As preparations are underway for the anticipated health-care "working meeting" between Prime Minister Justin Trudeau and Canada's premiers on Tuesday, new details are emerging about how the much-anticipated federal-provincial gathering will unfold.
Trudeau is expected to come into the afternoon meeting with a detailed two-hour presentation of what the federal government is ready to put on the table.
As federal officials have previously signalled, the prime minister’s offer will include billions of dollars in new funding.
This boost is expected to come in two forms: through a national increase to the Canada Health Transfer (CHT), which funnels money to all provinces on a per-capita basis, as well as direct decade-long bespoke bilateral deals with each province and territory tailored to their health-care needs.
"I'm very much looking forward to sitting down with the premiers tomorrow," Trudeau said on his way into question period. "As I've said many times, we will be there putting more money on the table."
Overall, the gathering between federal, provincial and territorial governments will be focused on ironing out how these long-term funding deals will be implemented in a way that sees premiers held accountable for delivering improved care.
But how this will look in each case is expected to vary.
In Ontario, for example, senior provincial government sources tell CTV News they are working towards a bilateral deal that would see Canada's most populous province receive $73 billion over 10 years. Of this, approximately $30 billion would be new money, equating to approximately $3 billion in increased funding annually.
The sources CTV News spoke with indicated that Ontario views this proposal positively, and while they aren’t coming to Ottawa ready to sign, they don't want a long delay before coming to an agreement.
This push is motivated by what the sources said was regret around being the last holdout province to sign a bilateral child-care deal, in hopes of getting more out of the federal government.
Not all provinces appear to be coming to the table as ready and eager to accept a deal in short order, however. According to provincial sources there is some expectation that Saskatchewan and Quebec are gearing up for a fight, seeking to get more out of the federal government before signing on the dotted line.
Speaking to reporters upon his arrival in Ottawa, Quebec Premier Francois Legault said that, based on a conversation he had with Trudeau ahead of the holidays, a deal was looking good and “substantial,” so long as the federal offer focuses on shared priorities.
"We don't need the federal government tell us how to invest the money," he said.
CTV News is also hearing from sources that there is some pressure on the Ontario government to try to push for more out of the gate, specifically from Saskatchewan. Though, while Ontario Premier Doug Ford has recently spoken about how the premiers need to "stay united," pressure from Saskatchewan Premier Scott Moe doesn't appear to be swaying him, according to sources.
"We recognize that different provinces have different needs and different priorities, and that flexibility is an important part," Trudeau said on Monday. Already signalling that he doesn’t expect to come out of Tuesday's talks with signed agreements, he indicated that work will continue over the "coming weeks" to iron out the details of each deal.
"That's a way of ensuring that we're respecting provincial jurisdiction on health care, while making sure the federal government is there," Trudeau said.
PREMIER SAYS DEVIL IS IN THE DETAILS
Premiers are gathering in the nation's capital on Monday evening for a meeting ahead of their sit-down with Trudeau.
Ahead of that confab, despite reporting offering indications of what's on offer, Chair of the Council of the Federation and Manitoba Premier Heather Stefanson told reporters that she still has not seen Ottawa's official proposal.
"I know we're all very much looking forward to tomorrow as premiers to see that proposal for the first time. I think there's been a lot of discussions through the media so far in terms of what some of those things may look like in the future," she said. "We very much look forward to seeing that proposal tomorrow."
Asked if premiers have a red line heading into the meeting, Stefanson said she and her colleagues are heading in with an "open mind" but that she would have liked to have seen what the Liberals plan to present ahead of time so that Tuesday's somewhat brief gathering could have been focused on a more substantive discussion.
"I don't think any of us expect a deal to be made tomorrow," she said. "But I think we want something sooner rather than later."
During a pre-Parliament retreat in Hamilton, Ont., Intergovernmental Affairs Minister Dominic LeBlanc told reporters that the federal government is aiming to have these deals inked ahead of the 2023 federal budget, typically tabled in the spring. Stefanson said this is her goal, too.
"As they say, the devil's in the details. We'll see what those details have tomorrow," she said.
In an interview on CTV News Channel’s Power Play with Vassy Kapelos, Premier of Newfoundland and Labrador Andrew Furey said that while an influx of federal dollars is important, what’s really on the table Tuesday is a “generational opportunity” to modernize and make sustainable health-care systems that were designed in the 1960s.
A MEETING MONTHS IN THE MAKING
Tuesday's meeting to discuss reaching cross-Canada health-care funding deals comes as hospitals and health-care facilities appear to be in crisis mode, and after premiers began indicating their willingness to agree to funding with strings attached.
