The Ontario government’s proposal to end out-of-country emergency OHIP coverage is a bad one. It is presented as a minimalist measure. It is anything but.
Rather, it is a violation of the Canada Health Act. It strikes right at the heart of medicare.
Canadian medicare is, in essence, an insurance plan. Those who live in this country are automatically covered by their provincial medicare programs when they use physician or hospital services anywhere inside or outside of Canada.
This is known as portability. In the case of those who are “temporarily absent” from the country, the Canada Health Act reads as follows:
“Where the insured services are provided out of Canada, payment is made on the basis of the amount that would have been paid by the province for similar services rendered in the province.”
Simply put, that means an Ontarian who, say, breaks a leg while travelling abroad and must pay out of pocket to a foreign hospital, is entitled to be reimbursed — for at least some of the medical costs incurred — by the Ontario Health Insurance Plan.
The amount of reimbursement is supposed to be based on what it would have cost to have the leg set in an Ontario hospital.
Over the years, various provinces — including Ontario — have played fast and loose with this particular portability requirement of the law. Some have chosen to arbitrarily lowball the estimated cost of domestic hospital services in order to limit the amounts claimed by Canadians requiring emergency care while travelling out of country.
An Ontarian requiring emergency outpatient hospital care while travelling outside Canada, for instance, is entitled to be reimbursed by OHIP at the rate of only $50 a day. That figure hasn’t increased in 20 years.
Yet, according to figures from Ontario’s auditor general, if that same person required emergency outpatient care while travelling in another Canadian province, he or she would be entitled to $359. And even that figure, the auditor-general says, doesn’t accurately reflect the real cost of treatment.
Overall, the current out-of-country rates paid by OHIP are chintzy. An Ontarian requiring hospitalization abroad can receive up to $200 a day ($400 in intensive care). Manitoba, Nova Scotia and the three territories are more generous. So is Prince Edward Island. It will pay up to $1,423 per day for a citizen needing emergency hospital care outside of Canada.
None of this suffices to cover U.S. hospital costs, which can amount to $4,000 a day or more. That’s why so many Canadians who travel in the U.S. choose to buy supplementary private insurance.
As a result, the proportion paid by public insurance — by OHIP — continues to decline. It now represents only five per cent of the cost of a typical medical emergency abroad.
Premier Doug Ford’s Progressive Conservative government uses this as a justification for its plan to end out-of-country OHIP coverage. If people are already buying private insurance to travel outside Canada, the government asks, why don’t they buy just a little more?
This is the wrong question. The real question is why the government is so anxious to rid itself of a program that, at just $12 million a year, represents such a minuscule proportion of its $163 billion annual budget.
In particular, why is it so intent on taking on the Canada Health Act, the federal statute governing medicare and one that specifically requires participating provinces to offer at least some out-of-country coverage?
And why the rush? The government quietly put this proposal on its website Wednesday and has given Ontarians only a week to comment.
We have seen provincial governments attempt to cut back medicare before by delisting services under the claim that they are no longer medically necessary.
The trick is first to starve such services so much that people won’t miss them when they are gone and then to quietly eliminate them altogether.
But the Ford government is taking matters to a new level. By attacking the key principle of portability — the notion that Canadian residents take their health insurance with them wherever they go — it is aiming a dagger at medicare’s throat.
Thomas Walkom is a Toronto-based columnist covering politics.
https://www.thestar.com/opinion/star-columnists/2019/04/25/doug-ford-ohip-move-strikes-at-the-heart-of-medicare.html
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