Hon. Ratna Omidvar: Honourable senators, I rise today to speak on Bill C-31, an act respecting cost of living relief measures related to dental care and rental housing. I support this bill in principle, and today I will focus my remarks on the dental benefit portion of the bill.

I wish to congratulate my colleagues, Senator Yussuff and Senator Seidman, for their excellent speeches. For my part, all this talk about dentists and kids takes me back to my own childhood of being dragged to a dentist. I was very traumatized. I have a vague memory of a lot of persuasion being at play. I think hard candy was involved, but I have my own teeth today, all of them. I’m very grateful that my parents had the means to insist on this essential care. It’s not the same for all Canadians. I speak from a bit of first-hand experience.

In 2016, just eight years ago, a Syrian refugee family with eight children under the age of 15 landed in Toronto. As their sponsor, the first three months were completely hectic for them and for us. We soon discovered a challenge we had not prepared for: the oral health of the eight children. Their teeth were in terrible shape. They were rotten, frankly, because apparently there were rivers of hard candy running through the camps, as opposed to healthy food.

Even to our untrained eyes, we could see there was a problem. However, although the federal government picks up the costs of health care for refugees in the first year of arrival, this coverage does not extend to routine dental care, only to emergency dental care. In other words, the family would have needed to wait for a dental emergency to get the care they needed or until they qualified for the Healthy Smiles program, which was a year.

Left up to our own resources, the sponsoring team had to dig into our pockets, and we relied on the good will of many volunteer dentists.

Oral health for all children, as we have heard today, is very important. Let me quote some further facts for you.

According to the 2010 Canadian Health Measures Survey, well over 50% of 6 to 19 year olds have or had at least one cavity and have, on average, 2.5 teeth affected by tooth decay. Bad oral health is the most common chronic disease in children, five times more prevalent than asthma.

Poor oral health also increases gum disease, and has been linked to cancer — as Senator Yussuff has pointed out — Alzheimer’s, diabetes and heart disease. A study has shown that:

Across OECD countries . . . 5% of total health expenditures originate from treatment of oral diseases. Direct treatment costs due to dental diseases worldwide have been estimated at US$298 billion yearly, corresponding to an average of 4.6% of global health expenditure. . . .

Having good oral health is good for the kids. It’s good for our health care system. It’s certainly good for the economy.

Colleagues, I know that during questions and debate today, we have talked about concerns that this bill moves into provincial jurisdiction. We know that provinces and territories in Canada have pre-existing dental care programs for children. However, according to the Canadian Dental Association:

While several of these programs have a solid infrastructure in place, others are currently underfunded and, as a result, do not always respond to the individual oral health needs of pediatric patients.

They noted that P.E.I. does oral health fairly well, whereas the outcomes don’t seem to be so good in my province of Ontario.

In an ideal world — I do not dispute, Senator Seidman — it would have been preferable to use the plumbing of existing provincial agreements and sign agreements with the provinces to bolster their own programs to get the money faster, through existing machinery, to the people. I do not dispute that. However, as we well know, such agreements are hard to negotiate. They take a very long time. Every agreement with every province and every territory is different, and, inevitably, we would see a patchwork of services.

As we have heard from Senator Seidman, Quebec does this, Ontario does this, Newfoundland does this, et cetera.

With this initial two-year program, the government accomplishes a number of objectives. First, it covers the whole nation regardless of where you live. If you have a child aged 1 to 12 years old, they will benefit from the program. It is contingent only on income levels.

Second, it takes effect almost immediately, bringing much-needed relief to poor people in a timely manner.

Third, I believe it allows the government to assess the efficacy of a two-year initial pilot program, let me call it that, as they consider rolling out the permanent program.

Whilst we are on federal-provincial agreements, let me clutch a bit on the province I live in. Even when agreements are signed, there is no assurance of accountability. In Ontario, parents are still waiting for $10-a-day daycare program, although the agreement was signed, I don’t know, maybe even a year ago. Again in Ontario, we have seen a government accrue a budget surplus of $2.1 billion when our health care system is in shambles. It is the same government that is using the “notwithstanding” clause to deal with the labour issues. It makes sense to me that the federal government will trust families to make the right decisions for their children. That given a chance, given a little extra money, the extra boost in financial confidence, they will call their dentist and make appointments for their children and use the money to bridge whatever gaps there may be in provincial programs.

To those who say that $650 is not enough, honestly, you may well be right. But the government has not dreamt up this figure out of thin year. At pre-study at the National Finance Committee, we heard from the Parliamentary Budget Officer that the average cost of dental care for children under 12 — remember under 12 they still have milk teeth — is under $650. The same was confirmed by the Canadian Dental Association.