For some time the premiers have been putting pressure on the federal government to increase the amount of money Ottawa provides through the federal-provincial health-care transfer.
These calls have been met by Trudeau acknowledging that, while systems across the country are "strained, if not broken," any influx in funding has to come with provinces and territories agreeing to be accountable for delivering improved systems and access in return.
This year Canada is expected to send the provinces $45.2 billion through the CHT, increasing on average five per cent annually since 2017, as The Canadian Press has reported.
The longstanding ask of the premiers is to see the amount Ottawa covers under the CHT increase from 22 per cent to 35 per cent.
Though, some provincial leaders have already signalled to CTV News that they aren't expecting to see that request met, as doing so would cost the federal government an estimated additional $28 billion a year.
SHARED METRICS CENTRAL TO DEALS
Trudeau has signalled that there will be elements of what is in the works that will take the shape of a nationwide agreement, perhaps connected to a cross-Canada accord on data and health information sharing, while the bilateral deals will look on a province-by-province basis at specific metrics relevant to each system's needs.
Core to these deals, according to federal and provincial officials, are establishing shared agreements around what areas of each province's health-care systems need the most triaging.
"In 2023, we have an aging population, more chronic and infectious diseases, lots of Canadians don’t have access to family doctors and family health teams. That puts pressure on hospitals, on long-term [care] homes," said Health Minister Jean-Yves Duclos on Monday. "I think we all agree that we need to do things differently."
The shared priorities that both the federal government and premiers have been discussing include:
- Timely access to family health teams;
- Reducing backlogs in surgeries and diagnostics;
- Retaining, recruiting, and recognizing the credentials of health-care workers;
- Investing in mental health; and
- Modernizing the health information system so medical records can be shared with various providers, electronically.
Ahead of Trudeau and all his provincial and territorial counterparts meeting for the first time in person since the COVID-19 pandemic, stakeholders are making their expectations known.
According to the Canadian Mental Health Association (CMHA), officials from the organization have been invited to participate in a briefing with the federal government on Tuesday morning.
"Despite critical gaps in mental health and substance use health care, the federal commitment to a Canada Mental Health Transfer has yet to materialize," said CMHA spokesperson Emma Higgins in an email to CTV News. She said the organization "expects to hear a commitment towards a much-needed investment in mental healthcare coming out of the meeting."
HEALTH WORKERS RALLY AGAINST PRIVATIZATION
Front-line health-care workers and advocates are planning to rally on Parliament Hill to demand Canada's universal public system be protected.
With the federal-provincial funding dispute stretching on while Canadians face long emergency room wait times and an extensive backlog of surgeries and medical procedures, some provinces have announced plans to forge ahead with initiatives to address their specific health-care systems’ needs, including plans to allow more private clinics to offer certain procedures.
This has revived the privatization debate and raised questions over whether what some provinces are doing contravenes the Canada Health Act, which ensures all eligible residents have 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.
Largely, federal officials asked about privatization creep concerns have said they take their responsibility to uphold the Canada Health Act seriously, but that they are confident premiers intend to uphold the universal health-care system.
Though, as Canadian Health Coalition spokesperson Pauline Worsfold told reporters on Monday, these assurances aren't enough.
"Prime Minister Trudeau must insist that premiers guarantee each dollar transferred from the federal government is used for health care, not for tax cuts or wasteful rebates. Second, we want to stop public health care dollars going to private for-profit clinics operating outside the Medicare system," said Worsfold, a registered nurse in Edmonton, Alta.
"Stakes for Canadian Medicare could not be higher. There is a crisis in our hospitals that I witness every day when I go to work," Worsfold said. "Front-line workers are burnt out, feel overwhelmed and underappreciated, and patient care is suffering. They all want to see action by all political parties at every level of government."
The health-care worker unions and public health care advocates behind the rally are also calling for action on the long-promised national pharmacare program.
NDP Leader Jagmeet Singh has also been putting pressure on the Liberals to ensure that the universal public system will be upheld and that the federal pharmacare plan will be launched this year.
During a press conference backed by leaders who represent thousands of health-care workers, Singh restated these calls Monday, calling for Canada's health-care systems to be rebuilt.
"Right now we're up against a health-care crisis. We're saying that the public money that we use at the federal level should not be going to for-profit care. And while there's a negotiation happening right now, the prime minister has an opportunity to say 'we will not be spending public money to invest in for-profit delivery of care,'" Singh said.
With files from CTV News Chief Political Correspondent Vassy Kapelos and Senior Political Correspondent for CTV News Channel Mike Le Couteur
