The federal government is offering premiers $46.2-billion in new health care funding over 10 years, a figure that is significantly less than what they had demanded, but which they appeared resigned to accepting after a meeting Tuesday with Prime Minister Justin Trudeau.
Over the next decade, just under half of the new federal money would go toward the baseline funding that is sent to provinces and territories through the Canada Health Transfer, and $25-billion would go toward bilateral deals. Those individual deals with provincial and territorial governments would target federal cash to specific areas, such as primary care and mental health.
The funding proposal from the Prime Minister largely repackages promises from the Liberal Party’s 2021 election campaign that were not included in the 2022 federal budget. The party’s platform promised $21.9-billion in new health care funding over five years. The government is now offering premiers $21.3-billion in new money over the next five years.
In total, including previously committed funding hikes, Ottawa says it will now increase its health care spending by $196.1-billion over the next 10 years. “This is significant amounts of money,” Mr. Trudeau said at a post-meeting news conference, at which the premiers were not present. He suggested that the offer is the final one his government will make.
At their own news conference after the meeting, none of the country’s premiers said they would reject the proposal.
Mr. Trudeau did not explain why the government decided against increasing the new spending beyond what was promised in the 2021 election. “It’s not just about money,” he said, “it’s about making sure we’re delivering real results for Canadians.”
The Canada Health Transfer grows automatically in line with the country’s nominal GDP, which takes inflation into account. That formula was already set to produce an above-average increase of 9.3 per cent this coming fiscal year, to $49.3-billion. Under the federal government’s proposal, the minimum guaranteed rate at which the health transfer increases would be boosted to 5 per cent a year, for five years. It would then drop back down to the current floor of 3 per cent.
The funding is “significantly less” than what the premiers were asking for, said Manitoba’s Heather Stefanson, the chair of the premiers’ council. Her B.C. counterpart, David Eby, called Ottawa’s proposal “fiscally limited.”
The premiers had been asking for an immediate annual top-up to the Canada Health Transfer of $28-billion, plus a minimum 5-per-cent annual increase. That would have totalled well over $300-billion in new spending over 10 years.
Still, Ontario Premier Doug Ford said he welcomes any new money, “no matter how small or large.”
He called the federal offer a “starting point.”
“It’s a down payment on further discussions,” he said.
The premiers say the offer would increase the federal share of health care costs to 24 per cent next year, far short of the 35 per cent the provinces and territories were demanding. They first requested the dramatic increase in funding in 2020.
For more than two years, it appeared that the two levels of government would not be able to come to an agreement. But in the past few weeks the message from the premiers softened, and the federal government became more amendable to a meeting.
Quebec Premier François Legault told reporters Tuesday that ahead of the meeting Mr. Trudeau had pledged to present premiers with a substantial increase to health care funding. Mr. Legault’s conclusion after their two-hour gathering was: “We might not have the same idea of what substantial means.”
“Any amount, even if it is small, is welcome. But it is indeed far from what is needed over the long-term to fund health care.”
At his own news conference, which took place at an Ottawa-area hospital campus, Mr. Trudeau was asked repeatedly whether he is open to increasing the federal funding proposal through negotiations. His answers suggested his government has no intention of offering the premiers any more money.
“We put forward the fiscal frame that the federal government has,” he said, adding that provinces have the flexibility to spend more in specific areas if they choose. “This is a massive investment in not just the present of health care, but the future of health care.”
In addition to primary care and mental health, the separate bilateral deals would target staff shortages, surgery backlogs, substance use and health system modernization. Mr. Trudeau said he hopes those deals will be completed within weeks.
The increase to the health transfers will be conditional on provinces and territories improving their health data collection and sharing. The federal government said it will use the data to “measure and report annual progress.” That process will be led by the Canadian Institute for Health Information.
This will include statistics that will track how many people in Canada have access to a regular family health team, doctor or nurse practitioner; recruitment levels for new family physicians and nurses; patients’ access to personal electronic health records; and the percentage of health professionals, such as pharmacists, who can share patient health information electronically.
The federal government will also track youth access to mental health and substance use services, wait times for mental health and substance use services, and the percentage of Canadians with mental health disorders who have unmet care needs.
The federal government said in a news release that the tracking will allow Canadians to see how different provinces and territories are performing, and how they compare with other countries.
The funding offered through the bilateral deals will be conditional on provinces and territories reporting on how the money will be spent, and expected results.
NDP Leader Jagmeet Singh described the Liberal plan as the “bare minimum,” and predicted it will make the health care crisis worse. He said in a statement that the federal offer “won’t do nearly enough to recruit, retain and respect front-line workers, does not address the conditions in long-term care, and throws open the door for premiers that are pursuing staff-poaching privatize-for-profit schemes.”
In a statement, Bloc Québécois Leader Yves François Blanchet called the federal offer disappointing. “The truth is that Ottawa offers very little,” he said. “An average of $4.6 billion per year, shared between all the provinces and all the territories, is not even the share that should have gone to Quebec alone for a first year.”
In a late statement on Tuesday, the Official Opposition Conservatives decried the federal government’s plan as lacklustre, but did not say how much of the country’s health care costs they think Ottawa should shoulder.
The Prime Minister and premiers faced sharp criticism for their decision to leave Indigenous leaders out of Tuesday’s first ministers meeting. At times, these types of gatherings have included Canada’s national Indigenous organizations.
Despite not inviting Indigenous leaders to the table, Mr. Trudeau said his government will also dedicate an additional $2-billion over the next 10 years to Indigenous health care.
Ahead of the announcement, Indigenous leaders said Ottawa should have discussed health care funding with them directly. They said their communities are receiving inadequate services, and that the health transfers should go directly to them, rather than through the provinces.
“A lot of times our community members keep going back to the clinic over and over again only to get discharged. ‘Go home. Here’s a Tylenol. You use that.’ And oftentimes they go into medical distress and the lives are lost,” Chief Gaius Wesley of the Northern Ontario Kashechewan First Nation told a news conference on Parliament Hill.
The news conference was hosted by NDP MP Charlie Angus. He noted that while some Canadians are just discovering the crisis in health care, “Indigenous communities have been living this reality for years.”
With reports from Janice Dickson, Ian Bailey, and The Canadian Press.
Ottawa has offered provinces and territories $46.2-billion in new health care funding, for a total of more than $191-billion over the next 10 years. Here are some key outcomes from Tuesday’s meeting in Ottawa to strike a deal.
The Globe and Mail
For subscribers: Get exclusive political news and analysis by signing up for the Politics Briefing.