Does the GN follow the Canada Health Act?
Jurisdictional confusion makes federal health money hard to track in Nunavut
Special to Nunatsiaq News
The Government of Nunavut is responsible for health issues, conferred upon it by the Nunavut Act. Even though the GN is a territorial government, it received most province-like authorities upon becoming a territory in 1999.
Because of this, the federal government does not have the authority to legislate or set policies on matters of health in a province or a territory.
The federal government, however, is responsible for “Indians” conferred upon it by the Constitution Act of 1867. Inuit were included as eligible to receive certain benefits endowed upon Indians in a landmark Quebec case in the 1930’s.
Among many other things, the federal government has therefore exercised this jurisdictional duty by providing medical benefits coverage to eligible First Nations and Inuit in Canada.
This “stewardship” is limited, however, to providing medical benefits where a province or private health insurance companies would not otherwise provide, such as prescription medication, and dental coverage. They also include coverage for medical travel and accommodations.
But that is limit of the federal governments’ role in providing this stewardship. The protocol has always been that First Nations and Inuit receive health care like other ordinary Canadians in their respective province or territory, and for that province or territory to cover the costs of providing that health care.
The Government of Nunavut, as a public government, is accountable to all of its residents and is responsible for legislating and setting policy on matters of health for all of its residents, and does not differentiate delivery of health care to its Inuit and non-aboriginal residents.
However, because 85 per cent of its residents are Inuit, a large portion of funding, I assume, is claimed through the federal program called the First Nations and Inuit Health Branch for the medical travel and accommodations portion of its health care delivery.
Apart from these jurisdictional delineations, there is another aspect of health in Canada to consider. Since the 1960’s, Canada has provided free “medicare” to all of its residents. This was a social policy program initiated by the federal government along with other social policy programs such as welfare and unemployment insurance.
Nowadays, medicare comes in the form of block transfers of funding to the 10 provinces and three territories called the Canada Health Transfer.
Although the federal government does not have the authority to legislate on matters of health in provinces or territories, it does so in this instance — this legislation is called the Canada Health Act. The purpose of this legislation is to ensure the Canada Health Transfer is used properly by the provinces and territories for the intent of the program.
According to the Health Canada website, the purpose of the Act is “to protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers.”
Given the recent discussions and debate on non-beneficiary medical transportation in Nunavut, there are things I would want clarified in this confusing myriad of jurisdictional authority and financial transfers if I were in the same situation — just in the broader legal and policy sense.
The questions I would ask of the federal government and the Government of Nunavut are these:
• Does the Government of Nunavut have Contribution Agreements with the federal government to establish boarding homes for its aboriginal patients?
• Were the construction and maintenance of boarding homes financed exclusively by the Contribution Agreements or was part of the Government of Nunavut’s budget, which contains funds from the Canada Health Transfer, used to finance the construction and maintenance of these boarding homes?
• If a resident felt that the Canada Health Act was not properly adhered to by a province or a territory, how can one report such instances and ask Health Canada to investigate how the Canada Health Transfer is used?
• How are enforcement mechanisms carried out, if it was found that there was a breach of an agreement under the Canada Health Transfer?
• How do other provinces and territories in Canada separate their exercise of jurisdictional authorities on matters of health? And can we learn from them?
• And my last question is this, can’t the Government of Nunavut use part of the Canada Health Transfer to make medical travel and accommodations easier for the small 15 per cent of its non-aboriginal residents?
Even though the Canada Health Transfer is intended for free primary health care, it just defies common sense that medical travel and accommodation for non-aboriginals in Nunavut can’t be included in this coverage, given our demographics as being one of the most northerly, inaccessbile and costly territory in Canada.
I am sure, somehow, with a lot of tweaking, medical travel and accommodations can be made to fit into the five basic tenets of the Canada Health Act: “universality; comprehensiveness; portability; accessibility; and, public administration.”