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Ontario extended medical care coverage to uninsured patients during a pandemic, but that’s ending

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Rose Celeste of Toronto says she spent years avoiding a visit to the doctor.

As an undocumented migrant worker from the Philippines, she fears something as simple as a checkup could lead to a run-in with the law and jeopardize her life in Canada.

But when the COVID-19 pandemic hit three years ago, that changed. The province directed hospitals to temporarily provide medically necessary care to patients without coverage while reimbursing them for the expense — something that led Celeste, 61, to discover and then treat her thyroid cancer.

Without the program, she estimates she’d be thousands of dollars in the red trying to pay for health care herself — or worse, dead.

“For migrant workers like me, this is very important and this is very crucial,” said Celeste, an active member of the migrant workers’ movement in Canada.

“My God, you can just imagine how happy I am.”

And she’s not alone. A report released Thursday by the advocacy group Health Network for Uninsured Clients found that the government program improved health outcomes and reduced financial hardship for Ontario residents without insurance. That’s why, among other recommendations, the network is advocating for this program to be made permanent.

Despite this, the province confirmed it’s winding it down. In an email statement to CBC Toronto on Saturday, the Ministry of Health said program funding — which was also available for limited physician services performed in community settings — would cease at the end of this month, citing similar reasons in line with its recent move to end its paid sick days program.

“With lower rates of COVID-19 and the ending of public health restrictions, the province is winding down its pandemic response measures to focus resources on delivering services Ontarians need the most,” the ministry’s email reads.

“As was the case prior to the pandemic, from April 1, those who are not eligible for the Ontario Health Insurance Plan (OHIP) and do not have any other form of health insurance coverage are encouraged to speak to the treating hospital and/or physician to develop plans for future care.”

A permanent program of health-care coverage for uninsured people living in Ontario … happens to be both the smart thing to do and the right thing to do.-Dr. Edward Xie, emergency physician

In a statement, the network called the ministry’s plans to end the program “devastating.”

“If you have to choose between feeding your family and treating an infection — those are not real choices. People will choose to feed their families, and they will suffer,” the network wrote.

“We know how this story ends. It’s not good for patients, for families and not the health-care system. This program needs to be made permanent.”

The program wins in danger of backsliding

The network surveyed 18 health-care practitioners who directly work with uninsured clients. While the report notes implementation was imperfect throughout the province due to lack of awareness, respondents said the directive had greatly improved health outcomes and reduced financial hardship, stress and delays to accessing care.

Dr. Edward Xie, an emergency physician in Toronto, was one of the professionals polled. Before the program came into place, he recalled watching patients forced to choose between paying for the health care they needed and the bills they had to pay — and sometimes leaving the hospital unnoticed because of it.

A man smiles at the camera.
Dr. Edward Xie is an emergency physician with the University Health Network and an assistant professor at the University of Toronto. He says giving uninsured patients access to hospital care and then taking it away is ‘terrible.’ (University of Toronto)

To extend health care to uninsured Ontarians and then take it away is something Xie calls “terrible.”

“For the last three years, we’ve actually had a universal health-care system in Ontario, where if you’re living or working or studying here, you can actually just walk in and get essential health care,” he said.

The report says this program helped people with study or work permits, precarious housing and mental health issues, as well as those like Celeste without an authorized immigration status. But they’re hard to track — the most recent research in 2016 estimated there were about 500,000 people living in Ontario without insurance.

The Ministry of Health did not respond to questions on how much the program cost in its entirety since its inception in March 2020.

However, an analysis by the Ontario Medical Association (OMA) looked at what some 7,000 doctors in the community billed OHIP through the program and found it came out to roughly $15 million. The analysis does not include costs associated with patients seen in hospitals.

Opposition vows to push the government to reverse course

The Progressive Conservative government notes that uninsured people can still access some publicly funded health-care services, including primary care, at one of Ontario’s 75 community health centres.

But until something can be done for the long term to help improve care for this group of people, OMA says it’s asking the ministry to extend the program.

“The OMA has expressed concern for the ministry, as this decision will be detrimental to the livelihoods of marginalized Ontarians who often face the greatest barriers in our society,” the association said in an email to CBC Toronto.

“The government will rely on the goodwill of physicians who often exercise a moral obligation to care for uninsured persons without being compensated.”

In a statement, NDP health critic France Gélinas called the move against the “small” cruel and inhumane program.

“Ford and his Conservatives are turning their backs on some of the most vulnerable people in Ontario,” she said, referring to Premier Doug Ford.

“The Ontario NDP will not stop until this decision is reversed because health care is a basic human right.”

Without this program, Xie said hospitals would be put back into a “difficult position” that could leave patients without access to care. This will make them vulnerable to worse health outcomes that may cost them and the system is more down the line, he said.

“A permanent program of health-care coverage for uninsured people living in Ontario, you know, it happens to be both the smart thing to do and the right thing to do,” Xie said.