NIHB talks “a continuing adventure” Nunavut minister says

Nunavut Health Minister George Hickes said talks between Nunavut and Ottawa on renewing their agreement on the Non-Insured Health Benefits program, or NIHB, have started, but getting the federal government to recognize Nunavut’s high costs is a continuing struggle. (FILE PHOTO)

The pot of federal government money that the Government of Nunavut uses to help pay the cost of health care for Indigenous people in the territory is under negotiation right now, and the GN’s biggest challenge, as always, is getting Ottawa to recognize the territory’s high costs, Nunavut Health Minister George Hickes said in the legislative assembly last week.

Hickes made those comments March 14 while responding to questions from Iqaluit-Niaqunnguu MLA Pat Angnakak about Ottawa’s Non-Insured Health Benefits program.

The NIHB, now a constitutional right for Inuit and First Nations, is similar to supplementary health insurance, funding many health services that aren’t covered by provincial and territorial health insurance plans, like prescription drugs, dental care, eye care and medical travel.

Métis and non-status Aboriginals, however, still don’t appear to be covered by the NIHB, despite a landmark decision by the Supreme Court of Canada in 2016 that said those groups should enjoy the same rights as Inuit and First Nations.

In 2017-18, the GN expects to spend $37.36 million through the NIHB, the same amount they estimate spending in 2016-17.

That’s about $7 million more than the figure the GN first budgeted for the NIHB in 2016-17: $30.725 million. That’s a sign that the GN’s demand for NIHB dollars is growing fast.

In one of her questions, Angnakak asked Hickes about how the GN goes about requesting more money through the NIHB, in view of the high cost of doing business in Nunavut.

Hickes said the GN constantly raises Nunavut’s cost issues with the federal government, but ultimately, it’s the federal government who decides.

“All I know is that the agreement that we have with Health Canada, like I had said, it’s a continual adventure, I’m going to call it, of educating our federal counterparts in acknowledging the level of care that we need to provide, considering the limitations that we have geographically and economically,” Hickes said.

He said the GN holds “continual conversations” with federal officials on the cost of boarding homes, medical travel, food allowances, and prescription drugs, Hickes said.

But at the end of it all, it’s the federal government that sets how much money Nunavut will get through the NIHB, and what services the NIHB will or will not pay for.

That’s why the NIHB covers medical travel costs for Inuit or First Nations patients, but not the cost of escorts who travel with certain kinds of patients, such as unilingual elders.

“They still have control over the rates of what we receive from the services that we [do] on their behalf. An example, escort travel is not covered through NIHB. That turns out to be a Department of Health expense,” Hickes said.

Yet another cost issue is raised by “reciprocal billing” agreements with other jurisdictions.

That term refers to how much the GN has to pay health care providers outside Nunavut who serve Nunavut patients who travel south for medical treatment.

“We rely upon NWT, Alberta, Manitoba, and Ontario to provide health care for our residents out of our different regions… It is an ongoing effort to make sure that other people recognize the high level of costs,” Hickes said.

Hickes didn’t say when talks between Nunavut and Ottawa on a new NIHB agreement would conclude.

But there’s no doubt the Nunavut Department of Health’s budget continues to rise.

With an estimated $353.38 million budget for 2017-18, it’s by far the biggest spending department at the GN, consuming at least 23 per cent of the government’s budge, according to the GN’s most recent budget document.

But proportionately, pretty much all Canadian provincial governments spend far more than Nunavut on health care. The Canadian Institute for Health Information estimate that in 2015, most provincial governments, except for Quebec, spend more than 40 per cent of their annual budgets on health care.

During that same year, 2015, health spending in Nunavut amounted to only 27 per cent of the territorial government’s budget, and in the Northwest Territories, about 25 per cent, the CIHI reported.