Institute. Health Equity Impact Assessment. https://www.wellesleyinstitute.com/health-equity/heath-equity-impact-assessment/