Mr. Speaker, like the parliamentary secretary, I would like to thank the witnesses who appeared before the committee to provide testimony for the context of this report. I also would like to thank all of my colleagues on the committee, who undertook a very rigorous study of this issue.
The Conservative Party of Canada did append a dissenting report to this report on behalf of the official opposition. Today I will highlight some of the differences of opinion that our party had and some of the similarities that we had with the main recommendations that were put forward. I believe the New Democratic Party also put forward a dissenting opinion, although I could be wrong on that. Perhaps my colleague will correct me or remind me.
For anyone who is watching, and for the purpose of the debate, the content of the study was on the medical inadmissibility and excessive demand regulations for potential newcomers. In particular, the committee reviewed paragraph 38(1)(c) of the Immigration and Refugee Protection Act, which states that a foreign national is inadmissible on health grounds if his or her health condition “might reasonably be expected to cause excessive demand on health or social services.”
After careful examination of the limited evidence made available to us at the committee, committee members in my party were left with many unanswered questions and felt that data was lacking. Nonetheless, we wanted to state that there are ways the current regulations could be better applied and that Canada's immigration system must strike the right balance between protecting the health and social services that Canadians rely on and ensuring that the excessive demand clause is not hindering our ability to attract and retain immigrants. We felt that the main body of committee's report, as adopted, was lacking in this regard. It is in that context that we submitted the dissenting report.
Canada is a generous and welcoming country. Since Confederation, millions have immigrated to Canada to start a new life, get a job, open a business, raise a family, or escape persecution. Our country has been enriched by the multicultural nature of our communities and has warmly embraced the diversity of our citizens.
In order to continue to welcome immigrants to Canada, the general public must support the overall objectives of our immigration system. Everyday Canadians need to trust that the system is efficient and of benefit to the country. Throughout the study, the committee discovered many flaws and irregularities in the application of existing medical inadmissibility regulations. The committee heard suggestions on how to improve the service delivery and how the department, IRCC, can update unnecessary and confusing bureaucratic language during the application process.
Throughout our meetings, questions were frequently based on the question of fairness in the context of competing interests: If demand for specialized services was increased due to a total removal of the excessive demand provision, would that be fair to Canadians who have already waited months on a wait-list? Would it be fair to provinces and territories that are already having cash issues in terms of their budget? Is it fair if someone who wants to immigrate to Canada is rejected because it was determined that this person or someone in their family would cause excessive demand on our health or social services?
In terms of the excessive demand clause, one of the things I had some questions about was the difficulty of finding any sort of modelling or quantitative data on the projected increase in demand if paragraph 38(1)(c) were repealed and if we could look back at even the data that were available for past years. I remember the chair had to ask a lot of questions of officials on how the numbers were calculated, because it is a confusing formula. One of the things we asked over and over again was whether, if this paragraph were to be repealed, there would there be an increase in demand that was not forecast by a previous year's number, since people were self-deselecting from the application process because they knew they would not be eligible under the current paragraph 38(1)(c). Without that data, it would be difficult for provinces to forecast what the future demand on provincial health care systems would be, so we noted that in our dissenting report.
We also noted the fact that at that time consultation was still ongoing with the provincial governments, which the minister had not made available to the committee. There were only a few committees that actually put forward their recommendations. There were several provinces that were very hesitant and critical about the flat out repeal of 381(c), as is recommended in the report, due to questions around the potential cost and whether Ottawa would foot the bill, as it were.
Again, I want to that ensure the system is fair and that we do not lose people due to this provision. On the other hand, without the data to understand what the potential demand could be or how we would pay for that demand, that lack of data was not congruent with some of the recommendations in the report. We tried to outline that logic very soundly in the dissenting report.
The other component was sort of an amazing business case. If we had just repealed this section, then we would remove all of the bureaucratic costs associated with processing these applications. However, again, we did not have the data with respect to the anticipated demand on the health care system. In fact, even with the government's current changes, I am not sure we have the data on what the demand on the health care system would be. I think provincial governments are still asking those questions. It is very difficult to make that argument, because we cannot look at one basket of costs to the other without that modelling being done.
On determining excessive demand costs, I want to read through some of our thoughts on that. We state:
An individualized medical assessment must be undertaken to determine excessive demand. This is to ensure that every individual's current and future health and social service needs are taken into consideration.
The Canadian Bar Association (CBA) provided the committee with two briefs and appeared in person to provide recommendations. In the evidence submitted to the committee, they outlined the challenges associated with how IRCC calculates the costs to determine if someone is projected to cause an excessive demand on health and social services.
The difficulties in estimating the costs for special education needs were brought to the committee's attention. As education is a provincial jurisdiction, no two provinces that are identical in how they determine funding levels to assist students with special education needs. For example, Ontario's Inclusive Education Model funding is different than how Manitoba supports special education needs as every school division is unique in how support is provided for students with special needs.
