Question Period Note: HEALTH FUNDING AGREEMENTS AND TRANSFERS

• The government continues to work collaboratively with provinces and territories (PTs) to strengthen Medicare and provide funding through transfers and bilateral agreements to improve health care. In addition to the Canada Health Transfer, the Government provided over $19 billion to provinces and territories last fiscal year to help them manage the pandemic, and directly invested another $19 billion in health to support the fight against COVID, including public health support and the purchase of vaccines and tests. This is in addition to targeted funding provided to the PTs to support specific health care priorities, such as home care, mental health, substance use, long term care and virtual care.
• As part of its new mandate, the government has committed to providing PTs with additional pandemic support including for immunization and therapeutics, as well as support for primary care, virtual care, long-term care, palliative care, mental health, and problematic substance use.

• The pandemic has highlighted the need for resilient health care systems in Canada. That is why our government is committed to working collaboratively with provinces and territories to provide pandemic supports and to strengthen Medicare.
• Our Government will continue to work closely with provinces and territories in order to improve health care and health outcomes for Canadians across the country.

IF PRESSED (GENERAL) …
• From the beginning, the Government of Canada has been there to support provinces and territories in the fight against COVID-19. More than eight of every ten dollars spent to fight COVID-19 and support Canadians comes from the federal government.
• In 2020-21, the Government of Canada provided $41.9 billion in cash support to provinces and territories through the Canada Health Transfer (CHT), growing to $43.1 billion in 2021-22 and $45.2 billion in 2022-23. This stable, predictable funding is in addition to another $19.1 billion in pandemic support for provincial and territorial health care systems in 2020-21 (e.g. $4 B to help address health system pressures and $1 billion to support immunization campaigns).
• In addition to funding directly to provinces and territories, the federal government made $19 billion in direct health investments in 2020-21 to support the fight against COVID, including public health support and the purchase of vaccines and tests.
• Between 2019 and 2027, the federal government estimates that federal health related COVID-19 spending will total $72.4 billion. This includes a total of $23.2 billon in transfer to provinces and territories and $49.2 billion in direct federal spending (e.g., spending on PPE, vaccines, and rapid tests).
• This does not include our continued collaboration with provinces and territories on shared priorities, supported by targeted federal investments of:
o $11 billion over 10 years for provinces and territories to improve access to home and community care and mental health and addiction services; and
o More recently, $4 billion to help provinces and territories improve infection prevention and control and the standard of care in their long-term care facilities.

IF PRESSED ON Bill C-237 – BQ PRIVATE MEMBER’S BILL INTRODUCED BY MR. PLAMONDON (Bécancour—Nicolet—Saurel) …
• The government of Canada is committed to protecting our publicly funded health care system and supporting provinces and territories in the delivery of care to their residents. The Canada Health Transfer (CHT) remains the key federal funding mechanism for supporting Canada’s health care system, providing long-term, predictable funding to provinces and territories.
• The Canada Health Act (CHA) establishes principles that provinces and territories must fulfill in order to receive their full Canada Health Transfer (CHT) cash contribution. The five principles of the CHA are designed to ensure that all Canadians, regardless of which province or territory they reside in or travel to, have universal access to comprehensive, publicly administered care. Beyond the link to these basic principles, the CHT is unconditional and gives provinces and territories the autonomy to decide how best to allocate these funds in order to address the health care needs of their residents and communities.
• However, our system is in need of improvement. Past experience tells us that improvements will not be easily achieved by merely adding more federal money. Canada is among the world’s top tier of spenders on health care and yet we are not achieving the kind of results that Canadians need. Canadians expect new funds to be invested in a way that achieves tangible improvements in health care. The federal government understands that targeted investments are needed to accelerate change and improve the responsiveness and sustainability of the health system.

IF PRESSED ON THE CANADA MENTAL HEALTH TRANSFER – PLATFORM COMMITMENT …
• The Government of Canada is committed to ensuring Canadians have access to mental health and substance use supports when and where they need them. That is why it is so important to assist jurisdictions to expand the delivery of high-quality and accessible mental health and substance use services.
• The Government of Canada has already made significant investments in this area, including $5B to support mental health and substance use services through its bilateral agreements with provinces and territories. The Government of Canada is committed to make significant additional investments, with accountability and data to demonstrate results for Canadians. We want to ensure that Canadians get the services and supports they need and that our investments have a positive impact on their mental health.

