Question Period Note: Canada Health Act- Abortion Services

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• Although access to abortion services in Canada has been improved by the approval and roll-out of Mifegymiso for medical abortion, the availability of surgical abortion varies both between provinces
and territories and nationally. Health Canada is aware of coverage issues resulting in patient charges for surgical abortion services in a limited number of private clinics in both New Brunswick (1) and Ontario (5). Patient charges for access to abortion services received in private clinics are considered user charges under the Canada Health Act.
KEY MESSAGES
• This Government is committed to upholding the fundamental right to choose and believes that no one should be forced to carry an unwanted pregnancy.
• Health Canada has taken action under the Canada Health Act to combat patient charges for access to insured surgical abortion services by levying deductions to Ontario and New Brunswick’s Canada Health Transfers.
• In addition, this Government has invested $8 million to date under the Sexual and Reproductive Health Fund to support access to abortion, with renewed funds committed under Budget 2023.
IF PRESSED ON FURTHER COMPLIANCE ACTION UNDER THE CANADA HEALTH ACT …
• While abortion services are insured in all provinces and territories there is still work to be done to improve access in many areas of the country.
• Health Canada continues to engage with Ontario as they work to implement their action plan to eliminate patient charges for access to abortion services.
• New Brunswick will continue to be subject to Canada Health Transfer deductions as long as the province refuses to cover insured surgical abortion services provided at private clinics, resulting in patient charges.
IF PRESSED ON THE SEXUAL AND REPRODUCTIVE HEALTH FUND …
• This Government is committed to making sexual and reproductive health services more accessible, with an emphasis on populations experiencing the highest risks and greatest barriers, including Indigenous people, racialized populations, members of 2SLGBTQI+ communities, women, and youth.
• That is why Budget 2021 committed $45 million over three years to establish the Sexual and Reproductive Health Fund. An additional $36 million was committed in Budget 2023 to renew the fund for three years (starting in 2024-25). This fund supports community-based organizations that help make access to abortion, as well as other sexual and reproductive health care information and services, more accessible for vulnerable populations.
IF PRESSED ON THE LEGAL STATUS OF MEDICATION ABORTION IN THE UNITED STATES, AND THE AVAILABILITY OF MIFEGYMISO IN CANADA …
• Health Canada is aware of decision issued by the U.S. Supreme Court, allowing continued access mifepristone, a drug used to safely induce abortions.
• Mifépristone is not marketed in Canada.
• Mifegymiso is the only abortion pill authorized in Canada and is not available in the US. It includes mifépristone and misoprostol. Mifegymiso is publicly covered by all provinces and territories.
• Health Canada is closely monitoring the supply of Mifegymiso in Canada. There are currently no supply issues.

Health Canada’s top priority is to protect the health and safety of people in Canada, including women who choose to end their pregnancy. The Government of Canada unequivocally supports the right to choose and works to ensure that safe and legal abortion services are available to everyone. Abortion services are deemed medically necessary and are insured in all provinces and territories. Individuals should not face charges when seeking these insured services, regardless of where the services are provided.

The Canada Health Act establishes criteria and conditions related to insured health services and extended health care services that the provinces and territories must fulfill to receive the full federal cash contribution under the Canada Health Transfer (CHT). The aim of the Act is to ensure that all eligible residents of Canadian provinces and territories have reasonable access to medically necessary hospital, physician, and surgical-dental services that require a hospital setting on a prepaid basis, without charges related to the provision of insured health care services.

U.S. Abortion Landscape
Ongoing developments in the United States since the overturning of Roe v. Wade in June 2022 have galvanized the discussion around abortion in Canada. These developments include conflicting federal district court rulings in Texas and Washington State on April 7, 2023 concerning the U.S. Federal Drug Administration’s (FDA) approval of mifepristone (medical abortion pill). On April 21, the U.S. Supreme Court stayed the decision that would have undermined the FDA’s approval of mifepristone; however, appeals have already been filed. The 5th U.S. Circuit Court of Appeals heard oral arguments on May 17, 2023. The ruling has not been released.

Access to Abortion in New Brunswick
In New Brunswick, Regulation 84-20 of the Medical Services Payment Act limits coverage of surgical abortion services to approved hospitals. 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 (Clinic 554) where the province does not provide coverage for services. In December 2022, the Government of NB passed legislation allowing for some insured surgeries to occur in private clinics (including cataracts) as a means of reducing surgical waitlists. However, this new legislation does not extend to surgical abortion services in private clinics.

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. Since March 2020, deductions totaling $334,766 have been levied against the NB’s Canada Health Transfer (CHT) payments in respect of patient charges for surgical abortion services. The lack of coverage for abortions performed in private clinics has been discussed bilaterally with NB since 1995, without resolution. Currently, Clinic 554 appears to be operating one day per week, offering only surgical abortion services for $700.
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 and was granted standing on June 2, 2021. The group argues that the regulation is inconsistent with and in violation of the Canada Health Act. 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. The case is currently in the discovery phase and the CCLA is awaiting information from the province, which was requested in January 2022. To date, no trial date has been set.

Access to Abortion in Ontario
In summer 2019, evidence in Ontario revealed fees charged to individuals to access surgical abortion services in some private clinics. 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). Evidence gathered confirmed that some private non-IHF abortion clinics charged fees for uninsured services, while not consistently informing patients these fees were optional, with respect to accessing insured surgical abortion services.

When the Ontario Health Ministry conducted further investigations the patient charges discovered were reported to Health Canada. These charges formed the basis of Ontario’s March 2021, 2022, and 2023 deductions (totaling $53,265).

Under the Canada Health Act Reimbursement Policy, which came into effect in 2018, provinces and territories that face mandatory deductions have the opportunity to be reimbursed if they work with Health Canada to develop a plan to eliminate patient charges for medically necessary services, and the circumstances that led to them within a specified timeframe (two years from the date of the deduction).

In December 2021, Ontario submitted a Reimbursement Action Plan to Health Canada, and has committed to revisit the current framework for the funding of insured surgical abortion services in the province. Health Canada continues to engage with Ontario as they work to implement their action plan to eliminate patient charges for access to abortion services.

Additional Federal Initiatives with Respect to Sexual and Reproductive Health
Of the $45 Million committed to sexual and reproductive health in Budget 2021, the Government has invested $8 million to date specifically to support access to abortion in Canada. In the first six months of funding, Action Canada served 208% more people, and provided 234% more financial support, as compared to the same period in 2021. An additional $36 million has been committed in Budget 2023 to renew the Sexual and Reproductive Health Fund for three years (starting in 2024-25).

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