There is also a discrepancy between provinces with financial support for prescription drugs. In some provinces medically required services are covered in full while outpatient drug costs are not automatically covered. There are also disparities in the amount of what each province reimburses residents for various prescription drugs.
The CBA noted that the IRCC's Central Medical Accessibility Unit, which was recently introduced, might alleviate some of the challenges in determining the true costs in determining if one will cause an excessive demand. However, they are urging IRCC to improve its Medical Officer's Handbook and to work with provincial and territorial governments to get the most up-to-date and accurate costing information available for the intended place of residence of the applicant. Denying applicants based on irrelevant information is not acceptable and all steps must be taken to ensure the accuracy of cost estimates.
Furthermore, there were circumstances where IRCC took so long to review a medical assessment that it was deemed out of date. Due to IRCC's wait times for processing excessive demand applications, 886 applicants needed a new independent medical assessment. In our opinion this is unacceptable and IRCC needs to improve its service delivery if medical assessments are not being reviewed in a timely manner.
I do not think that was actually addressed in the government's response. Certainly that was something we wanted to see.
With respect to the procedural fairness letters, there were several comments made by witnesses who were confused by them. They “often do not provide enough information for the applicant in a meaningful way. In many circumstances the language used in the letters is overly bureaucratic and is difficult to decipher.” We go on to say, “Further, because IRCC mails Procedural Fairness Letters, the time it takes for the physical letter to arrive cuts into the already short 60 days that applicants are given to provide an answer. We were informed due to the time delays with mailing a letter to various parts of the globe...it is difficult for an applicant to respond...” .
We heard a lot of testimony around sort of the nebulousness of the mitigation plan. We did not actually look at a template mitigation plan, even though it was discussed in broad strokes of what one might include. We thought it would be helpful to review how IRCC communicated what was expected in an applicant's mitigation plan. Our aim would be for IRCC to provide as much guidance as possible for applicants to improve the level of information received and to decrease the amount of appeal.
Our conclusion in the dissenting report was “It is evident that numerous provinces have hesitations on completely eliminating the excessive demand clause”, which was one of the key recommendations of the report. “Yet, numerous concerns were raised with the implementation of the current policy. Our job as policymakers is to strike the right balance of protecting our health and social services while also meeting Canada's immigration needs. We want our immigration policies to be fair and compassionate. We also firmly believe that Canadians must trust and support the overall immigration system.”
However, this is where, again, there was a lack of data. When we are talking about potentially adding cost to Canada's health care system, and we are in a significant deficit situation, as are many provincial governments, it is worthwhile for us to look at that modelling, especially when there were very anecdotal stories.
I want to be perfectly clear. There were some very heartbreaking stories brought forward in committee, but as policy-makers, we also have to ask what the overall likely demand would be created by the repeal of section 38(1)(c). There were some anecdotal stories about the fact that, if this was repealed, we would have more economic immigrants who would be highly successful, but there really was not any data brought forward to back up that claim.
Overall, we felt there was a lack of data to really analyze the cost of repealing section 38(1)(c). Then subsequent to that, it was difficult to question the government on how it would plan to finance that particular change. Certainly, as a Conservative, I have great hesitancy with putting forward major changes that might affect provincial spending without that piece of information.
The recommendations that we put forward in our dissenting report were:
1. That any change to 38(1) (c) of the Immigration and Refugee Protection Act must be done in full consultation with provinces and territories.
2. That provinces and territories be given a formal procedure to waive the excessive demand clause for an applicant they deem is essential for their province and where they fully accept the costs associated with the applicant.
3. That IRCC create a process where provinces and territories on a yearly basis provide the most up-to-date costing information for health and social services to improve the accuracy when determining excessive demand cases. Furthermore, we recommend this costing information be made public and accessible.
4. That IRCC take all necessary steps to eliminate delays that result in an applicant needing a new independent medical assessment for no fault of their own; for example by digitizing the process.
5. That IRCC immediately work to simplify Procedural Fairness Letters to ensure they are easy to understand and expected outcomes are clear to the applicant.
6. That IRCC involve provinces and territories to review the efficacy of mitigation plan, including an exploration of the enforcement of mitigation plans and to measure their success in cost avoidance.
7. That IRCC review its training process to ensure that officers are aware of their obligation to provide a detailed breakdown of expected costs to health and social services.
We did provide a fairly robust and balanced dissenting report. I would hope that as we go forward, as the parliamentary secretary has said, the government is committed to reviewing its plan in the future. I would like to see some formal modelling of any sort of increased demand be included in that review to understand how much of an extra burden this would place on provincial health care systems, in combination with that data around economic migration. Also, much of the report did not talk about some of those administrative changes that could be made to streamline the system for applicants as well.
That was the opinion of the Conservative Party of Canada. With respect to this concurrence debate, that opinion would stand.