In comparison to other jurisdictions — you may be interested in this — we are playing catch-up. We are always playing catch‑up, I feel. Australia rolled out a very similar program in 2014. Its program functions very much the way this program is designed to function, except it extends to children up to 19 years old. Of course, the gold standard would be the National Health Service in the U.K., which covers all dental costs and encourages parents to start with dental appointments as soon as milk teeth appear.

We all know that this is a time-sensitive program. This interim program of two years will eventually develop into a more permanent program; at least that is the hope of many Canadians. It targets those in highest need. Parents who have private dental insurance are not eligible, and those who are covered by a provincial program are only eligible to have out-of-pocket expenses compensated. Provinces and private plans will always be the first payers, and the federal dental program will come after that. At committee, we were informed by officials that there will be no clawback from provincial governments, as this bill does not touch on or harmonize with any of theirs.

I do have some concerns about the bill. Some of these have been raised by other people, but I think it doesn’t matter if we raise concerns again and again; maybe the committee will take note of them. We know that about 10% of Canadians are non-filers. How will they access this benefit? For those who are already in the system and receive the Canada Child Benefit, it is fairly simple. The individuals have a CRA My Account and they simply have to use it to apply for the new benefit. My concern, though, is for the non-filers, and this is not an insignificant number, 10% to 12%.

I don’t know who these non-filers are. I know they are low-income, as studies have pointed out, but we don’t know if they have children. We don’t know if they are working or not; likely they are, but they are not filing their tax returns. I do believe it is time that the CRA address this very important question in a serious manner. To my question to the officials at the committee, I was told that they have a strategic plan called “Get ready,” but they don’t appear to have set any standards or benchmarks against this plan to assure the people of Canada that they are reaching non-filers, and that non-filers are beginning to file. I would like to see a benchmark, an objective put in place that after the end of their “Get ready” program, on evaluation, at least 3% more are filing. That would be a success.

The second question is about capacity. We know that certain parts of the country, especially rural and Northern communities, do not have good access to dental care. There are shortages in dentists and hygienists. The extra demand from the South — I hesitate to say “South” in the context of Canada, but I think you all know what I mean — creates a concern that supply of dental services and dental professionals may migrate to the South. One unintended outcome could be the loss of dentists and dental hygienists from small and rural communities.

The federal and provincial governments should think long and hard about using an untapped source of workers, and those are internationally trained dental health care professionals. We know that many of these internationally trained professionals come here through the Express Entry program, which favours people whose skills are badly needed. However, when they arrive, they get in what I call “credentialism hell,” which takes a great deal of time and a huge amount of resources to pull yourself out of.

This is a national problem which is complicated by the fact that regulated occupations such as dentistry are under the jurisdiction of provincial governments, who, in turn, maintain, “This is not our business — these are self-regulating, independent occupations. We cannot force them to do anything.” It is a veritable maze.

However, the issue of capacity in the context of dental care in remote and rural communities could be addressed by providing a restricted licence to those dentists who have passed some portion of their exams as long as they work in a restricted location, restricted practice. Clearly, this would have to be done province by province, but it does provide an impetus for provinces to consider this or other proposals. Perhaps the federal government could even play a role in incentivizing such behaviour. This practice is followed by Australia, for example.

In conclusion, colleagues, the absence of dental coverage for poor people, especially children, is a blemish on Canada’s avowed aspiration to be a nation of inclusion and opportunity. This bill takes the first small but very important step in building a healthier future for our children.

Thank you.

Hon. Paula Simons: Honourable senators, I rise today to address Bill C-31, An Act respecting cost of living relief measures related to dental care and rental housing.

In specific, I wish to speak to the bill’s provision with regard to dental benefits for Canadian children. I don’t think — especially after what we’ve heard here today — that there need be any doubt that proper dental care for kids is a fundamental question of public health and disease prevention. We claim to have universal health care in this country, but as long as some families are forced to forgo timely dental care for their children, our boasts are a tad hollow.

I was lucky when I was the parent of a young child to work for a company that provided excellent dental benefits to its employees, but I was not always so lucky. As a young adult, I went for years with no dental insurance. I was working full-time as a journalist, first for a small magazine and then for the CBC, but I had no dental benefits. In fact, I worked full-time as a producer with the CBC for six years with no dental plan and a low enough salary to make trips to the dentist seem like a luxury. As soon as I was hired on by the Edmonton Journal, I rushed to the dentist to make up for all those years when I had no cleanings or checkups. I know all too well that thousands of working Canadians and Canadian families simply do not have the means to make regular trips to the dentist a part of their budget.

