Citizenship and Immigration Committee on Nov. 20th, 2017

[Jenny Kwan, NDP, Vancouver East, BC]

On a similar track, we've been talking about people with various different abilities. There is also another issue related to this, and that is for people who have HIV and AIDS, for example. That would also be deemed under this provision to be an excessive demand.

I wonder, Mr. Waldman, if you have some comments about that.

[Lorne Waldman]

It's been an interesting question because, as the treatments for HIV have gone up, it's certainly not a problem that creates any kind of public danger but we do see people refused because the cost of the medication is quite high. People are being refused because the government estimates the cost of the drug cocktails they're going to need and says it's above the average. This creates a serious problem, and I've seen quite a few cases where people were rejected on that basis.

[Jenny Kwan, NDP, Vancouver East, BC]

Then to fairly apply a policy in this area, to make sure that we have a fair system, what I'm hearing from the both of you—and I'm sorry, to our folks from CIHI, it's not that I'm trying to exclude you but it's because you can't really comment on policy—is that the thing the government really needs to do is to get rid of this provision. That's what I'm hearing from both Mr. Rae and Mr. Waldman.

[John Rae]

If you look at the history of Canada's immigration system, in the past other groups were arbitrarily excluded and Canada has changed sometimes more slowly than various groups would have liked. Now we just think it's time that Canada continue that incremental improvement in its system by removing this. We think it's our turn to be more fairly dealt with than is currently the case.

[The Chair, Liberal, Rob Oliphant]

Thank you, Mr. Rae.

Mr. Sarai.

[Randeep Sarai, Liberal, Surrey Centre, BC]

I want to thank you all. I think it's abundantly clear that most of us here are very sympathetic to this and think it's time for change in the right course. By my own calculations, it appears that 44% of immigrants are exempt from this and about 56% of immigrants are the ones who have this legislation apply to them, the economic, and the parents and grandparents.

To CIHI, you provided data used to calculate the average Canadian's health needs. Do you believe this data is the most appropriate metric to decide whether a potential immigrant would introduce excessive demand to the health service?

[Brent Diverty]

What we provide is the estimated and actual costs of health care for Canadians. What we hope and aim to do with that is to make it available so that it can be used for policy-making and system performance, etc. But at the end of the day, it's really important to say these are simply budget estimated numbers for the current year that come out of provincial budgets and some other data sources that we use. We create an estimate of the expenditure for the country, divide by the population, and get a number. We can also do that by age groupings, and we can do that for each province and territory. You get a range of estimated average costs for different aspects, as I mentioned, but really I think that's where our job stops and that's where we make those available for policy and system performance.

[Randeep Sarai, Liberal, Surrey Centre, BC]

You say the average cost ranges from province to province, but $7,000 is just an easy number I'm using. If you have 900 who were refused, that's approximately $6.3 million that would be the average cost for those people, but what would you consider the average cost of somebody who is currently refused or considered inadmissible? Is there an average number that you guys have been able to calculate on that?

[Brent Diverty]

The way the data comes to us is often in aggregated amounts, and we're not able to disaggregate it by things other than age groupings and provinces.

[Randeep Sarai, Liberal, Surrey Centre, BC]

If you took all the immigrants who are coming in, and you allowed the 900 who are currently considered inadmissible, and you put the cost that they had versus the average cost of the others, would it not be the same averages as we currently deem? Wouldn't it average out? Obviously, in the Canadian population, we have people with excessive demand, and so has the public coming in.

Would the average not be $6,300 in British Columbia or $7,000 on average? Would it not come out to the same average?

[Brent Diverty]

It's a good point that you make. I think we're saying we're going to spend roughly $242 billion on health system expenditures this year divided by our population. That's the average. There is a range of people within that number who use different health care. We know, for example, if you're below one, it's about $10,000 a year. If you're above 80, it's over $20,000 a year, and there are amounts in between. I think there's nobody being excluded from that number. That's based on the numbers we're getting from provincial budgets.

[Randeep Sarai, Liberal, Surrey Centre, BC]

Would it be possible for you to calculate the cost of the, say, potential 900 who are considered in the excessive demand category if you looked at the Canadian population to see what that cost is? I'm not saying that this is a cost issue, but obviously, anyone who's going to prove this is going to look at a number to see what it would cost, and $6.3 million would be what it would cost anyway if they're a healthy individual by their normal demographic.

