Bill C-64

Pharmacare Act

An Act respecting pharmacare

This enactment sets out the principles that the Minister of Health is to consider when working towards the implementation of national universal pharmacare and provides the Minister with the power to make payments, in certain circumstances, in relation to the coverage of certain prescription drugs and related products. It also sets out certain powers and obligations of the Minister — including in relation to the preparation of a list to inform the development of a national formulary and in relation to the development of a national bulk purchasing strategy — and requires the Minister to publish a pan-Canadian strategy regarding the appropriate use of prescription drugs and related products. Finally, it provides for the establishment of a committee of experts to make certain recommendations.

Government Business No. 39—Proceedings on Bill C-64

[Tom Kmiec, Conservative, Calgary Shepard, AB]

Madam Speaker, I listened attentively to what the health minister was saying, so I am glad to be the first person to rise on my side to maybe provide a rebuttal and also to reset the debate, because the debate is not directly about Bill C-64; it is about a programming motion.

When I listened to the minister's speech, I also had the time to compare it to his speech that he gave at second reading. The same three anecdotes he raised today were raised then. Two of the three are completely misleading, and one was a very personal experience of his that he raised, which is his right as a member and a minister.

However, this is about a programming motion that would guillotine debate in the House. It would order a committee of the House to basically consider a bill within 10 hours, a bill that would have profound impact on the structure of Canada's health care systems, plural because they are systems. Quebec has a different system than Alberta, than British Columbia, than Saskatchewan and than other provinces in Canada.

We know from much research that has already been done by CIHI, The Conference Board of Canada, Statistics Canada, and CLHIA, which is the life insurance trade association, that 97.2% of Canadians already have access or are eligible for access to an insurance benefit plan of some sort. I know that in my home province, we have Blue Cross, which is usually the insurer of last resort that provides a lot of the services that the minister talked about.

The worst part of all is that we would be programming a committee of the House to study what essentially amounts to a pamphlet of legislation. The minister talked about finding common ground and solutions. I have also heard other members of Parliament talk about how important committee work is to them. Now we would basically be guillotining and gag ordering a specific committee of the House, the Standing Committee on Health, to do its work in 10 hours.

That is why I asked a question for the health minister on why he felt the need to exclude himself from having to come to testify before the health committee. One would think that he would put himself before the members at committee and answer all of their questions on the reasoning behind C-64 and the wisdom of it, because it is not a national pharmacare plan. That is not what it would do. It would cover two very small areas of medicine.

I will note that in the minister's second reading speech about Bill C-64, he had all of one sentence devoted to rare disease drugs and rare disease patients, typically the source of the most expensive therapies, the most expensive drugs, on an individual basis, not on a broad basis. Typically most drug plans in the provinces, whether private or public, spend the most on things like the very basic medication for infections. Medications like amoxicillin or penicillin and variations thereof are the ones that are quite expensive because people get a lot of infections, so it it just a question of volume in those situations.

There is a lot of medication out there that is expensive because it is brand new; it is coming onto the market for the first time. Recently I learned about a new oncology drug that is going to be made available in the United States, but it is cutting-edge, specialized medicine made for the individual patient. The drug comes with a few tens of thousands of dollars of cost associated with its delivery. There will be some cancer centres in Canada that will not be able to have it available for patients, but it will be available to other patients in other parts of Canada. Oncology drugs would not be covered under the plan.

There would actually be nothing covered in the plan except for those two areas of medications, which are very specific ones as well. Like I said, there would be nothing for rare disease patients. The minister talked, in his original speech at second reading, though not today, about the $1.5 billion being devoted to rare disease drugs. That announcement was made in 2019, yet only now has some of the spending gone out, not to cover drug costs but to cover things like the creation of rare disease registries to get foundations, universities and private organizations to start up a rare disease registry specific to one individual drug.

There is often a problem in how the Liberals propose things. They say something, make claims, and then it takes years before anything actually happens. As an example, in 2019 there was an announcement. In 2024, still not a single rare disease drug has been covered by the $1.5 billion. It took five years of waiting. Rare disease patients cannot wait. In fact it was the Liberal government that cancelled the original rare disease strategy in 2016. At that time, the president of the Canadian Organizations for Rare Disorders, Durhane Wong-Rieger, said that it was the kiss of death for patients with rare diseases.

She is a literal ball of energy and an amazing woman, an amazing advocate for patients with rare diseases. This was in 2016. It took the government three years just to announce funding and five years after that to roll out a single dollar. Now the government wants to convince us that it needs to expedite Bill C-64 by programming and ordering the Standing Committee on Health to consider certain things but not others.

I will go through the programming motion, since the minister did not feel the need to even explain why this was necessary. He repeated, essentially, his second reading speech on why we need to expedite this so quickly. There were three days of debate in the House before there was a vote at the Senate and in the Standing Committee on Health. I looked at the work the Standing Committee on Health had done. It did not even have the chance to consider the bill. That is how quickly the government is now programming what is going on.

The first line of this programming motion is very simple: “the committee shall have the first priority for the use of House resources for the committee meetings”. It seems quite reasonable that it would be given first right to interpretation, rooms and catering services if the committee is expected to sit for hours and hours on end. I guess a programming motion would have to have that in it.

The second part is, “the committee shall meet between 3:30 p.m. and 8:30 p.m. on the two further sitting days following the adoption of this order to gather evidence from witnesses, provided that any meeting on a Friday may start at 12:00 p.m. for a duration of not more than five hours”. Essentially, that is saying there will be two more meetings of the Standing Committee on Health and 10 hours of testimony. There are countless members in the House who will say that, during consideration of a bill, witnesses will testify, explain an idea or perhaps a missing amendment or particular line in a bill between the French and the English, which happens on a fairly regular basis. They either do not match, do not make sense or there could be more added to a bill to clarify or constrain a bill. Ten hours is simply not enough for a bill that would have such a substantive impact.

According to the health minister, the Liberals are going to celebrate a bill with such a substantive and profound impact as some great achievement. I do not believe that. I believe this is a pamphlet. This is not national pharmacare. There is no spending associated with this bill. Every one of my constituents back home knows there is no spending associated with this bill. If the Liberals keep ramming the bill through at this pace and it passes through the Senate at some point in the future, not one single drug will be paid for through this legislation because there are no dollars associated with it. There is no, what we call, ministerial warrant from the Minister of Finance connected to this bill. There will be no medication paid for through this particular bill. That is why I do not understand why this programming motion is of such necessity when the committee has not even had a chance to consider it.

I understand perhaps it would be easier to tell Conservatives, members of the Bloc and independent members that they are slowing down the committee's work, that they are not allowing the committee to proceed with witness testimony or consider the contents of the bill, but that has not even happened yet. We have not even had a chance to invite witnesses to explain to us their views on the contents of the bill.

