PM Trudeau presents premiers $196B health-care funding deal, with $46B in new funding over the next decade

OTTAWA -

The federal government is pledging to increase health funding to Canada's provinces and territories by $196.1 billion over the next 10 years, in a long-awaited deal aimed at addressing Canada's crumbling health-care systems with $46.2 billion in new funding.

This new cross-Canada offer includes both increases to the amount budgeted to flow through the Canada Health Transfer (CHT) as well as federal plans to sign bilateral deals with each province and territory that are mindful of each system's unique circumstances.

This funding influx is coming with an expectation that in order to access new federal dollars, provincial and territorial governments have to maintain their current health spending levels and commit to new transparency and accountability requirements around how health information is collected, shared, used, and reported to Canadians.

Prime Minister Justin Trudeau— accompanied by a handful of ministers—spent two hours on Tuesday afternoon presenting this proposal to his provincial and territorial counterparts at the first in-person meeting of all First Ministers since the COVID-19 pandemic. 

While Trudeau is billing the Liberals' commitment as "a major federal investment in health care," early indications are, the offer hasn't satisfied provinces' demands.

Here's what the federal government has put on the table:

• An immediate national and "unconditional" $2-billion top-up to the Canada Health Transfer (CHT) to address urgent pressures being experienced at pediatric hospitals, emergency rooms and surgical centres;
• A five-per-cent increase to the CHT over the next five years provided through the annual top-up, to be rolled into the CHT base after five years to ensure a permanent increase that would provide an estimated $17.3 billion over 10 years;
• $25 billion over 10 years for decade-long bilateral deals with each province and territory tailored to their health-care needs, but connected to shared priorities such as family health access, investing in mental health and substance abuse services; and modernizing the health information system;
• $1.7 billion over five years to support hourly wage increases for personal support workers and related professions as levels of government work together on retaining, recruiting, and recognizing the credentials of health-care workers;
• $150 million over five years for the Territorial Health Investment Fund to help cover medical travel and the cost of health care delivery in the North; and
• $2 billion over 10 years aimed at addressing the access challenges uniquely faced by Indigenous people.

"These additional federal investments will be contingent on continued health care investments by provinces and territories," said Trudeau's office in a statement unveiling the details.

While the prime minister met the premiers behind closed doors, federal officials provided reporters a technical briefing on the plan. 

• Capital Dispatch: Sign up for in-depth political coverage of Parliament Hill

Ahead of the meeting, Trudeau said that while Canadians are proud of the universal public health-care system, it hasn't been delivering up to the level expected.

From staffing shortages and a cold-weather surge of illnesses compounding extended wait times in emergency rooms, to hundreds of thousands of surgeries and medical procedures backlogged due in part to COVID-19 cancellations, there have been steady calls from those in the sector for urgent action as Canada's population continues to grow and age.

"The pandemic reminded each and every one of us just how important our health is. It also put enormous pressure on our health-care systems and on our health-care workers, and it made us take a hard look at the long-standing issues facing our healthcare," said Trudeau during a post-meeting press conference.

"As leaders, we've come together to deliver tangible actions and outcomes today, while building a more modern system to ensure results for all Canadians for the future," he said, with a backdrop of empty beds at an Ottawa hospital.

OFFER LESS THAN PREMIERS CALLED FOR

Prior to the details being revealed, there were indications that some provinces, such as Ontario, were ready to sign on the dotted line in short order, while other provinces, such as Quebec, may want more time before agreeing to any new accord, depending on how they feel about federal conditions being imposed on how the new money will be spent.

Largely, the sense of optimism coming from premiers over the fact that the two sides finally were able to meet to discuss how to address Canada's strained health-care systems seemed to dissipate somewhat after the meeting, with Ontario Premier Doug Ford calling it a "starting point," and a "down payment."

"There wasn't a lot in a way of new funding that is a part of this package," said Chair of the Council of the Federation and Manitoba Premier Heather Stefanson during a post-meeting press conference. "I think we were a little disappointed at that."

The premiers’ longstanding ask has been for the federal government to increase the share of Canada's health-care costs that they cover, from the current 22 per cent to 35 per cent. This deal does not satisfy this demand.

Seeing the CHT increased by the amount premiers' had called for would mean the federal government would have to send out an additional $28 billion to the provinces annually. Based on the new funding put on the table on Tuesday, what Trudeau has offered instead works out to on average less than $5 billion in new funding a year.

According to federal figures, in 2023-24 the federal government will provide $49.4 billion to provinces and territories under the CHT, with this longstanding predictable pool of funding projected to grow by 61 per cent over the next 10 years. 

"It's significantly less than what we were looking for," Stefanson said, going on to tell CTV News Channel's Power Play host Vassy Kapelos on Tuesday's show that there was little time for deliberation after Trudeau's presentation and that there are "lots of unanswered questions."

NO DEALS TODAY, NEXT STEP? 'ACTION PLANS'

Neither Trudeau nor the premiers planned to walk out of today's "working meeting" with deals in hand.

The next step for provincial and territorial governments will be to develop "action plans" describing how they plan to use the funding and measure improvements to their systems. 

Among the metrics the federal government says it will be looking at to assess whether tangible progress comes from these funding arrangements:

• The net new family physicians, nurses, and nurse practitioners in each province and territory;
• The percentage of Canadians who have access to a family health team or family doctor;
• The size of the COVID-19 surgery backlog;
• The median wait times for community mental health and substance abuse services; and
• The percentage of Canadians who can access their health records electronically.

The federal government made a point on Tuesday of stating that the bilateral agreements have to respect each government's jurisdiction and uphold the Canada Health Act to protect Canadians' "access to health care that is based on need and not ability to pay."

Recently, in an effort to address their over-capacity operating rooms and winding wait lists, some provinces have announced plans to allow more private clinics to offer certain procedures. This has revitalized a debate over privatization and whether what some provinces are doing goes against the longstanding requirement to provide reasonable access to publicly-funded health services.

In order to maintain eligibility for their full Canada Health Transfer, provinces are required to uphold the Act's criteria and ensure there is no extra billing and user chargers for insured health services.

Ahead of Tuesday's meeting, calls were made on Parliament Hill by front-line health-care worker unions, advocates, and NDP Leader Jagmeet Singh to insist not a single new federal dollar flows to a for-profit provider.

In a statement reacting to the details of the multibillion-dollar federal proposal, Singh called it "the bare minimum."

With both federal and provincial governments working on drafting their 2023 budgets, the expectation is the bilateral details will need to be worked out in time for the funding to be accounted for in the upcoming fiscal plans.

"In the coming weeks—not months—we will conclude bilateral agreements, begin flowing more money, and Canadians will start seeing real results," Trudeau said.