Citizenship and Immigration Committee on Oct. 24th, 2017

[Michael MacKinnon]

To be clear, it's an assessment against the basket of services that we have defined in the regulations. It is direct health care costs plus.... I'd have to dig through my binder to find the list of the specific things in the regulations.

There have been misperceptions in the media recently. For example, they were asking why we weren't calculating in the social assistance costs or the social housing costs or the amount of the Canada social transfer, but these amounts are out of scope, according to the regulations.

It's strictly the basket of services that are directly related to medical diagnoses. Occupational therapy, behavioural therapy, long-term care, and those sorts of costs are the ones that are considered in there.

[Bob Saroya, Conservative, Markham—Unionville, ON]

These costs are on top of the $135 million.

[Michael MacKinnon]

No. Those are the ones that are included in there. Social assistance or social housing are out of scope for this decision, because we can't forecast whether or not somebody is going to be poor on arrival in Canada. It's strictly speaking health care, plus the immediately affiliated social services that we have in the regulations.

[Bob Saroya, Conservative, Markham—Unionville, ON]

How much of this cost is borne by the provinces, or is it all clumped in together?

[Michael MacKinnon]

The estimates are based primarily on the assessment of the individual conditions and the expected costs that those would impose on provincial services. The estimate of savings on the order of $135 million from each year of decisions is what we would expect the provinces would have to bear if these individuals were allowed to be admitted into Canada.

[Bob Saroya, Conservative, Markham—Unionville, ON]

Mr. MacKinnon, what year was this cost threshold developed?

[Michael MacKinnon]

I'm not certain. For many, many years the average per capita cost for Canadians for these services has been used as a basis.

[Bob Saroya, Conservative, Markham—Unionville, ON]

How often do you reassess it?

[Michael MacKinnon]

The amount for health care costs adjusts automatically, because the Canadian Institute for Health Information reports this as an individual piece of data each year. On our way here, Dr. Saeed advised me that they're ready to publish the estimated cost of the adjustment for the next year based on revised population estimates and the total health care costs for Canadians for the previous year. That gets adjusted on an annual basis.

We also adjust the amount for the social services that aren't included in that estimate for inflation on an annual basis, using the inflation rate for the health sector as opposed to the general CPI.

[Bob Saroya, Conservative, Markham—Unionville, ON]

Dr. Saeed, where are these physicians located? Are they throughout the world? Are they in Canada?

[Dr. Arshad Saeed]

You're talking about the panel physicians who conduct the medial examinations?

[Bob Saroya, Conservative, Markham—Unionville, ON]

Yes.

[Dr. Arshad Saeed]

They're all around the world, in each country. They're in Canada as well, designated by IRCC. They're all around, everywhere.

[Bob Saroya, Conservative, Markham—Unionville, ON]

How often—

[The Chair, Liberal, Rob Oliphant]

I'm afraid I need to end things there. We'll be around for another tour.

We'll go to Mr. Sarai.

[Randeep Sarai, Liberal, Surrey Centre, BC]

Thank you to the panel.

Just to clarify, is the $33,275 over five years indexed every year by inflation, or was that number established some time back?

[Michael MacKinnon]

The health component of that adjusts automatically each year. The smaller amount, the $356, is for social services. We do the adjustment based on inflation, but the amount for health care costs that's reported by CIHI gets reported each year. In effect, because of that reporting, it self-adjusts for inflation each year.

[Randeep Sarai, Liberal, Surrey Centre, BC]

Do you know when that original number was established?

[Michael MacKinnon]

I'm not aware; it would have been probably more than a decade ago.

[Dawn Edlund]

The current definition in the regulations dates from when the Immigration and Refugee Protection Act was passed, which was 2002.

[Randeep Sarai, Liberal, Surrey Centre, BC]

What are the current limits on discretion when, say, a family is applying and one person has a disability? There's a discretion, as you said. What are the conditions or limits on that discretion?

[Dawn Edlund]

There are the usual conditions that an officer has in making a decision.

As I spoke earlier, they're looking at the response to the procedural fairness letter that was sent out. The family may dispute the medical condition, the prognosis, and bring their own specialist reports to bear in relation to the condition and the expected health and social services the individual may need over the next five years. For the social services side, then, after the Supreme Court decision in Hilewitz and De Jong, they can present one of their mitigation strategies for not having the same impact.

For example, if someone is going to be employed in Canada and the employer has a health care plan that will cover expensive prescription medications, that could be a mitigation plan. The officer would take that into account and say that expensive medication is covered off by their health care plan, so they find they're not medically inadmissible.

Generally, then, on the temporary resident permit, humanitarian and compassionate grounds are powers that officers have all the time, as does the minister.

[Randeep Sarai, Liberal, Surrey Centre, BC]

How many applications have applied for that discretion annually?

[Dawn Edlund]

We could try to get the numbers for you. There are thousands of people who apply for humanitarian and compassionate consideration writ large every single year.

[Randeep Sarai, Liberal, Surrey Centre, BC]

I'm talking just on the medical side.