So I applaud the intentions of Bill C-31. Here we are after all, the day after Halloween. Who amongst us would want to deny cleanings and X-rays and fillings to all the princesses, lions, monsters, firemen and pirates eating their Halloween candy today? But I confess, I do have some misgivings about the jurisdictional complexities of this bill and its interconnection — or lack of interconnection — to various provincial and First Nations dental programs. I want to put those concerns on the record because Bill C-31 is obviously meant to be just the first step in the creation of a more ambitious national dental care program.

Health, as we have all said today, is an area of provincial jurisdiction. As we roll forward, we need to be sure that provinces, to the best of our ability, are at the table as partners.

These are times when certain provincial governments are being even more than usually prickly on this subject.

Last week, on October 27, Alberta’s new premier, Danielle Smith, released, via Twitter, a letter to all her ministers asking them to make what she called a “united front” against federal policies that would, in her words, “threaten Alberta’s interests,” even if that meant rejecting federal government grants for various programs, especially targeted transfers. She further instructed her cabinet to insist that Ottawa respect constitutional division of powers, specifically related to health care and other social programs, and to seek, instead, to accept money only by “unconditional block transfers” to be spent entirely at Alberta’s discretion.

She further noted that when unconditional block transfers — money with no strings attached — were not on offer, Alberta would seek to opt out of new federal programs.

And if Ottawa does not, in the premier’s words, “honour co-operative federalism,” then, said Premier Smith, Alberta would refuse to participate in consultations with the federal government.

Now, please do not confuse me with Premier Smith. We are both, indeed, former newspaper columnists turned politicians, but we have rather different perspectives. I wanted to quote from this letter, not because I share all its views but because I want us to be fully alert to the complicated political tenor of the moment and to be alert to the future challenges of attempting to put together some kind of jury-rigged dental plan using the Canada Revenue Agency to do an end run around provincial jurisdiction.

Giving money directly to families, for all the reasons Senator Omidvar mentioned, does seem like an attractive option, but it comes with real political risks.

Of course, the program laid out in Bill C-31 would be of huge benefit to thousands of Alberta families. Alberta does have the Alberta Child Health Benefit which, as Senator Seidman explains, covers basic and preventative services like fillings, X‑rays, examinations and teeth cleaning. But the income cap for a couple with two children is $36,634, whereas this new federal benefit would be extended to families making up to $90,000 so that many more working families would be covered.

But if we don’t properly coordinate future federal and provincial programs, we are going to end up in a jurisdictional and political quagmire. We don’t want to duplicate existing services. We certainly don’t want to leave some families worse off than they were before. We also don’t want tremendous inequality across the country, where this top-up gives some provinces tremendously strong dental programs and leaves families in other provinces struggling.

Then there’s the question of how this program would coordinate with the one offered to First Nations and Inuit families via Indigenous Services Canada’s own NIHB — Non‑Insured Health Benefits — program, which provides comprehensive dental care, including orthodontics, to Inuit Canadians and those with Indian status.

Now, I’ve been told that First Nations and Inuit families can still receive the dental benefit proposed in Bill C-31, but only if they incur out-of-pocket expenses that are not covered by the NIHB — and the NIHB covers almost everything — and only if they file their tax returns. You don’t need much imagination to contemplate the kinds of complications that might ensue if some families claim the new benefit in mistaken good faith and then have it clawed back via audit. Given the percentage of Indigenous families that already live in poverty, it would be ironic indeed if Bill C-31 actually did little or nothing to help them, or ended up in some way undermining the future of the dental benefits they already have.

I trust that, while this bill is at committee, some of these questions can be explored in more depth. Thank you, hiy hiy.

(On motion of Senator McCallum, debate adjourned.)

On the Order:

Resuming debate on the motion of the Honourable Senator Duncan, seconded by the Honourable Senator Clement, for the third reading of Bill S-236, An Act to amend the Employment Insurance Act and the Employment Insurance Regulations (Prince Edward Island), as amended.

And on the motion in amendment of the Honourable Senator Ringuette, seconded by the Honourable Senator Petitclerc:

That Bill S-236, an Act to amend the Employment Insurance Act and the Employment Insurance Regulations (Prince Edward Island), as amended, be not read a third time, but that it be referred back to the Standing Senate Committee on Agriculture and Forestry to hear from the Parliamentary Budget Officer concerning his office’s fiscal analysis on the bill; and

That the committee report to the Senate no later than November 15, 2022.

And on the subamendment of the Honourable Senator Black, seconded by the Honourable Senator Dagenais:

That the motion in amendment be not now adopted, but that it be amended by:

1.adding the words “additional witnesses, including” between the words “to hear from” and “Parliamentary Budget Officer” in the first paragraph; and

2.by deleting the final paragraph.