When the minister talks about finding common ground and solutions, he accuses the Conservatives of being against it. Of course we are against it. We voted against the bill, but that doesn't mean we cannot improve an F product and make it maybe an F+ product. I know that is not a grade in universities or colleges in Canada, but we can always make something terrible a little less terrible. This is essentially, like I said, a pamphlet. For me, it was easier to vote against it because I saw nothing for patients with rare diseases. That is not a surprise to anyone in this place.

I remember the original debate on an NDP private member's bill, which I believe was Bill C-340, if memory serves. It was on national pharmacare. At least the title was on national pharmacare, not the contents. It was put forward by the member for Vancouver Kingsway. He and I debated it for most of the day. I was all about access for patients with rare diseases, and I said that was why I could not vote for that bill at the time.

It is not a big surprise to many members of the House and members of the other place that I would be against a bill that has has a title of national pharmacare, but would not do anything for patients with rare diseases. Members know of a personal anecdote I have mentioned many times in the House. I have three living kids with a rare disease called Alport syndrome. One daughter passed away very young, at 39 days old, with a different rare disease. I always joke with my friends in the rare disease community that I am due. I should probably play the lottery as I would I have a decent chance of winning because both of those conditions are rare.

In the case of my living kids, it is a rare disease of the kidneys, CKD, a chronic kidney condition. In the case of my youngest daughter who passed away, she had Patau syndrome, which is a chromosomal condition and very, very rare.

If one knows a child with Down syndrome, one should hug them. They are very special little kids. My daughter had a condition that is considered much worse than Down's. Down's is survivable. There are a lot of very sweet kids who live with Down syndrome, and their families are made incredibly happy by them because they are sweet into the teen years, into their twenties, thirties and forties. One never has to go through those teenage years, as I am going through right now with one of my kids, where suddenly, as the dad, I know nothing and they know everything, which is okay. I will go through this three times in my life.

I will move on to the next part of the programming motion, which reads, “all amendments be submitted to the clerk of the committee by 4:00 p.m. on the second sitting day following the adoption of this order”.

We are quite fortunate there was unlimited time provided, I believe, for the first two speakers on a programming motion. Perhaps members are surprised I would rise on this, but I intend to use this time to explain why I do not like the programming motion and the defects with Bill C-64, and to remind the minister about what the summary of his own legislation says that it does, because it is the complete opposite of what the minister just explained to the House. It is the complete opposite from his second reading speech as well, so members can stay tuned for that part.

On these amendments, we are fortunate because we have a constituency week coming up. I can guarantee many of us will be sitting down and working with patient advocacy groups. We will be going to our stakeholder groups and meeting with our constituents. I have a few who have emailed me on this subject. I will be finding useful amendments to this bill that would improve it in my eyes and in the eyes of my constituents. We have the time.

Had we had a sitting week coming up, had there not been unlimited time for the first speaker on the official opposition side, we could have been rushed to provide amendments by 4 p.m. after the first day. That is an incredibly low amount of time considering this first came to the House February 29 and then the last vote was on April 16 before it was sent to the committee.

Doing a programming motion like this, or a gag order to the committee, is wrong. I do not agree with programming motions. I believe I voted against nearly all of them that ever came through the House. I believe the health minister was also the House leader at one point when Motion No. 16 was being moved through the House. There was also a previous one, and I believe it was a member for Waterloo who moved Motion No. 6, which would have programmed how committees work in the Standing Orders forevermore for the Houses.

I cannot base our opposition or our support for any particular motions and programming motions on good faith coming from that side because I simply do not believe the cabinet, the front-benchers. I do not believe them. There are many good-hearted backbenchers in the Liberal benches. They are easier to work with, I find, than those on the front bench. The front bench I just do not trust. I do not trust the front-benchers to do the right thing for Canadians. In fact, Canadians do not trust them. If we look at the polls, there is about a 20-point disparity, depending on which poll we consider, between what the government is polling at and what the official opposition is polling at.

I will move on to the next point, which reads, “amendments filed by independent members shall be deemed to have been proposed during the clause-by clause consideration of the bill”. I actually do not have a problem with that. Independent members should be treated like every other member of the House, especially during considerations of bills.

Now comes the next one, which gets gets quite technical:

the committee shall meet at 3:30 p.m., on the third sitting day following the adoption of this order to consider the bill at clause-by-clause, or 12:00 p.m. if on a Friday, and if the committee has not completed the clause-by-clause consideration of the bill by 8:30 p.m., or 5:00 p.m. if on a Friday, all remaining amendments submitted to the committee shall be deemed moved, the Chair shall put the question, forthwith and successively without further debate on all remaining clauses, amendments submitted to the committee as well as each and every question necessary to dispose of the clause-by-clause consideration of the bill, and the committee shall not adjourn the meeting until it has disposed of the bill...

This means that, once the 10 hours of testimony are done, once that particular portion of the committee's work is done, every single amendment has to be voted on immediately, with no debate for amendments. In those 10 hours, if witness testimony takes five or six or seven hours, we then have a few hours left over to consider and debate amendments. We could not even persuade the other side of the wisdom of the amendment. This is so profoundly wrong. I see this programming motion all the time when it comes to omnibus budget bills.

I will remind the House that the Liberal platforms in 2015 and 2019 promised not to do omnibus budget bills, yet they have done them repeatedly, over and over again. In fact, in Liberal budget 2023, they had section changes to clauses 500 to 504 on natural health products. That has nothing to do with the budget. There are no spending items related to it, but it was a regulatory expansion to apply rules for pharmaceuticals directly onto natural health products.

It caught a lot of people by surprise, including myself, that in a budget bill, which sometimes has hundreds of pages, one would do such a thing. They basically clip what they usually do at the finance committee, and now they have dropped it and ordered the Standing Committee on Health to do it in one particular way, in their way, their preferred way, with no debate on any amendments.

Why should one allow backbenchers from any of our political parties to freely consider the judgment and the argument being made by another member of another political party, individually or on behalf of their political movement, on the wisdom of a particular amendment to a government bill? I know, it would be shocking to even have that consideration.

It would be even more shocking for some members of the government benches to know that I have voted for government amendments at committee. I know. I hear “shame” from my side of the benches, but it happens. Sometimes they have a good idea. I am willing to consider good ideas. I am willing to. I have been on several committees over my time, from foreign affairs to finance to the Standing Joint Committee for the Scrutiny of Regulations. I am on the immigration committee and the Canada-China committee now, the select committee. I will vote for reasonable amendments. I will even talk to my own side to try to convince them if there is a reasonable, logical amendment that makes sense. Sometimes there is an argument made by a member of another party that actually makes sense. This section prevents that. There will be no debate on amendments. One is just supposed to vote on them.

Of course, what will happen is that there will be a question of having a recorded division on every single one of those votes. This means the committee will continue, likely, late into an evening, because it is basically programmed. To demonstrate that this is wrong and should not be done, I am fairly sure that there will be members of the committee who will want a recorded division on every single item so that we can go back to it later with our errors and mistakes and illogical situations that arise because two sections perhaps conflict with each other. This type of amendment process, clause by clause, is incredibly important, and we now will not be allowed to be given this opportunity.

