Finance Committee on Nov. 7th, 2017

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

I understand. Living with diabetes is obviously very disruptive to someone's life to have such a medical condition and so forth. For the 80% rejection rate, I would love to be able to see the hard data on where that number is coming from, and not just have it as a circumstantial number that has been polled.

[Kimberley Hanson]

I share your desire. As I said, I've “ATIP'ed” the hard data, and once I have it, I'll be happy to share it.

I think, though, a key point is that even the CRA itself has acknowledged in the last week that it changed the verse in the first week of May that introduced the language that an adult independently managing insulin therapy generally does not require the required 14 hours a week for that therapy, unless complications are present. Thus, they acknowledge that they made that change, and that change has caused a spike in the order of hundreds if not thousands of additional disallowances of people who had previously been allowed and whose doctors and nurses are certifying them. Therefore, whether my 80% number is valid or not remains to be seen, but the unquestionable reality is that there has been a marked change in practice that is adversely affecting tens of thousands of Canadians, and we need it to change as quickly as possible.

[The Chair, Liberal, Wayne Easter]

You're over the time, but go ahead.

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

I'll move to Victoria.

I met up with the Startup folks from York region. If you could you talk about what's most important for the small innovators out there, that would be great. Thank you.

[Victoria Lennox]

As I said, Startup Canada works with over 200,000 entrepreneurs, including in York region, and at the earliest stage our entrepreneurs are looking for access to capital and access to information. One of the biggest opportunities that the Government of Canada has is making all of the investments in innovation and infrastructure for entrepreneurs actually work for Canada. There are investments in accelerators, incubators, small business programs, IRAPs, and SR and ED tax credits. We're supporting superclusters. How does the mainstream Canadian engage with that and the mainstream entrepreneur? I think the biggest thing that our entrepreneurs ask for is access to capital, so that's why we support them with financial literacy and financing skills, help to connect them with financial institutions, including working with the Business Development Bank of Canada. But what they really need is access to information to be able to access the support they're looking for as quickly as they possibly can.

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

Thank you.

[The Chair, Liberal, Wayne Easter]

Thank you, all.

Mr. Poilievre, go ahead.

[Pierre Poilievre, Conservative, Carleton, ON]

Thank you very much.

My question is for Kimberley Hanson, from Diabetes Canada. I'd like to begin by thanking her for her advocacy on behalf of the thousands of people whose applications for the disability tax credit are being rejected.

I'd like to read a letter from the Minister of National Revenue—I have it before me—in which she is referring to the requirement that diabetics need 14 hours a week of life-sustaining therapy in order to qualify for the disability tax credit. She says, “adults who independently manage their insulin therapy on a regular basis are unlikely to meet the 14-hours-per-week requirement.”

Is that statement true?

[Kimberley Hanson]

It is not true.

As I've said before, it's certainly not our statement that every person with type 1 diabetes needs more than 14 hours a week to manage that disease, but many, if not the majority of us, do. That's even for the activities that are presently allowed under the Income Tax Act and by the CRA guidelines. For example, allowed activities that type 1s must perform daily include testing blood sugar. We do that between six and 10 times on a normal day. That's about five minutes each time. We are allowed to calculate the time it takes for us to calculate and administer doses of insulin. We take a minimum of four injections a day, and that would be on a good day; often it would be more than that. Each time, the calculations and the process of preparing the insulin and taking it would take about five or six minutes. We are permitted to count the time we spend logging blood sugar, and that takes about 15 minutes a day to do well. Then, we are permitted to account for the time we spend analyzing the results, because the patterns in our blood sugar and our responses to insulin tell us what our next dose ought to be. As I mentioned during my remarks, those vary wildly day by day.

Just on those very basic activities—which are by no means all that goes into managing type 1 diabetes—it's very easy to spend an average of two hours a day, 14 hours a week, managing type 1.