IF PRESSED ON QUEBEC …
• Our Government is committed to ensuring it is there to meet the needs of the people of Quebec, and continues to work with all provinces and territories to strengthen public health care.
• The Canada-Quebec home and community care and mental health and addiction services bilateral agreement will flow approximately $2.5 billion over 10 years in funds targeted to support home and community care and mental health and addiction services and reflects the principles of asymmetrical federalism as recognized in 2004.
• Our government also committed to new targeted funds for Quebec and other provinces and territories for virtual care, safe long-term care and support through the Safe Restart agreement.
• This is in addition to the Canada Health Transfer, which will flow over $10.1 billion to Quebec in 2022-23.
• Quebec will also receive $450 million and $902.4 million as part of its share of the $2 and $4 billion, one-time top-ups to the CHT. It will also receive a further $225.6 million to support COVID-19 immunizations.

IF PRESSED ON NEXT STEPS FOR BILATERAL AGREEMENTS …
• The Government of Canada signed home and community care and mental health and addiction services bilateral agreements with all provinces and territories to flow $5 billion in targeted funding for home care and mental health from 2017-18 through 2021-22.
• We are now working with provinces and territories to amend those agreements to flow funding for the $1 billion Safe Long-term Care Fund.
• A new round of bilateral agreements will be negotiated to flow the remaining $6 billion in funding starting in 2022-23, and these agreements will also flow Budget 2021 commitment of $3 billion over five years to ensure that standards for long-term care are upheld across the country and that seniors are guaranteed the care they deserve, no matter where they live.

Council of the Federation (CoF) Request for Increased in (CHT)
In September 2020, the Council of the Federation (CoF) made a formal request for an increase in health transfers to help address the PT projected increase in health care costs associated with COVID-19 and pressures such as an aging population, and new drugs/technology. The increase requested by CoF would have had the CHT rise to $70 billion, an increase of $28 billion from $42 billion in 2020-21, or from its current 23% share of PT health spending to 35%. CoF has also called for the CHT to grow by an annual escalator of at least 5% (March 4, 2021), and reiterated this demand in December 2021.

In July 2021, the Government provided provinces and territories with an additional $5 billion for health care, including a $4 billion, one-time top-up to the CHT intended to support PTs to clear the backlog of procedures caused by waves one and two of the pandemic. Bill C-25 also provides PTs with $1 billion to support Canada’s COVID-19 immunization plan. Additionally, the Bill provides $2.2 billion to address infrastructure priorities. The $4 billion CHT top-up is in addition to the COVID-19 Response Fund that also provided one-time funding of $500 million through the CHT in 2019-20 to support PTs’ critical health care system needs and COVID-19 mitigation efforts.

The Canada Health Transfer (CHT), the largest major transfer to PTs, provides long-term predictable funding for health care, and is tied to PTs’ respect for the principles of the Canada Health Act, which are: universality; comprehensiveness; portability; accessibility; and, public administration. In 2021-2022, PTs will receive $43.1 billion through the CHT, growing to $45.2 billion in 2022-23.

BILL C-237 - An Act to amend the Federal-Provincial Fiscal Arrangements Act and the Canada Health Act
This BQ Private Member's Bill was introduced by Mr. Plamondon (Bécancour—Nicolet—Saurel) on 7 February 2022. It was also tabled in the previous parliamentary session (43-2) but did not proceed past First Reading on 27 May 2021. The Bill seeks to amend the Federal-Provincial Fiscal Arrangements Act in order to allow a province with a program whose objectives are comparable to those of a federal program in an area under provincial legislative authority (e.g., health care) to withdraw from the federal program, with full compensation.

The Bill also seeks to amend the Canada Health Act in order to exempt Quebec (and other provinces) from the national criteria and conditions that are required for a province to receive its full allocation of the Canada Health Transfer. The Bill would also exempt Quebec from other federal standards including planned long-term care standards.

Pandemic Funding:
In 2020-21, the federal government provided $19.1 billion, beyond the Canada Health Transfer, in pandemic support for provincial and territorial health care systems in 2020-21 to support the fight against COVID, including public health support and the purchase of vaccines and tests and other funding (e.g. $4 B to help address health system pressures and $1 billion to support immunization campaigns).

As part of its new mandate, the government has committed to providing additional pandemic support including for immunization and therapeutics, as well as, support for primary care, virtual care, long-term care, palliative care, mental health, and problematic substance use.

Between 2019 and 2027, the federal government estimates that federal health related COVID-19 spending will total $76.7 billion. This includes a total of $25.6 billon in transfer to provinces and territories and $51.1 billion in direct federal spending (e.g., spending on PPE, vaccines, and rapid tests).

Federal Targeted Funding:
On March 22, 2017, Budget 2017 committed to $11 billion over 10 years to improve access to home care and mental health services.