The sixth portion of this guillotine gag order on the Standing Committee on Health says:

a member of the committee may report the bill to the House by depositing it with the Clerk of the House, who shall notify the House leaders of the recognized parties and independent members, and if the House stands adjourned, the report shall be deemed to have been duly presented to the House during the previous sitting for the purpose of Standing Order 76.1(1)

This is a fairly reasonable amendment that is often provided by members in other committees to make sure that, when reporting on a bill, the House leaders are informed, typically to go on the Notice Paper. I do not have a direct issue with this particular portion, apart from the fact that this is a programming motion, a gag order, that is going to guillotine a committee of the House without that committee even having had the chance to consider a bill.

The next section is section (b). It says:

not more than five hours shall be allotted to the consideration of the bill at report stage, and at the expiry of the time provided for the consideration of the said stage of the bill, or when no member rises to speak, whichever is earlier, any proceedings before the House shall be interrupted, and in turn every question necessary for the disposal of the said stage of the bill shall be put forthwith and successively, without further debate or amendment, and, if a recorded division is requested, the vote shall not be deferred...

It continues. There is another one, but I am going to stop right here. This essentially means that, when amendments come back from committee, they are sometimes ruled out of order. They cannot be considered at committee but they can be considered by the House because the House has control of its committees, and the House can decide whether certain amendments can be voted on. Those are typically then submitted to the Speaker.

This essentially says that this process will also be guillotined after five hours. I know they love gag orders. I know they love to guillotine debate. My hope is, too, that during this debate on the programming motion, they do not gag order the gag order. I would hate to see that. It would be like a double gagging of the orders of the House and really limiting debate.

They have done it before. They have done it on Bill C-7 and Bill C-14, the two medical assistance in dying bills. At different stages of those bill, they both programmed and then shut down debate on them. I have seen, plenty of times, allocation motions being moved by cabinet to force bills through the process on matters of conscience.

It is not as if they are technical bills where perhaps there is timeline the Liberals need to reach and where, for the proper administration of government, they can perhaps make an argument they can stand on, but for matters of conscience, to guillotine debate is wrong. In this particular case, I would say that this is not a matter of conscience. I think this is about administration of government services and what the contents of the bill are actually about versus what they are not about. When the Liberals impose a guillotine with time allocation and force the closure of debate, the major disadvantage to Canadians is that they cannot prepare themselves. They cannot organize themselves when they are opposed to particular ideas and when they want to ask questions like, “Why is my rare disease, my health condition or MS not covered in this bill? Why is diabetes covered?”

I know a lot of diabetics, and I am not picking on them directly. I am just asking a simple question. The most common rare disease is multiple sclerosis, or MS. A lot of people in my family have it, as well as friends, colleagues and co-workers. There are spouses of members on this side who have it. Therefore, why is that particular condition, and its medication, which is expensive medication, not in this particular piece of legislation?

It is a choice the government made, so why can we not debate that choice the government has made for those two particular conditions and the medications associated with them? If they are being covered, why not others? There are so many other types of medications, such as the most common ones: penicillin, amoxicillin and all the variations of the “-cillins”, because there are so many of them. Why are they not covered in this particular piece of legislation?

On this programming motion, should we put forward such an amendment to be considered at committee? If it is deemed non-votable at committee, why can it not be considered at report stage?

I guess I will only get through the programming motions, and I will have to come back later to finish talking about Bill C-64 and some of the things the minister said, as well as my concerns with the PMPRB, CADTH, pCPA and the entire architecture of drug approval in Canada.

The motion reads, “not more than one sitting day shall be allotted to the consideration of the bill at the third reading stage, and 15 minutes before the expiry of the time provided for Government Orders”, and it goes on like that, which basically means that there will be one day for final speeches, and then it will be done and sent to the other place. It is wrong to ram through a bill in this method, with bad faith being shown by the health minister, claiming that we were opposing it and not willing to consider things, when he has never bothered to listen.

[Mark Holland, Liberal, Ajax, ON]

Madam Speaker, through you to the Conservatives, they are against this bill and against providing contraceptive and diabetes medications. That is fair. They can be against it, but the House has an elected will. What we saw on the very first day that we attempted to put this bill before the House was obstruction and what we have seen with other bills is obstruction, not obstruction to continue a conversation, but obstruction because they do not want it.

I do not know how long we could have a debate about whether or not we should do it. What is the value of that debate to public discourse? We could talk about it until the cows come home, but Conservatives are against it. There is going to be an opportunity obviously at committee, at third reading and at report stage to have a lot more debate on the bill, Bill C-64, and to hear their single position, which is in opposition.

[Tom Kmiec, Conservative, Calgary Shepard, AB]

Madam Speaker, I listened attentively to the health minister's speech. He talked about, at one point, finding common ground and finding solutions. He recited every single anecdote in this speech that he did in his second reading speech on the bill.

This bill, Bill C-64, only got three days of debate in the House, and it was then sent to committee. Now, we have a programming motion, so it is a guillotine or gag order attempting to be imposed on the House of Commons to order a committee of the House to dispense with the bill after something like 10 hours of consideration at committee. If we are talking about finding common ground and finding solutions, then we should allow the House and its committees to do their work instead of ramming things through.

I wonder if the minister could explain why, in the programming motion, he is not obliged to testify before the committee.

[Mark Holland, Liberal, Minister of Health]

moved:

That, notwithstanding any standing order, special order, or usual practice of the House, Bill C-64, An Act respecting pharmacare, shall be disposed of as follows:

(a) during the consideration of the bill by the Standing Committee on Health,

(i) the committee shall have the first priority for the use of House resources for the committee meetings,

(ii) the committee shall meet between 3:30 p.m. and 8:30 p.m. on the two further sitting days following the adoption of this order to gather evidence from witnesses, provided that any meeting on a Friday may start at 12:00 p.m. for a duration of not more than five hours,

(iii) all amendments be submitted to the clerk of the committee by 4:00 p.m. on the second sitting day following the adoption of this order,

(iv) amendments filed by independent members shall be deemed to have been proposed during the clause-by-clause consideration of the bill,

(v) the committee shall meet at 3:30 p.m., on the third sitting day following the adoption of this order to consider the bill at clause-by-clause, or 12:00 p.m. if on a Friday, and if the committee has not completed the clause-by-clause consideration of the bill by 8:30 p.m., or 5:00 p.m. if on a Friday, all remaining amendments submitted to the committee shall be deemed moved, the Chair shall put the question, forthwith and successively without further debate on all remaining clauses, amendments submitted to the committee as well as each and every question necessary to dispose of the clause-by-clause consideration of the bill, and the committee shall not adjourn the meeting until it has disposed of the bill,

(vi) a member of the committee may report the bill to the House by depositing it with the Clerk of the House, who shall notify the House leaders of the recognized parties and independent members, and if the House stands adjourned, the report shall be deemed to have been duly presented to the House during the previous sitting for the purpose of Standing Order 76.1(1);