[Pierre Poilievre, Conservative, Carleton, ON]

There is a change at CRA in the department's perception of the amount of time it takes to treat type 1 diabetes. Is it your view that this change in perception is responsible for the massive increase in rejections of diabetics applying for the disability tax credit?

[Kimberley Hanson]

That is my view, and it is consistent with what we have been told by the CRA, in conversations as recently as yesterday, which is that they formed that belief, wrote it into verse, and began using that new verse in interpreting and responding to applications from people with type 1, and that verse is saying that adults with type 1 don't take 14 hours.

[Pierre Poilievre, Conservative, Carleton, ON]

I'm sorry to interrupt. By “verse”, do you mean that this is the language I just quoted from the minister's letter?

[Kimberley Hanson]

That is what I understand from the CRA. I am trying to learn their lingo.

[Pierre Poilievre, Conservative, Carleton, ON]

So CRA has taken wording that has been used in the minister's letter and used it to deny thousands of diabetics their disability tax credit.

[Kimberley Hanson]

That is correct. We asked them whom they consulted with in order to form that opinion. It appears they have acknowledged, themselves, that it was perhaps a misinterpretation of some complaints they had from some endocrinologists who were saying that they didn't feel comfortable having to attest to the fact that I spend 14 hours a week checking my blood sugar or dosing insulin, because I do a lot of that outside of a clinical setting. That's a very valid concern, and we share that concern. We don't like the criteria as they are written, but the complaints and criticisms from those endocrinologists were about the certification process, not saying that adults with type 1 don't spend 14 hours.

Even the CRA has acknowledged to us that they may have misinterpreted those complaints and formed them into a new interpretation that is resulting in a discrimination against adults with type 1.

[Pierre Poilievre, Conservative, Carleton, ON]

You brought that discrimination to light about a month ago. It has been on the public record, widely reported in the media. Since that public controversy erupted, roughly four weeks ago, has the government solved the problem?

[Kimberley Hanson]

No, they have not. Our conversations with them, as recently as yesterday, are to look at how we might set up a process to engage in a series of conversations with experts to inform them about what goes into managing type 1 so that they can inform us about their clarification procedures and questions. We are certainly willing to participate in those conversations. We think that educating them about the ins and outs of managing type 1 is critical to a real solution, but I don't feel optimistic, based on those conversations, that change is anywhere near imminent, or that they have a willingness to look at changing their recent practices.

[Pierre Poilievre, Conservative, Carleton, ON]

Of those who had doctors certify that they qualified for the disability tax credit but were rejected by CRA in the last year, how many have had their tax credit reinstated in the last month? Have you heard of even one case of someone who has called you up and said, “Since the minister learned of this problem, I have had my tax credit reinstated”?

[Kimberley Hanson]

No, I have not heard of any cases of anybody being reinstated. My understanding is that, since our meeting on October 25, they have frozen the application of every person with diabetes for the disability tax credit. Right now, none of us are getting refused or approved, but I have not heard.... I've searched far and wide, and I have been able to find only five cases, literally, of people who have been approved since May. No one is getting through, that I can find.

[Pierre Poilievre, Conservative, Carleton, ON]

Wow.

How much time do I have?

[The Chair, Liberal, Wayne Easter]

You're pretty near there, but go ahead. You're on a line of questioning. We'll let you finish.

[Pierre Poilievre, Conservative, Carleton, ON]

Okay.

When was the first time you brought this issue, this high rejection rate, to the attention of CRA or other members of the government?

[Kimberley Hanson]

Late June or early July we wrote some letters to both the minister's office and the CRA and attempted to engage with them.

[Pierre Poilievre, Conservative, Carleton, ON]

It has been four months.

Thank you.

[The Chair, Liberal, Wayne Easter]

Thank you, Mr. Poilievre.

On that series of questions, have you, or anybody else from Diabetes Canada, met with senior officials at CRA in recent weeks? Have you requested a face-to-face meeting with officials?