Hon. Flordeliz (Gigi) Osler: Honourable senators, I would like to begin by recognizing that we are gathered on the traditional and unceded territory of the Algonquin Anishinaabe people, who have lived on this land since time immemorial.

I rise today to support the principle of Bill C-64.

[English]

My speech today will have three parts: first, a short background on the Canada Health Act and how that framework relates to the current gap of national pharmacare in Canada; then an outline of how access to contraception improves health; and finally, I will touch on a few areas of Bill C-64 where I believe further scrutiny is required.

To start, it is important to understand the Canada Health Act in relation to this piece of legislation. Bill C-64 states that the minister is to consider the Canada Health Act along with the principles of accessibility, affordability, appropriate use and universal coverage when collaborating with provinces, territories, Indigenous peoples and other partners and stakeholders toward national universal pharmacare.

Consideration of a national prescription drug plan is not new. In 1961, the Royal Commission on Health Services, also known as the Hall commission, recommended a national health policy and a comprehensive health care program, thus laying the foundation for the Canada Health Act. One recommendation from the Hall commission was that prescription drugs be included as a benefit of the proposed health system.

Fast-forward to 1984 and the enactment of the Canada Health Act, which established the funding framework from the federal government to the provinces and territories, as well as the principle of single-payer health care. It also set out the criteria and conditions that the provinces and territories must fulfill to receive their full federal cash contribution available under the Canada Health Transfer. Keep that phrase in mind — “criteria and conditions” — as I will elaborate later.

Under the Canada Health Act, insured health services include medically necessary hospital, physician and certain surgical-dental services, but not prescription drugs, hence the gap that Bill C-64 is attempting to fill. Some of you are likely familiar with the 2019 report of the Advisory Council on the Implementation of National Pharmacare, better known as the Hoskins report. It emphasizes that:

We are the only country in the world with universal health care that does not provide universal coverage for prescription drugs.

While the latter half of that statement is true in that Canada does not have universal coverage for prescription drugs, it is important to note that Canada does not have a universal health care system.

And this is from the Government of Canada website:

Canada does not have a single national health insurance plan. Rather, the 13 provinces and territories have their own health insurance plans, which share certain common features and basic standards of coverage defined by the Canada Health Act . . . .

Furthermore, alongside the 13 provincial and territorial health insurance plans, the federal government provides funding and some direct health care services to certain population groups, including First Nations people living on reserves, Inuit, serving members of the Canadian Forces, eligible veterans, inmates in federal penitentiaries and some groups of refugee claimants. Again, keep those groups in mind.

Now, moving on to the second part of my speech on how access to contraception improves health. Contraception saves the lives of women and babies by reducing both maternal mortality and infant mortality.

To start, contraceptive use reduces the number of abortions, especially those that are unsafe and lead to maternal deaths. Nearly one quarter of Canadians are of reproductive age, and nearly half of all pregnancies in Canada are unintended. Seventy per cent of people seeking abortions report no insurance coverage for contraception.

Although many Canadians have some form of insurance coverage, incomplete coverage impacts access. Requiring insurance companies to cover a 12-month supply of a contraceptive prescription has been associated with a 30% reduction of unintended pregnancies.

Additionally, data from the United States shows that even small out-of-pocket costs reduce the use of contraceptive services and medication, especially among low-income and uninsured women.

Family planning has contributed to substantial declines in global maternal and infant mortality. The ability to plan and time pregnancies provides health benefits for both mothers and babies.

Several studies show that both maternal and infant mortality risks increase with short birth intervals. For instance, beginning a pregnancy within six months of a live birth is associated with an increased risk of premature birth and low birth weight for the newborn.

Family planning reduces maternal mortality by reducing parity — that means the number of births — which then decreases the number of times a woman faces the morbidity and mortality risks associated with childbirth.