(b) not more than five hours shall be allotted to the consideration of the bill at report stage, and at the expiry of the time provided for the consideration of the said stage of the bill, or when no member rises to speak, whichever is earlier, any proceedings before the House shall be interrupted, and in turn every question necessary for the disposal of the said stage of the bill shall be put forthwith and successively, without further debate or amendment, and, if a recorded division is requested, the vote shall not be deferred; and

(c) not more than one sitting day shall be allotted to the consideration of the bill at the third reading stage, and 15 minutes before the expiry of the time provided for Government Orders that day, or when no member rises to speak, whichever is earlier, any proceedings before the House shall be interrupted, and in turn every question necessary for the disposal of the said stage of the bill shall be put forthwith and successively, without further debate or amendment, and, if a recorded division is requested, the vote shall not be deferred. (Government Business No. 39)

Madam Speaker, it is my pleasure to rise to talk about Bill C-64, which is an opportunity for us to move forward with pharmacare in this country. In the first order, the bill represents the best of what Canadians should expect from the House, which is different parties working together to find common ground and solutions.

I will start by thanking the member for Vancouver Kingsway for his work in what were often challenging conversations and negotiations, but which led to an exceptionally important bill that is going to do incredible good across the country. As well, I want to thank the member for New Westminster—Burnaby, the House leader for the New Democratic Party, for his work as House leader and now as health critic. In all orders, when we are facing something as challenging as the protection of our public health system and making sure Canadians get the care they require, working in a non-partisan way to drive results is exceptionally important.

I will speak to what is at stake, say a bit about what we have been doing in health and then talk specifically to the legislation that is in front of us today.

It was a stark day for me yesterday because I had two very different kinds of conversations. One conversation was with somebody who was saying, in a roundabout way, that maybe it would not be so bad if our public health care system became private. It is important to focus on what that would mean for this country and why it is something that we should all be adamantly opposed to.

If we allow our system to become a private health care system, there would be a migration of dollars toward a private system and expertise, in which the private sector would take that which was easy and lucrative and leave that which was difficult or involved folks who did not have the means to be able to pay for those services. This would leave less money in a public system that would be dealing with the most expensive problems and the most intractable issues. Over time, we would then see more and more migration of that which was easier into the private system, which would mean that people who do not have the means could not afford the same kind of care.

In a very practical sense, that ends up in the following type of situation: I had an opportunity to be in the United States with my partner for a weekend, and we witnessed a man collapse. It was clearly a person with not a lot of means. He fell unconscious to the ground. We went to his side and called 911. When he became conscious, his first thought was not about his health or worrying about what had just happened to his physical body; his concern was how he was going to be able to afford what just happened to him. I thought about the phone call I made to 911 and whether this was what this man even wanted, because now he has to think of exorbitant health costs to get the care he needs.

Even those who do not fundamentally care about whether their fellow citizens, regardless of their financial circumstances, get the same level of care as everybody else in the country, even if we cannot compel people's morality to care about the circumstance of whether somebody in their own community gets the same level of medical care that they do, the reality is that when somebody does not go to a hospital to get checked for something that is minor, because they do not have money, then it becomes something major. We are then left with the existential question, when that person becomes so sick that they are on death's door, of whether we just let them die or whether we pay the exorbitant costs that we have allowed to accumulate through not having a system that took care of those problems in the first place.

For the prognosticators of doom about our health system, for those who push the idea that we should just allow it to deteriorate and not make the investments or say that it is too difficult, they have to be honest about the future they are painting for Canadians in this country and the type of health care system that they would be left with. It is one where only the affluent have the opportunity to get the care they need. We can imagine a world where nurses cannot afford the care and services they require, but the affluent they are serving do. I do not think that is a society we want to be in.

That is why the investments we are making in health care are so critically important. The federal government has come to the table with nearly $200 billion to invest in partnership with provincial and territorial governments over the next 10 years. In the same spirit as the legislation, the question was not asked about one's partisanship or one's jurisdiction, because I do not think Canadians are interested. They want to see answers and forward progress.

I really want to commend the health ministers across the country because, over the last 10 months, as I had an opportunity to work with them to negotiate the agreements we signed, it was a spirit of co-operation and putting the health of Canadians first. It does not matter whether it was Adriana LaGrange in Alberta, Tom Osborne in Newfoundland and Labrador, a Conservative and a Liberal, or Adrian Dix, a New Democratic health minister in B.C.; they understand we have an important job to do and that we need to focus on what unites us and how we make things better.

The results were incredibly detailed health agreements that not only put money into the system but also showed exactly how that federal money is going to be spent. Thus, Canadians can view where those dollars are going to go to improve their health system and issues such as the health workforce, where we make sure that we have the doctors and nurses Canadians need and that everybody has a relationship with a doctor in this country. In addition, this enables us to put common indicators across the country so people can see the progress their province is making.

We know what is measured is achieved, and for the first time in our health system, these agreements put common indicators across the country so we can see the progress occurring in our health system and see what those investments are doing on key indicators identified by CIHI, which is an independent agency dealing with health data.

However, in dealing with the urgency of the now, let us recognize that our health system has been enormously strained. Throughout one of the darkest periods in public health that, certainly, we have known in our lifetime, health care workers were asked to do Herculean amounts of work. They were asked to rise to an occasion and do more than I think any reasonable person could be expected to do, but they met that hour and did it. As in health systems all over the world, instead of being met with a break, they were met with even more work, with burnout, with all kinds of mental fatigue and mental health issues as a result of the pandemic, with a backlog of procedures and with a health system that was even more overwhelmed.

What was remarkable about that period of time, going back to the spirit of co-operation, is that we made extraordinary progress. This was when the health system was fully aligned in the darkest moments of the pandemic, everybody was given more agency to practise at top of scope, jurisdiction was of distant consideration and people's immediate urgent health needs were first. We are dealing with that, with these workforce agreements and the work we are doing bilaterally with provinces and territories, but it is not enough to deal with the crisis of now. We have already made such huge progress. On where we were a year ago versus where we are now, that progress is evident through our whole system, but we recognize we also have to be upstream.

That brings me to another conversation that I had yesterday. I had the opportunity to be with the member for Ottawa—Vanier at a denture clinic in Vanier. Here is another example of parliamentary co-operation, where two parties came together and recognized an essential need in this country, which is that some nine million Canadians do not have access to oral health care.

We have now seen more than 30,000 seniors, just in the first few days of this dental program, receive care for the first time. I have been able to see what that means, in many instances by going into clinics. I will talk about what I saw in that denture clinic in Vanier. A denturist was talking about a senior who had not had their dentures replaced in 40 years; they did not have the money. This senior had no teeth and used a black apparatus to crush food in their mouth. One can imagine the dignity and the spiritual change in that person when they came in and realized that, after 40 years, they were finally going to get teeth in their mouth. The denturist being able to describe that moment, the pride they had in being able to deliver that service and give that senior that dignity, was absolutely extraordinary.

