Question Period Note: CANADA HEALTH ACT – ABORTION SERVICES

• In New Brunswick (NB), Regulation 84-20 of the NB Medical Services Payment Act limits coverage of surgical abortion services to approved hospitals (three NB hospitals currently offer the service – two in Moncton and one in Bathurst). This means that individuals who receive these services at Clinic 554 in Fredericton are required to pay out-of-pocket. Patient charges for abortion services received in private clinics are considered user charges under the Canada Health Act. This regulation also poses concerns under the comprehensiveness and accessibility criteria of the Canada Health Act. Evidence indicates that some abortion clinics in Ontario (ON) are also charging patients to access insured services.

KEY MESSAGES

• Our Government believes that Canadians should have access to the full range of reproductive health services, including abortion services.

• Individuals should not face charges when seeking these insured services, regardless of where the services are provided.

• The Act is clear: where there is evidence of patient charges, a mandatory deduction to federal health transfer payments to the province or territory must be taken.

• This Government will uphold the Canada Health Act to help ensure that patients do not face barriers when accessing medically necessary health care.

In New Brunswick, Regulation 84-20 of the NB Medical Services Payment Act limits coverage of surgical abortion services to approved hospitals (three NB hospitals currently offer the service – two in Moncton and one in Bathurst). This means that individuals who receive these services at the private clinic in Fredericton are required to pay out-of-pocket. New Brunswick is the only province with a private abortion clinic where the province does not provide coverage for services. Patient charges for abortion services received in private clinics are considered user charges under the Canada Health Act and raise concerns under the accessibility and comprehensiveness criteria of the Act. Deductions to NB’s Canada Health Transfer occurred in March 2020, in the amount of $140,216 (for patient charges in 2018-2019) and March 2021, in the amount of $64,850 (for patient charges in 2019-2020). The lack of coverage for abortions performed in private clinics has been discussed bilaterally with NB since 1995, without resolution.

On January 6, 2021, the Canadian Civil Liberties Association (CCLA) filed a statement of claim in the NB courts, as part of a Charter challenge against NB’s restrictive regulation 84-20. The Association was granted standing in the case by the NB Court of Queen’s bench on June 2, 2021. The group argues that the regulation is inconsistent with and in violation of the Canada Health Act. The Association had previously advised the province it would take legal action if the regulation was not amended to permit coverage for abortion services received outside hospitals. The province filed their Statement of Defence on July 2, 2021, which denied many of the CCLA’s allegations and indicated that Regulation 84-20 does not violate the Canada Health Act. A trial date has not yet been established.

In December 2020, the NB Legislative Assembly passed a motion instructing the province’s two Regional Health Authorities to determine if access to abortion services in NB satisfies the requirements of the CHA and, if not, how the Act’s requirements could be met while respecting NB legislation (i.e., without providing coverage for clinic abortions).

Evidence indicates that some private abortion clinics in Ontario (ON) charge to access insured surgical abortion services. While the Ontario Health Insurance Plan provides coverage for physicians' fees related to abortion services in all private clinics, the province only covers facility fees in the four private abortion clinics licensed as Independent Health Facilities (IHF). Health Canada has advised ON that patient charges being levied in non-IHF clinics are user charges under the CHA, and based on patient charges reported by ON to Health Canada, a deduction of $13,905 was levied against the province’s CHT payment in March 2021.

Budget 2021, released in April 2021, acknowledged the need for greater access to sexual and reproductive health care information and services across the country. It is also specified that the federal government is committed to collaboration with the PTs to strengthen the health care system and ensure access to a full suite of reproductive and health services in any upcoming Canada Health Transfer discussions. The Budget proposed $45 million over three years to fund community-based organizations that help make sexual and reproductive health care information and services more accessible for vulnerable populations.

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