Finally, a few words on the economic benefits of contraception. A report by the Institute for Women’s Policy Research lists the economic effects of contraceptive access. The report is based on research that identifies causal impacts on educational attainment, labour force participation, career outcomes, earnings, poverty and effects on the next generation.

In the 1960s, expanded contraceptive access for women led to increased women’s college enrollment by an estimated 12 to 20%. Access to the birth control pill allowed women to delay childbirth, boosting their investment in education and careers.

Contraceptive access accounted for 15% of the increases in women’s labour force participation and nearly one third of the rise in women entering professional fields like medicine and law from 1970 to 1990.

Now, moving on to the third part of my speech, allow me to highlight two reasons why I look forward to studying this bill in committee.

First, the projected cost and lack of a compliance and enforcement mechanism in Bill C-64 should undergo further scrutiny. The Parliamentary Budget Officer has estimated that the first phase of national universal pharmacare will increase federal spending by $1.9 billion over five years. Yet, despite the almost $2 billion increase in federal spending, I find accountability lacking in Bill C-64 as it does not contain language on compliance and enforcement.

Recall earlier how the Canada Health Act sets out the criteria and conditions that the provinces and territories must fulfill to receive their full Canada Health Transfer. The Canada Health Act lists five criteria of public administration: comprehensiveness, universality, portability, accessibility and two conditions on information and recognition.

If the federal minister of health is of the opinion that a province or territory’s health care insurance plan does not meet one of the five criteria or does not meet the two conditions, the minister may refer the matter to the Governor-in-Council. If the Governor-in-Council agrees, they may direct that any cash contribution to that province or territory for a fiscal year be reduced or direct that the whole of any cash contribution to that province or territory for a fiscal year be withheld.

In short, if a province or territory does not fulfill the Canada Health Act’s criteria or conditions, the federal government may reduce or withhold their Canada Health Transfer.

Furthermore, the Canada Health Act provides that a provincial or territorial health care insurance plan must not permit extra billing or user charges by health facilities or health care practitioners. Amounts charged to patients in the form of either extra billing or user charges must be deducted from the cash contribution made under the Canada Health Transfer.

Bill C-64 aims to provide universal, single-payer, first-dollar coverage. Unlike the Canada Health Act, however, Bill C-64 does not contain language on compliance and enforcement.

I question how the provinces and territories will be held accountable. What recourse does the federal government have if a province or territory fails to uphold the principles set out in clause 4 of the bill? What will happen if patients continue to have upfront, out-of-pocket expenses like an insurance co-pay or a pharmacy dispensing fee?

One would assume that co-pays and dispensing fees will be included in the discussions held between the federal minister of health and provinces, territories, Indigenous peoples and other partners and stakeholders.

But as parliamentarians, we cannot make assumptions when it comes to passing legislation. This leads to the second reason I look forward to the committee study on this legislation — to gain more information from the minister and government officials on the future bilateral discussions.

As mentioned earlier, the federal government provides funding and some direct health care services to certain populations including First Nations people living on reserves, Inuit, serving members of the Canadian Armed Forces, eligible veterans, inmates in federal penitentiaries and some groups of refugee claimants.

Clause 5 of Bill C-64 outlines the funding commitment in which the Government of Canada commits to maintaining long-term funding for the provinces, territories and Indigenous peoples, with funding for the provinces and territories provided primarily through agreements with their respective governments. But other than Indigenous peoples, Bill C-64 does not detail a commitment to long-term funding for the other federal populations. Perhaps these groups are the “other partners and stakeholders” referred to in clause 4, but coverage for federally funded populations should be further explored in committee.

To conclude, I support improving health through better access to affordable medications. But with Bill C-64 in its current form, questions remain. How will provinces and territories be held accountable for the federal funds transferred to them? What will the compliance and enforcement mechanisms be, especially if they are not entrenched in legislation? Will all federal populations have a commitment from the Government of Canada to improve access and affordability of prescription drugs and related products?

Honourable colleagues, I hope you join me in supporting Bill C-64.

Thank you. Meegwetch.