I had an opportunity in my own riding, just a few days before that, in Ajax, to meet with a senior. I never had a chance to meet him before. His name is Wayne. He sometimes goes by “Moose”. He was talking about himself and his wife. He had a need for partial dentures, and he had other oral health problems, as did his wife, which they had been putting off. In terms of what it meant to him to feel seen and to be able to get those issues taken care of, the truth is that we know it is not just a matter of dignity. It is not just a question of what kind of country we want to live in. What about the cost?

I think of Wayne and his inability to pay for the medical care that he needed for oral health care. Left untreated, Wayne could very well end up in a hospital room with an unnecessary surgical procedure, placing his life at risk. Imagine the staggering cost of that.

Dental care is not about some kind of boutique political intervention. It is fundamentally about making sure that people get the preventative care they need. It is part of the overall action that we are taking as a government, not only dealing with the crisis of the now, but also casting our eyes into the future and asking how we can work together.

Clearly the Bloc Québécois members have concerns about the jurisdiction issue, which I completely understand. It is a concern for me too. However, in my opinion, this is not a question of jurisdiction. It is actually a question of co-operation. There was one question that dominated my conversations with Quebec's health minister, Christian Dubé: How can the Government of Canada and the Province of Quebec work together to improve our health care system?

There are plenty of opportunities for us to work together in a spirit of co-operation to improve our health care system. It is easy to pick quarrels, point out differences and raise the issue of jurisdiction. However, I believe that for Quebeckers, what really matters is their health and government action.

Dental care is a great example of that. In Quebec, the Minister of Heritage has done extraordinary work in her riding. Almost all the providers in her riding have signed up, meeting a lot of that misinformation that was coming from the Conservatives with true facts. The experiences of those providers have been extraordinary. That is an example of us working together.

I said to Minister Dubé in Quebec that if they want to administer the program, it is no problem. Our care is about the patients, not about the jurisdiction. Our only requirements, if a one wants to take it over, is that one has to have at least the same level of care, number one, and number two, we are not going to give more to administer the program than it costs us to administer it. If it costs one more, that is something one has to bear on one's shoulders or look internally at how one is operating one's system.

That is an example of making sure that we get the care now and that we fix the question of jurisdiction later. For somebody who has a dental emergency, for a senior who does not have teeth in their mouth, they do not care about jurisdiction. They care about care and about getting it done. That is what we are focused on.

Before I come to pharmacare, one of the other things we are doing is about school food. When I was at Heart and Stroke, I had the opportunity to lead the Ontario mission and to be the national director of children and youth. One thing that was shocking to me was that when a child has one healthy meal, it can totally change their health outcomes. It does it for a couple of reasons. First, just the act of eating fruits and vegetables and healthy food has a transformative effect on health and prevents chronic disease and illness. Second, how does one learn if one is hungry? Third, one actually gets to develop a taste for healthy food that lasts one's entire life. Therefore, this is an extraordinary investment that is going to make a massive difference.

We are also taking action on marketing to kids with front-of-pack labelling and taking action with the $500-million fund to develop capacity for mental health services on the ground in communities across the country. I could go on and on, but I only have a short period of time to talk about the thing that we are here to talk about. I see the member for Vancouver Kingsway, and I want to thank him for this.

When we talk about contraceptives, it is incredibly frustrating to me that, over the last number of days, we have seen a march and a protest here to try to take away women's rights and take away their right to choose. We have seen over 80 Conservative members, I believe is the number, who have been endorsed because of their belief that they should take away a woman's right to choose, and that is fine. I am pro-choice, and there are members who are not.

However, what I do not understand is if someone is against a woman's right to make a choice about her own body, how can they also be against giving her contraception? What choice is she left with? Let us look at that very specifically. If a woman today is in need of contraception and does not have the money for it, what are they supposed to do? Maybe they can find the money for oral contraception, but it has a failure rate of 9%. An IUD has a failure rate of 0.2%, but it costs $500 up front. For the women who do not have the money to pay for it up front, they are left with a less effective tool to be able to have control over their sexual and reproductive health.

How, in the one order, can we say to a woman that they are not allowed to choose or make a choice for their body, but in the other order, say that we are not going to help them get contraception to be able to make a choice about their body that way either? In other words, they get no choice. What conversation is being had about sexual health? If someone is against giving contraception to women and against them having a choice over their body, then they would at least talk about sexual health.

For women, it is extremely important to know that their body is something that they should always have autonomy over. Sex is something that should feel empowering and should make them feel like themselves. It is something they should never be coerced or pressured into. It is something that they should never feel ashamed of. It is something that should feel pleasurable.

Pharmacare Act

[The Speaker, Liberal, Greg Fergus]

It being 3:17 p.m., the House will now proceed to the taking of the deferred recorded division on the amendment of the hon. member for Cumberland—Colchester to the motion for second reading of Bill C‑64.

Call in the members.

The House resumed from May 6 consideration of the motion that Bill C-64, An Act respecting pharmacare, be read the second time and referred to a committee, and of the amendment.

Second reading

[Arnold Viersen, Conservative, Peace River—Westlock, AB]

Madam Speaker, debate on second reading of Bill C-64 took place tonight without quorum, which means that Bill C-64 will have been considered without the constitutional requirement of quorum. In the event that Bill C-64 receives royal assent, I trust that the fact—

[Ziad Aboultaif, Conservative, Edmonton Manning, AB]

Madam Speaker, Bill C-64 is a classic example of the legislation the Liberal government has brought before this Parliament. Once again, it has over-promised and under-delivered.

When the leader of the NDP sold his party's soul and coincidentally guaranteed that he would receive a pension for his efforts, many people thought he got too little for it. New Democrats did not even get 30 pieces of silver, as they betrayed their ideal and the Canadian people.

What has this betrayal cost Canadians? Inflation continues at record levels, fuelled by the carbon tax. Housing costs have doubled. Health care has vanished. Food bank use is at record levels. The immigration system is broken. Our military suffers from neglect, and foreign governments try to influence our elections. The Liberal response is to shrug. Canada has become a joke on the world stage.

What does the NDP receive for this blind support of the Prime Minister and his disastrous policies? It receives a promise to look at what it would take to establish a national pharmacare program. It is not even that, really.

Canadians thought a pharmacare plan would cover their drug costs. For the majority of the country, this was not a pressing issue. According to The Conference Board of Canada, 97% of Canadians are already eligible for some form of drug coverage, although the final report of the advisory council on the implementation of national pharmacare indicated that 20% of Canadians receive what could be termed inadequate coverage. In December of last year, a Leger poll indicated that only 18% of Canadians thought the establishment of a national pharmacare program was a health care priority.

