The Conservative government’s decision to stop covering the health expenses of Ontarians who travel abroad is making waves. France Gélinas, Ontario’s New Democratic Party (NDP) health care critic, opposes the measure, notably because of its potentially dire consequences.

Gélinas, who is also the chief opposition Whip, stresses that this decision creates serious problems for people with chronic kidney failure treated by hemodialysis. Up to now, the Ontario Health Insurance Plan (OHIP) has been reimbursing $210 per treatment received abroad; dialysis patients require several such treatments each week. This coverage will end on October 1, 2019.

According to the The Canadian Organ Replacement Register (CORR), 9,532 Ontarians with kidney failure were treated by hemodialysis in the province in 2017. “For these people, provincial medical insurance is often the only insurance they can obtain,” to cover the cost of hemodialysis received abroad, Gélinas told Insurance Journal. “Patients cannot bring their machines with them. They would need four large movers to help them do that.” Yet some dialysis patients are required to travel, for instance to study, work or visit relatives.

Insurers to the rescue?

Christine Elliott, Ontario Ministry of Health and Long-Term Care, recently contacted stakeholders to discuss ways “to protect hemodialysis patients' ability to safely travel abroad and to better understand the challenges facing these individuals," her spokesperson Hayley Chazan told Insurance Journal.

The minister also met with people receiving dialysis, and “told them that she would find a solution to keep them insured. The patients sensed that she may want to force insurers to sell them insurance,” France Gélinas explains. “I don’t know of any insurance companies that work pro bono. Even if they include hemodialysis in their coverage, if they sell it at a price that patients cannot afford, it is not a solution,” she adds.

Hayley Chazan rebuts this allegation: “To be clear: Minister Elliott is not asking insurance companies to cover individuals who require dialysis while travelling outside of Canada. This is not part of our government’s ongoing conversations with stakeholders."

The Canadian Life and Health Association (CLHIA) told Insurance Journal it has no comment “for now.”

A decision outside the law?

Although the outcome of these discussions is still uncertain, France Gélinas is “keeping her fingers crossed” that the minister will reconsider her decision. The MLA wants Ontario to continue to cover all Ontarians travelling outside Canada. Her concern about the implications is heightened by “the federal government being involved,” because not covering Ontarians abroad violates the Canada Health Act (CHA), she explains.

“Provincial drug insurance must follow insured from one Canadian province to another, as well as outside Canada. It is one of the five conditions to meet to ensure that the provincial plan receives federal funding. Starting October 1, we will not be satisfying this condition anymore. Ontario is flouting this important law and is heading for a two-tier system,” Gélinas points out. In response, Christine Elliott’s spokesperson says that “CHA is federal legislation. Whether a province is in breach of the CHA is a federal determination.”

In fact, the condition of “portablity,” stated in section 11 of the CHA, foresees that provincial health insurance plans “provide for the payment of amounts for the cost of insured health services provided to insured persons while temporarily absent from the province.” The law states that if these services are “provided out of Canada,” the amount should be equivalent to “the amount that would have been paid by the province.” The Canadian provinces must satisfy this condition “to qualify for their full share of the cash contribution available to them under the federal Canada Health Transfer,” the law reads.

Health Canada had not replied to Insurance Journal’s queries on this topic by press time. Each year, about 20,000 Ontario residents use the OHIP program, which covers a portion of the health expenses they incur outside Canada. This service costs the Ontario government between $10 and $12 million annually.