Snowbirds should fly away on their own dime
Canada’s universal health- care system, envy of many Americans and few others, has always been a curious beast. It famously doesn’t include prescription drug coverage, except where it sort of does, as in Quebec. “Portability” is one of the so-called “five pillars” underpinning the system, but if you need porting to hospital in another province, you’ll likely get a bill. If you’re from Quebec and travelling to the Rest of Canada, or vice versa, you might get billed directly for any healthcare services at all.
Another pillar is “comprehensiveness,” which the Canada Health Act describes as follows: “The health care insurance plan of a province must insure all insured health services provided by hospitals, medical practitioners or dentists.” In other words, provinces must insure what they insure, not including routine dentistry.
The Ontario Superior Court of Justice recently added another quirk, quashing a provincial regulation, which came into effect January 1, that eliminated all coverage when Ontarians are out of the country. ( It later relented on coverage for kidney dialysis.) This is a win for the Canadian Snowbirds Association, which launched the challenge with Robert Slack, one of their flock.
“For ( snowbirds), leaving Canada to reside in a warmer climate is not a ‘choice’, but a necessary precaution for preserving their health and well- being,” Justice Harriet Sachs wrote in her Sept. 23 decision, summarizing their position. “( Slack) travels to Florida to avoid the hazards associated with the Canadian winter and to alleviate the symptoms of his medical condition” — namely hereditary hemochromatosis, an unusual propensity to absorb iron.
Sachs made short work of the Snowbirds’ laughable Charter arguments: that the government had breached nothing short of its members’ rights to liberty and equality. But the government may be dead to rights on the law. “Where the insured health services are provided out of Canada, payment (must be) made on the basis of the amount that would have been paid by the province for similar services rendered in the province,” the Canada Health Act stipulates. Ontario’s Health Insurance Act is equally clear that the government can’t implement provisions that “would disqualify the province” from federal funding.
The government may have more luck on appeal. This ruling contradicts the reasoning in previous ones on several minute but crucial points, notably just what “would disqualify” means. ( The feds complained about the new regulation, but didn’t threaten any cuts.) Or perhaps it should just change the Health Insurance Act. Because this was an eminently sensible regulation, and it deserves to be reinstated. Moreover, the status quo ante is nearly as vulnerable to all the same arguments that won the day.
Even before Jan. 1, never mind what the Canada Health Act says, Ontarians were not reimbursed for health- care expenses incurred abroad based on “the amount that would have been paid by the province for similar services rendered in the province.” Rather, the reimbursement was capped at $55 per day for outpatient services, and either $ 200 or $ 400 a day for in- patient services, depending on their nature. That will be the case again if this ruling stands.
According to figures from the Canadian Institute for Health Information, $400 is about half of what Queen’s Park pays to keep an Ontarian in hospital for a day: The average stay in 2018 was 6.9 days and cost $ 5,484. Some other provinces are even stingier. Alberta spends just over $ 1,000 a day on the average hospital patient at home, but caps out- of- country claims at $100 a day. British Columbia spends about $850, and caps at $75.
The non- profit FAIR Health has estimated the average cost of a six- day admission to an American hospital due to COVID-19 at $73,300. If you can foot that bill, you don’t need $ 2,400 back from Ontario’s taxpayers, or $450 from B.C.’S.
Of course very few people can afford a $12,000-a-night hospital stay — and in the U. S., if your luck goes very bad, you could be liable for much more. That’s why anyone visiting the United States without ample travel insurance, even for an afternoon, should book an urgent appointment with their local brain doctor.
The Snowbirds Association is quite clear on this point: “The CSA continues to advise travellers to obtain adequate travel medical insurance prior to all trips abroad,” it stressed in its response to the decision. But it said, “re- establishing coverage will lower insurance premiums, making travel more affordable, particularly for seniors in the province.”
And there you have it, straight from the snowbird’s mouth: It’s a subsidy for people wealthy enough to travel in general, and specifically for affluent elderly people with second ( third?) homes in Florida and Arizona. That’s a turkey of an idea in normal times. With Florida’s and Arizona’s rates of COVID-19 cases 28 and 68 times higher than in Ontario, respectively, and with the feds advising us not to leave the country, period, the timing to reinstate this provision could hardly be odder.
It won’t make much of a difference in the province’s bottom line: The Ontario Ministry of Health claims it was spending $ 2.8 million a year to process $ 9 million in claims. But the ministry is unlikely ever to discover an easier, more logical or less painful $ 11.8 million to cut. For love of God, people, don’t go abroad without health insurance.