It may come as a surprise to the Liberals and the NDP, but Canadians are worried about rising prices on everything, due in large part to the carbon tax. When people are worried about being able to feed their family, pay the rent or mortgage and put gas in their car so they can get to work, they do not spend much time thinking about a drug plan that does not cover the medications they need.

Canadians were hoping the Liberals could get it right. That turns out to have been a false hope. On this issue, as on many others, the Liberals are proving once again to have no idea what they are doing. The Liberal idea of pharmacare is restricted to just two types of medication. If one suffers from heart disease, one is out of luck. Heart disease is the second-leading cause of death in Canada, but medication for it would not be covered.

The Liberals' approach to pharmacare reminds me of their approach to Canadian liquid natural gas, or LNG. When the chancellor of Germany came to Canada looking to buy Canadian LNG, the Prime Minister told him there was no business case for such exports. That was a huge surprise to those companies looking to expand their markets.

Not only is there a business case for Canadian LNG, but there is a moral one as well. In the aftermath of the Russian invasion of Ukraine, countries are looking to replace Russian LNG and have turned to Canada, only to be told by the Canadian government that it does not want to sell Canadian LNG. The Prime Minister needs to learn that when there is a customer willing to buy the product, there is indeed a business case to support it. If Germany and Japan and Greece want to buy Canadian LNG, why would we not want to sell it to them?

A previous prime minister asked farmers, “Why should I sell your wheat?” This tells buyers there is not a business case to sell them the product they are asking for, while at the same time offering Canadians a pharmacare program they did not ask for, a plan so flawed it is unlikely to work.

This is the government that promised a firearms buyback program four years ago. So far, it has not managed to launch it, yet it wants Canadians to believe it has the skills necessary to design and implement a pharmacare program. Put simply, what is being offered is not pharmacare.

It is just another Liberal election gimmick, a promise they will campaign on in 2025, hoping that voters will not look at how many promises they have already broken. Anyone who has looked at the current state of drug coverage in Canada is concerned by this attempt to create additional bureaucracy. We already have some public drug plans; they do not seem to be as good as the private ones. Private drug insurance plans cover many more different medications than public plans do. The difference varies by province, but, on average, private coverage is 51% more extensive than its public counterpart is. In Quebec, the figure is 59.6%. Then there are the delays. Once a drug is approved by Health Canada, it takes an average of 226 days for a private insurer to approve the coverage. By contrast, it takes 732 days for approval by Health Canada, or a little over three times as long, for a public plan to add a drug to its list of covered treatments. These figures do not paint a rosy picture of the ability of public insurance to meet the Canadians' needs.

The marriage contract between the Liberals and the NDP required that the bill come before us last year. It did not. It took the Liberals two years to come up with the legislation, a bill that seems to have been put together without much thought, just to meet a deadline. Given how weak the bill is, I can only imagine what the first draft looked like. Maybe it was just one line, such as “We promise to look at establishing a pharmacare program in the hopes people will vote for us before we have to deliver.” Wait, is that not what Bill C-64 is?

After almost nine years of misgovernment, incompetence and mismanagement from the Liberal-NDP coalition, Canadians have lost all faith in the government's ability to discharge its responsibilities. What is the cost of this national pharmacare program? With two years to look into it, the Liberals either did not think to ask or are afraid to tell Canadians just how much more they want to raise taxes to pay for a plan that would benefit almost no one.

The bill is a public relations exercise by an utterly desperate government that is disliked by more and more Canadians every day. The inability of the Liberals to deliver on their promises is well known. Already, two provinces have opted out of this program. There is no indication that other provinces are interested. One would have thought that, in attempting to create a national program in an area of provincial jurisdiction, the Liberals would have consulted with the provinces. One might have expected that they would have hearings and consultations with stakeholders to see what exists now, what needs to be improved and the best way to do that. As far as I can tell, all they did was ask the NDP the minimum they could promise to keep the NDP's support.

Can the Minister of Health tell us what impact the bill will have on the 27 million Canadians who rely on privately administered workplace plans? If he is an honest man, he cannot, because he does not know. There was no consultation with the insurance industries when the bill was being drafted. Maybe he felt there was no need to check the facts. A promise had been made by the NDP, and the Liberals had to deliver. The needs and wishes for the Canadian people were not worthy of consideration. What is not worthy of consideration is this sad attempt at legislation; Canadians deserve much better than that.

[Brad Vis, Conservative, Mission—Matsqui—Fraser Canyon, BC]

Mr. Speaker, before I begin, I would just like to give a shout-out to the Abbotsford Rugby Football Club, which won the provincial championships over the weekend. The division 1 side has faced a lot of adversity. Our fields were flooded during the big flood in Abbotsford a few years ago. This team has really built back. Big congratulations go to Coach Chambers and all members of the squad on the game-winning kick by Mr. Rowell. Congratulations to all the boys for their accomplishments.

Now, I turn to Bill C-64, an act respecting pharmacare. As my colleague, the hon. member for Cumberland—Colchester, said in the House in April, the half-baked pharmacare plan being debated is truly about preserving the costly NDP-Liberal coalition.

In order to ensure that the coalition survives the next fixed election date, so many members can lock in their pensions, the NDP has agreed to a pharmacare plan that covers only two categories of drugs, while costing a billion and a half dollars and adding even more bureaucracy and gatekeepers to the already extremely bloated federal government.

There are 97.2% of Canadians who already qualify for some form of prescription drug coverage. It is important that we work to ensure that the 1.1 million Canadians without coverage can access pharmacare, but the proposed system would leave them woefully under-insured and no better off. In the context of British Columbia, we already have coverage for contraceptives through our provincial government.

What we have in front of us today is not a universal pharmacare system, as the NDP-Liberal government has been campaigning. It is a diabetes medication and contraceptive coverage system.

The member for Ottawa Centre just said in his speech that in 2028, diabetes alone will cost the medical system in Canada over $40 billion. Even the money put forward in this bill is only a drop in the bucket, and I wish the members of the NDP-Liberal government would come clean about misleading Canadians about what they are doing, because all of us have had constituents come to our offices and ask when the universal drug coverage will kick in. I am sorry to say that it will not; this is a PR exercise by this government, and it is shameful.

Canadians know how much a promise from the Prime Minister means, and it is not very much. This is the same Prime Minister who promised to balance the budget, or rather, that it would balance itself. This is the same Prime Minister who promised a $4.5-billion Canada mental health transfer that is yet to be delivered. This is the Prime Minister who promised British Columbians a universal day care system at $10 a day. Good luck trying to find that in our lifetime.

This is the same Prime Minister who promised that interest rates would stay low for a very long time, right before spending more money than any government in Canadian history and driving interest rates higher than they have been in decades. This is the same Prime Minister who has led to all of our GST payments, on every purchase we make in Canada, solely servicing the federal debt. Let that sink in. Every time we buy something, the taxes that we pay are only paying for the mistakes of the member for Papineau.

The only goal of this bill, as we all know, is to appease the NDP and avoid an election the government knows it would lose.

