Stephen Harper: “We have not taken away health care from immigrants and refugees. On the contrary, the only time we’ve removed it is if we had clearly bogus refugees who have been refused and turned down.”
By: Jacob Schroeder on
Stephen Harper, Prime Minister and Conservative candidate for Calgary Southwest, in the Globe and Mail leaders debate on September 17, 2015
In 2012, the Conservatives introduced health care changes that represented a cut in coverage for refugee groups beyond just rejected refugee claimants. The cuts affected ordinary claimants – people whose refugee status is, by definition, to be determined. The cuts also affected privately sponsored refugees.FactsCan Score: False
Refugees are getting attention this election season because of the refugee crisis in the Middle East. But in the second leaders debate on September 17, another refugee issue came up.
In response to a charge from Justin Trudeau that the Conservative government cut health care for refugees, Stephen Harper said, “we have not taken away health care from immigrants and refugees. On the contrary, the only time we’ve removed it is if we had clearly bogus refugees who have been refused and turned down.”
In the latest debate, on September 28, Harper repeated the claim. He said, “we have health support of our refugees and immigrants. Where we stopped those benefits is when we have cases of refugee claims that have been turned down, rejected because they were bogus.”
The phrase “bogus refugee” is political shorthand for a rejected claimant.
A refugee claimant is someone who arrives at Canada’s borders, or is already within Canada, and claims asylum. After someone makes a claim, and if that claim is eligible, it is then referred to the Immigration and Refugee Board. Here, the claimant will have a hearing to determine if he or she is a refugee or a person in need of protection – the two types of people who can receive refugee protection in Canada. If the claim is refused, and other appeal or judicial review channels are exhausted, the person is a rejected claimant.
Claimants are different than resettled refugees, who are assisted by the government, or sponsored by private citizens working with the government, to come to Canada as refugees.
Is it true that health care cuts made by the Conservatives impacted only rejected refugee claimants?
Changes to refugee health care coverage
The federal government provides health care coverage for refugees and refugee claimants for a period of time, typically before provincial care kicks in (or in the case of rejected claimants, before they’re removed from Canada). It’s called the Interim Federal Health Program (IFHP).
Before changes arrived in 2012, the coverage was approximately the same as a Canadian gets on social assistance, said Audrey Macklin, a professor and chair in human rights law at the University of Toronto. The program offered basic coverage – what Ontarians, for example, would receive under the Ontario Health Insurance Plan (OHIP), plus prescription drugs and supplementary coverage like emergency dental and vision, and some physical rehabilitation like a wheelchair.
In 2012, the Conservatives introduced cuts to the IFHP. This prompted a legal challenge, and in July 2014, a Federal Court judge ruled against the government, finding that the changes violated the Charter. The government decided to appeal the decision, and in the meantime, introduced temporary measures that came into effect in November 2014.
Who the changes affected
For Harper’s statement to be true, only rejected claimants would be affected by cuts to the IFHP, and not other immigrants and refugees like claimants or resettled refugees.
This is not the case.
Privately sponsored refugees as well as claimants awaiting a determination had less health care coverage after 2012. Certain types of claimants saw the largest cuts. Here are the main differences between the old coverage and the new coverage before the Federal Court ruled against the government changes:
|Refugee type||Who is this?||Before the recent changes (pre-2012)||After the recent changes (2012 to 2014)|
|Government sponsored refugees||The government brought them to Canada as a refugee.||Basic, prescription drug, and supplemental coverage||No change|
|Privately sponsored refugees||Private citizens, working with the government, brought them to Canada as a refugee.||Basic, prescription drug, and supplemental coverage||1. If they receive RAP*: No change
2. If they don’t receive RAP: Basic coverage
|Refugee claimants (ordinary)||They asked for asylum within Canada or at its borders, and are therefore called “claimants.”||Basic, prescription drug, and supplemental coverage||Basic coverage|
|Refugee claimants (from a Designated Country of Origin)||Same as above. This is a new sub-set under the Conservative government, which introduced a list of safe countries along with procedural changes for claimants from those countries (like Israel, Mexico, Germany, etc.).||Basic, prescription drug, and supplemental coverage||Public health or safety coverage**|
|Rejected refugee claimants||They received a negative decision on a refugee claim, and exhausted appeal and judicial review procedures||Basic, prescription drug, and supplemental coverage||Public health or safety coverage|
**Coverage for medical services like hospitals, labs and diagnostics, and immunization and medication only if required to prevent or treat a disease posing a risk to public health or a condition of public safety concern. Source: Order Respecting the Interim Federal Health Program, 2012.
“In essence, the Harper government changed the universal coverage framework for all categories of refugees … to a highly unequal and conditional model,” said Yogendra Shakya, an assistant professor at the University of Toronto’s Dalla Lana School of Public Health, by email. He called Harper’s claim “inaccurate on many grounds.”
Some evidence shows that the cuts have had an indirect impact on an even wider group of refugees and claimants because of confusion or uncertainty about access rights by the patients or by health care workers.
What was the government’s intent with the changes?
An explanatory note appended to the original government order introducing the IFHP changes in April 2012 identified the purpose was to restrict coverage: “The new criteria provide for rejected refugee claimants and refugee claimants from countries considered Designated Countries of Origin (DCO) … to receive more restrictive public health or public safety health care coverage.”
The April 2012 order got replaced by a June 2012 order, expanding the originally planned cuts. In this order, the explanatory note is still clear about the government’s intent: “Asylum seekers awaiting a decision and rejected refugee claimants will continue to be subject to the limited coverage.”
According to Shakya, privately sponsored refugees were not the intended focus of the cuts, but their coverage was cut accidentally. Their eligibility was tied to federal resettlement assistance that only some privately sponsored refugees access, and so two systems of coverage were born.
Temporary measures after 2014
After the government introduced new temporary measures following the Federal Court decision, there remains different levels of coverage for refugee groups.
Under the new system, some privately sponsored refugees and refugee claimants are not eligible for prescription drug and supplemental coverage, said Shakya. These groups have basic coverage plus prescription drugs only for reasons of public health and safety. In other words, prescription drugs are covered if the person “has an infectious disease or is violently psychotic and therefore poses a danger to Canadians,” explained Macklin.
The Conservative health care cuts did impact more refugee groups than just rejected claimants. They affected claimants and some privately sponsored refugees. Harper’s claim is false.