Shared Health Priorities and Bilateral Agreements:
In August 2017, all PTs (except Quebec) agreed to a Common Statement of Principles on Shared Health Priorities, which sets out priorities for action in home and community care, and mental health and addiction services. On March 10, 2017, the Government of Canada and the Government of Quebec agreed to an asymmetrical arrangement distinct from this Common Statement of Principles and based on the asymmetrical agreements of September 2004.

The Common Statement also includes a commitment for PT governments to work with the Canadian Institute for Health Information on a set of common indicators in these areas, to continue collaborating to advance work in health innovation and prescription drugs, and to engage with Indigenous leaders to improve health outcomes for Indigenous peoples. At the June 2018 Health Ministers’ meeting, Health Ministers (except Quebec) endorsed a set of common indicators, developed by CIHI and FPT governments, to measure and report progress to Canadians on shared priorities.

Recognizing the unique circumstances in Nunavut, and to provide Nunavut the flexibility it required to implement initiatives that will improve access to home and community care and mental health and addiction services, it was agreed that the start date of the agreement would be delayed by a year, i.e., beginning 2019-20.

The funding is allocated to PTs on a per capita basis.

Renewal of Agreements:
The first year of funding (2017-18) flowed to PTs based on their acceptance of the federal funding offer, as outlined in the Budget Implementation Act, 2017, No. 1. The Government of Canada then engaged with PTs to negotiate detailed funding agreements for the 2018-19 to 2021-22 period. The Government of Canada will negotiate the renewal of these agreements in 2021-22 for the remaining five years (2022-23 to 2026-27). Bilateral agreements with all provinces and territories have been signed and are posted online.

Safe Long-term Care:
The 2020 Fall Economic Statement announced a commitment of up to $1 billion for a Safe Long-term Care Fund, to help provinces and territories protect people in long-term care and support infection prevention and control. Funding will be contingent on a detailed spending plan, and conditional on provinces and territories demonstrating that investments have been made according to those spending plans. Provinces and territories will be able to use this funding to undertake a range of activities, including carrying out infection prevention and control readiness assessments, making improvements to ventilation and hiring additional staff or topping up wages.

Long-term Care Standards:
Budget 2021 proposed to provide $3B over five years to Health Canada to support provinces and territories in ensuring standards for long-term care are applied and permanent changes are made. The federal government will work collaboratively with provinces and territories, while respecting their jurisdiction over health care, including long-term care. This work would ensure seniors and those in care live in safe and dignified conditions.

The pandemic has shone a light on systemic issues affecting long-term care facilities across the country. The government welcomes the news that the Health Standards Organization and Canadian Standards Association are launching a process to help address those issues in Canada. The Health Standards Organization’s and Canadian Standards Association’s work with governments, stakeholders, and Canadians to develop national standards will help inform our ongoing discussions with provinces and territories on improving the quality of life of seniors in long-term care.

Virtual Care:
In May 2020, the Prime Minister announced $240.5M to support virtual care and digital tools for Canadians. This funding will support the rapid roll out of virtual care and needed supports for health systems, as the Government of Canada is working with provinces and territories to assist health services to undertake virtual care and provide health services at a distance. Of this funding, $150M will flow to PTs through bilateral agreements for enhancements to virtual services focused on secure messaging and file transfer, secure videoconferencing, remote patient monitoring, patient online access to test results, and back-end supports to integrate these tools within existing digital systems.

In addition, Canada Health Infoway will receive up to $50M to develop pan-Canadian standards on secure messaging and videoconferencing and support PTs as they implement new initiatives pursuant to the bilateral agreements.

KEY FACTS
• On March 25, 2022, the Government introduced Bill C-17 in the House of Commons, which would provide an additional $2 billion one-time Canada Health Transfer top-up to provinces and territories, to further help them to address pandemic-related health system pressures, particularly the backlog of surgeries, medical procedures and diagnostics.
• This is in addition to the $5 billion health care funding our Government provided to provinces and territories in July 2021, including a $4 billion one-time top-up to the Canada Health Transfer to support PTs to clear the backlog of procedures caused by the pandemic, and $1 billion to support vaccine roll-out.
• This is in addition to significant pandemic-related health system investments through the $19 billion Safe Restart Agreement, as well as $150 million for the rapid deployment of virtual care services.
• Furthermore, our government continues to collaborate with provinces and territories on shared priorities, supported by targeted federal investments of:
o $11 billion over 10 years for provinces and territories to improve access to home and community care and mental health and addiction services; and
o More recently, $1 billion for safe long-term care, and $3 billion to help provinces and territories improve the standard of care in their long-term care facilities
• For more information on Federal spending, please see funding charts in the Background.