Speaking of the New Democrats, they really ought to be ashamed of themselves for even agreeing to this plan. For decades, they have campaigned on a single-payer pharmacare system, and now that they finally have a sliver of power in this Parliament, they fold and accept a half-baked plan that would cost taxpayers billions while failing to provide coverage for the vast majority of medications Canadians rely on, which the NDP promised to deliver. Shame on them.

The leader of the NDP loves to say that he will win the next election and often starts phrases with “when I am Prime Minister”. If he truly believed what he was saying, why does he continue to prop up that failed government, and why did he agree to this plan, which fails to cover the vast majority of drugs and treatments? If they are going to do it, they should go all in and take a risk. They are not willing to take a risk, because it is just about covering their own butts and getting their pensions.

The bill could have negative—

[Yasir Naqvi, Liberal, Ottawa Centre, ON]

Mr. Speaker, I want to first thank the member for Nunavut, along with the member for Bruce—Grey—Owen Sound, for joining me on Sunday in support of Christie Lake Camp, which is a worthy organization in Ottawa, in my community, raising $20,000 to support kids from priority neighbourhoods. I must say the member for Nunavut is an excellent basketball player, so it was a great afternoon.

I agree with the member that we need to catch up with many countries that allow for free contraception. It is about the autonomy of women. It is making sure that women are able to make decisions about their own lives. By passing Bill C-64, we will take the very important step of making sure that Canada really values women and gives them the autonomy they deserve as equal citizens.

[Yasir Naqvi, Liberal, Parliamentary Secretary to the Minister of Health]

Mr. Speaker, I am thankful for the opportunity to speak about Bill C-64 and about how this represents a historic milestone in the evolution of the Canadian health care system.

This bill and other investments made by our government will help millions of Canadians who are struggling to pay for their medication.

I was very thrilled when the Minister of Health, and many other incredible Canadians who have been advocating for a pharmacare program in Canada, joined in my community of Ottawa Centre, at the Centretown Community Health Centre, where, toward the end of February, we made the announcement on Bill C-64, on covering diabetes and contraception medication. One could see the excitement among people when that announcement was made in my community.

In fact, I have been working on this issue for over a decade now, during my time as a member of provincial Parliament in Ontario. I was part of a Liberal government that brought something that we called OHIP+. That “plus” covered medications for young people, and then, we were moving on to cover medications for seniors. It was really unfortunate that the Conservative government under Doug Ford cancelled that incredible program because it allowed for care for so many Ontarians.

However, I am thrilled that we are taking this important step here at the federal level.

In 2021, Statistics Canada found that one in five adults in Canada did not have the insurance they needed to cover their medication costs. This means that over 20% of adults in Canada face out-of-pocket drug costs that create a financial burden. This can lead to people sacrificing their basic needs, such as buying groceries or heating one's home, in order to afford their medications. It can also lead people to ration their medications, causing them worse health outcomes. This is not acceptable and I do not think that this is the kind of country any of us want to have.

Choices like whether to fill a prescription have serious consequences. Whether skipping meals or skipping doses, the decision to go without can create a cascade of negative impacts on a person's health and can increase the burden on our health and our social safety nets.

We can and we must do better. That is why we introduced Bill C‑64 and proposed this first step toward universal pharmacare.

Our commitment to address the accessibility and affordability of medication can be seen with the various initiatives we have implemented with respect to national pharmacare. In addition to the introduction of the pharmacare act, which includes a commitment to work with provinces and territories to ensure universal access to contraception and diabetes medications, we also established a partnership with P.E.I. to improve the affordability of prescription medications, implemented the first-ever national strategy for drugs for rare diseases and established a Canadian drug agency.

Let me start with the pharmacare act, which outlines a way forward toward national universal pharmacare in Canada. Bill C-64 recognizes the critical importance of working with the provinces and territories, which are responsible for the administration of health care. It also outlines our intent to work with these partners to provide universal, single-payer coverage for a number of contraception and diabetes medications.

This bill is an important step toward improving health equity, affordability and outcomes, and could help reduce health care system costs over the long term.

Coverage for contraceptives would mean that nine million Canadians of reproductive age would have better access to contraception, reducing the risk of unintended pregnancies and improving their ability to plan for the future. We are a government that has always and will always recognize that autonomy over one's body and the ability to control one's own sexual health is a matter of fundamental justice.

Contraception is a key component of individual autonomy. It is an essential component of reproductive health and contributes to advancing gender equality.

Cost has consistently been identified as the single most important barrier to accessing contraception and the cost is unevenly borne by women, people with low incomes and young people, all of whom are more likely to work in part-time or contract positions and often lack access to private coverage. Studies have demonstrated that publicly funded, no-cost universal access to contraception can lead to public cost savings. The University of British Columbia estimates that no-cost contraception has the potential to save the B.C. health care system approximately $27 million per year. Having safe, reliable birth control represents freedom and safety. However, these costs continue to be a barrier. With Bill C-64, we are taking action to remove the barrier.

The same cost reduction principle applies to diabetes medication. Diabetes is a complex disease that can be treated and managed with safe, effective medication.

However, one in four Canadians with diabetes have reported not following their treatment plan due to cost. Improving access to diabetes medications will help improve the health of 3.7 million Canadians living with diabetes and reduce the risk of serious, life-changing health complications, such as blindness or amputations.

Beyond helping people with managing their diabetes and living healthier lives, if left untreated or poorly managed, diabetes can lead to high and unnecessary costs to the health care system due to diabetes and its complications, including heart attack, stroke and kidney failure. The full cost of diabetes to the health care system could exceed almost $40 billion by 2028.

Independent of the legislation, we have announced that we will work with provinces and territories on a diabetes devices fund. This fund would ensure that people with diabetes have access to the medical devices and supplies they need, such as syringes, test strips, glucose monitoring devices and insulin pumps. This, combined with the framework outlined in Bill C-64 for universal single-payer coverage for first-line diabetes medications, will help ensure that no person with diabetes in Canada is forced to ration their medication or compromise their treatment.

I previously mentioned our excellent work with P.E.I. and how this $35-million investment is focused on improving affordable access to prescription drugs while at the same time informing the advancement of a national universal pharmacare. The work accomplished by Prince Edward Island has been outstanding. Since last year, P.E.I. has expanded access to over 100 medications to treat a variety of conditions, including heart disease, pulmonary arterial hypertension, multiple sclerosis and cancer, and is saving millions of dollars in out-of-pocket costs for P.E.I. residents.

On a national level, we launched the first-ever national strategy for drugs for rare diseases in March 2023, with an investment of up to $1.5 billion over three years.

As part of the overall investment of $1.5 billion, we are making up to $1.4 billion available to the provinces and territories over three years through bilateral agreements.

This funding will help to improve access to new and emerging drugs for Canadians with rare diseases as well as support enhanced access to existing drugs, early diagnosis and screening for rare diseases. This will help ensure patients with rare diseases have access to treatment as early as possible for a better quality of life.