What I want to know is, would it cost $15 million for them, or would it cost $14 million, because then the Canadian public and our government could know it's only another $3 million, another $5 million, or $10 million, or whatever the cost would be.

Would that be something you could...? Out of the data you have based on Canadians who are considered in the excessive demand category, what would an average cost be for 900 people?

[Brent Diverty]

Unfortunately, the way the data comes to us, we're not able to disaggregate it in the ways that you describe. What we are happy to do is to make available any of the data that we have on this issue so that, if someone wanted to do some modelling work around that, it could be done. It would largely be based on the data we've provided here, which really, as I said, disaggregates by age groupings, by provinces, etc.

[Randeep Sarai, Liberal, Surrey Centre, BC]

If we took an average aggregate of the average population that comes in, the number would come out to the same as what Canada has, so if we did not exclude the 900, and we took 300,000 immigrants of which 0.2% were considered excessive demand, the average cost would still potentially be the same as the average Canadian cost, so on average they would not be a burden.

[Brent Diverty]

Based strictly on averages, it's hard to imagine how 900 people in 35 million could affect our average health care per capita of $6,600.

[Randeep Sarai, Liberal, Surrey Centre, BC]

Thank you.

Mr. Waldman, immigrants denied PR status due to alleged medical inadmissibility are allowed to provide a letter explaining how they would mitigate the costs that would otherwise fall to our health system. In your experience, how likely is it that such a letter or such mitigation factors are deemed admissible? How many are successful based on their application?

[Lorne Waldman]

It's important to note that this only applies to the social services aspect, not to the medical aspect. If a person is found inadmissible because they're going to cost a lot of money to social services, special education, or respite care, those types of services, then they can produce a letter explaining how their family is going to help, or that they're going to hire private individuals.

My experience is that, in most cases, they are not successful because the health authorities are very reluctant to accept this type of undertaking. Having said that, I have been successful in a few cases, but the vast majority of the cases where the fairness letters are provided, they're not accepted.

[Randeep Sarai, Liberal, Surrey Centre, BC]

You also said it makes no difference from a cost-benefit perspective. Can you just quicky elaborate on that?

[Lorne Waldman]

What I'm saying is, given the overall cost of health care, when you're talking about 900 people, which is such a small number of people, even if those people exceed the average cost by double or even triple, when you consider that as.... As you said, if you multiplied 900 by $7,000, that's $6.3 million. Even if we said these people on average, these 900, are going to cost triple, you're looking at maybe $12 million extra. It's really not worth it.

[The Chair, Liberal, Rob Oliphant]

I need to end there.

Ms. Rempel and Mr. Maguire, you have five minutes.

[Michelle Rempel, Conservative, Calgary Nose Hill, AB]

Thank you, Mr. Chair. I'll be brief.

I would like to give notice of the following motion:

That the committee invite the Auditor General to appear in a televised meeting with respect to Report 3 of his Fall 2017 reports dealing with settlement services for Syrian refugees, and that officials from Immigration, Refugees, and Citizenship Canada also be asked to appear at the same meeting, no later than December 7th, 2017.

Thank you. I'll pass the microphone over to Mr. Maguire.

[The Chair, Liberal, Rob Oliphant]

Thank you. That has now been received.

[Larry Maguire, Conservative, Brandon—Souris, MB]

Thank you, Mr. Chair.

I want to carry on with where Mr. Sarai went, with the whole process and your last comments, Mr. Waldman.

From the numbers that you gave us, Mr. Diverty, was it a cost of $20,000 to the health care system for a senior over 80?

[Brent Diverty]

I have a more specific number, if you like, but it's around $20,000.

[Larry Maguire, Conservative, Brandon—Souris, MB]

Okay.

I look at 900 seniors, then, as an $18-million cost, and you just indicated, Mr. Waldman, that if we tripled this, it would be somewhere in excess of $12 million more. I did the numbers, and according to the CIHI number here of $5,782 for an average person's spending in Canada on health care, it's $5.2 million. If you triple it, it's $15.6 million.

I look at your situation, and whether or not it's exactly 900 people who would be impacted by this, or 1,900. Do either of you, Mr. Waldman or Mr. Rae, have any idea what those costs were in regard to administration, or would you have those numbers, Mr. Diverty, from CIHI, for the costs of the admissibility, for doing the paperwork and that sort of thing, for each individual? As you've given us for health care costs, is there an average for paperwork, just for health care in Canada as well, that would apply here?