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André Picard

For a self-styled law-and-order regime, the government of Stephen Harper is shockingly contemptuous of the rule of law.

The sordid saga surrounding the provision of healthcare services to refugee claimants is a striking example of how the executive branch of government is disdainful of the judiciary and, by extension, of the electorate.

In 2012, Ottawa took the ax to the Interim Federal Health Program, which was designed to provide benefits to refugees while their claims were being processed. The government essentially created a tiered system, where some refugees got health benefits equivalent to those on social assistance in Canada, while others from countries deemed "safe" got a bare minimum, and rejected claimants awaiting appeals or deportation were ineligible for any coverage.

There are about 28,000 refugee claimants a year and providing them health care during the transition period to citizenship or expulsion cost about $84-million a year before the cuts.

The justification for the change was that there were large numbers of "bogus" claimants who were milking the system to get free services. Without saying so in as many words, Ottawa was taking aim at Roma refugees (who are sometimes referred to derisively as "gypsies").

There were no doubt a few cheaters among refugee claimants and difficulties with expulsion of rejected claimants (and about 60 per cent of claims are denied), but slashing health benefits was never a sensible solution to those problems. The notion that large numbers of people were fleeing their countries and coming to Canada for a few months of dental care and the like always beggared belief.

The IFHP cuts outraged physicians who provide care to immigrants and refugees and non-governmental organizations who sponsor them because they were mean-spirited, bureaucratic and ethically challenging.

They also "saved" very little money; IFHP costs fell to about $65-million. But those savings were illusory because refugees did to not stop having babies, getting sick and suffering from chronic conditions like diabetes, regardless of their country of origin. They just ended up emergency rooms, where no one is turned away and, having no insurance, they were billed, bills they could not pay. Essentially, the costs were shifted from Ottawa to cash-strapped hospitals; in response, a number of provinces offered health coverage to refugee claimants but grudgingly, because it's Ottawa's jurisdiction and responsibility, constitutionally.

There was also a lawsuit and, in a landmark ruling this past July, Madam Justice Anne Mactavish ruled, to no one's surprise, that the cuts were unconstitutional. What was surprising was the court deeming the cuts to be "cruel and unusual punishment" because they were aimed at the most poor and oppressed among us, targeted at "innocent and vulnerable children in a manner that shocks the conscience and outrages our standards of decency." Judge Mactavish gave the government four months to fully restore the program.

The government's response to being chastised in this manner was to dig in its heels. Immigration Minister Chris Alexander, once a respected diplomat, hinted the order would be defied. The government went to court and asked for the Nov. 4 deadline to be extended, which a judge rejected out-of-hand.

Then, at the last minute, on the court-imposed deadline, Mr. Alexander announced that the ruling would be appealed and, in the meantime, the program would be restored, but only partially and temporarily.

This is as shocking – if not more so – than the original cuts.

The IFHP should have been fully restored to its pre-2012 form. Period. No ifs, ands or buts.

Since when is a government allowed to partially respect a court order? How is this not contempt of court? The government has every right to appeal a court ruling but it should treat the institution with respect, not crass cynicism.

There is no question that the legal battle will continue.

In the meantime, the temporary measures provide a bit of relief. But they are unnecessarily complex and obtuse.

There is now a bizarre two-tier system where refugee claimants can get full health benefits, but only if they are government-sponsored. For the rest there are varying levels of care: Some men and women are entitled to health services only if they have a condition that is a threat to the public (that means not even basic physician and hospital care); some get physician and hospital coverage, but not drug benefits (that burden falls to their sponsors, which can be too onerous for sponsoring NGOs); to nominally respect the court ruling, pregnant women and children are also eligible for drug coverage, but only children are entitled to some dental and vision care.

Obviously, the government response was heavily lawyered – with the intent of doing the absolute bare minimum that they think they can get away with.

When you've fled a country, usually because of war or persecution, you're poor, and you don't speak the language, and then you fall ill, how are you supposed to navigate this sort of ponderous, politically-motivated bureaucracy?

The temporary rules may now only be partially cruel and unusual – if that is even possible – but they are still wholly unacceptable.

André Picard is The Globe's public health columnist.