I want to quickly mention that, in December of last year, we announced the creation of the Canadian drug agency, which will provide the dedicated leadership and coordination needed to help make Canada's drug system more sustainable and better prepared for the future.

This is an incredible opportunity for Canadians coast to coast to coast, working alongside provinces and territories, to allow for pharmacare, especially when it comes to contraception and diabetes. This is the beginning of building a more robust health care system that will work for all Canadians. I am excited to support this bill, and I encourage all my colleagues to do the same.

[Brenda Shanahan, Liberal, Châteauguay—Lacolle, QC]

Mr. Speaker, I have greatly appreciated the comments of my colleague from the NDP. It has been a very spirited debate here. We are talking about the provinces, the jurisdictions, and also about equality of care across the country. I think that is where the federal government comes in. That is where legislation like Bill C-64 comes in to ensure that there is equality of access to pharmacare, specifically in the areas of contraceptive care and diabetes.

I would like to hear my colleague's comments on that issue.

[Adam van Koeverden, Liberal, Parliamentary Secretary to the Minister of Environment and Climate Change and to the Minister of Sport and Physical Activity]

Mr. Speaker, reproductive and sexual rights are human rights. Our government recognizes that, and we stand by it as a matter of principle. Members of the Conservative Party caucus can stand in the House and say they are not interested in pursuing anti-abortion legislation that would infringe upon women's reproductive rights; however, sadly, that conviction is far from a universally held one in the caucus. In fact, the entire caucus has been designated as anti-choice by the Abortion Rights Coalition of Canada.

I am proud to say that, on this side, we are walking the walk. We are leading by example and putting forward Bill C-64, an act representing pharmacare, which would provide universal access to prescribed contraceptives to Canadians. In collaboration with provinces and territories, we will support universal coverage of contraceptive medications and devices so that nine million Canadians of reproductive age will have access to the contraception that they need and deserve. This will ensure that Canadian women can choose whether they are going to have children. It will give them greater control over their bodies and their futures.

Currently, Canada is one of the only countries in the world where access to health care is universal but access to contraceptives is not. Women therefore have a more limited range of options, and are more likely to experience unwanted pregnancies, which can impact their lives.

Access to safe, reliable birth control is essential. It gives women the freedom to plan their families and pursue their long-term goals and dreams. Unintended pregnancies, on the other hand, can cause a great number of negative health and economic impacts on families. At present, coverage for contraceptives varies across the country. Most Canadians rely on private drug insurance through their employer for their medication needs, and some populations are disproportionately affected by the lack of coverage.

Women, people with low incomes and young people, all of whom are more likely to work in part-time or contract positions, often lack access to private coverage, and only a fraction of Canadians are eligible for prescription birth control at low or no cost through a public drug plan. When a person pays out-of-pocket for their contraceptive needs, regardless of whether they have coverage, cost has been identified as the single most important barrier to accessing contraceptive medications or devices that they require.

One study showed that women from low-income households are more likely to use less effective contraceptives, or no contraceptives at all. Cost is a significant obstacle to gaining access to more effective forms of contraception.

For example, oral contraceptives cost approximately $25 per unit, or $300 per year. In comparison, intrauterine devices, or IUDs, are often more effective and last up to five years, but they have an upfront cost of approximately $500 per unit. IUDs are a much more effective method of contraception, since they have a low failure rate of 0.2%, compared with that of oral contraceptive pills, which is 9%. Furthermore, they do not require daily doses to remain effective, which is a long-standing challenge with the pill.

At this time, I would also point out that women can have the choice, but sometimes, it is not so much a matter of choice; it is a matter of how a woman's body reacts to these various interventions. It really should be a matter of choosing not based on cost, but based on what works best for them. If someone is a young woman in their twenties, working at a part-time job that does not offer private coverage, accessing an IUD or other contraceptive method can be a big cost when trying to manage other basic life expenses, such as rent or grocery bills.

As colleagues can see, this is the reality that many Canadians are currently facing and trying to manage. We have decided to intervene and help. Bill C-64 would address the lack of access by working with provinces and territories to provide universal coverage of contraceptive medications and devices, so Canadians can access the contraceptives they need. Furthermore, some provinces are already paving the way; this is similar to how Saskatchewan led the way by implementing universal health care in the 1960s. Last year, British Columbia became the first province to provide universal access to contraceptives to their residents. Recently, Manitoba also announced a commitment to implementing universal contraceptive coverage in their province. I would join my colleague in clapping.

There is a certain trend I see, with certain provinces offering these services to Canadians. What is that common trend? I think we can leave it to our imagination, but it tends to be parties that are left of centre, that are more progressive and that are willing to step in and help where people need it most. Studies from the United Kingdom show that universal access to contraceptives provided a return on investment in health and social services of nine to one for every investment in universal contraceptive access.

In the Canadian context, evidence from the University of British Columbia estimated that no-cost contraception has the potential to save the B.C. health care system approximately $27 million per year.

We commit to working with those provinces and the others in Canada to ensure that everyone in Canada has universal access to contraceptives.

This new coverage, to be delivered by provinces and territories that enter into a bilateral agreement with the Government of Canada, means that Canadians would be able to receive the contraceptives they choose, no matter where they live or how much they earn. In turn, Canadians will be healthier; they will be empowered to make important life decisions, and they will not have to opt for less-effective or less-desirable methods of contraception because of the cost of this essential medicine.

We will work with provinces and territories to provide Canadians with universal coverage for contraception. This is just the first phase of a national pharmacare plan, which can show how much of an impact universal coverage for contraception and, indeed, more than just contraception, will have on the lives of Canadians and further enshrine reproductive choice in Canada.

In closing, we look forward to working with all parliamentarians to pass the pharmacare act so that all Canadians can have reproductive choice and rights and get the contraception they need and deserve.

[Francesco Sorbara, Liberal, Vaughan—Woodbridge, ON]

Mr. Speaker, we know that almost four million Canadians have a form of diabetes, and we want to prevent their condition from deteriorating and their ending up in the hospital, which costs our hospital system even more. We want to prevent that, which is a big piece in Bill C-64.

Obviously, with contraceptives, we know that there are women out there who may not be able to afford the cost. We would be there to assist those individuals, especially the most vulnerable, in our country.

[Francesco Sorbara, Liberal, Vaughan—Woodbridge, ON]

Mr. Speaker, since 2015, when I was first elected to this most honourable House, my focus has been on helping and ensuring the success of the residents of my riding of Vaughan—Woodbridge and of all Canadians, and that is what we continue to do. We continue to implement policies that strengthen our social system, including what is contained in Bill C-64, specifically for folks with diabetes and individuals in need of contraceptives.

Obviously, the rare disease strategy is something near and dear to my heart as I have a nephew who suffers from a rare genetic disease. I understand the issues that my brother and sister-in-law go through in taking care of my nephew. The issue of expanding pharmacare, expanding our national system and strengthening our social safety net is very near and dear to my heart.