Madam Speaker, I am pleased to participate in today's debate on private member's bill, Bill C-237, an act to amend the Federal-Provincial Fiscal Arrangements Act and the Canada Health Act.
As proposed, this bill would do two things. First, it would allow any province to withdraw from federal programs in provincial jurisdiction if comparable programs exist. Second, it would exempt Quebec from the criteria and conditions that must be met in order to receive a full cash contribution through the Canada health transfer.
Before I get into the concerns that the government has with these amendments, let me very quickly provide a little history surrounding the Canada Health Act. The act was passed unanimously in the House of Commons in 1984. It represents a broad consensus among Canadians and their federal, provincial and territorial governments that access to insured health services should be based on medical need and not one's ability to pay. Since then the act has been considered the gold standard of federal spending power being used to set national objectives in the area of provincial jurisdiction. The act, in conjunction with the Federal-Provincial Fiscal Arrangements Act, does so by establishing broad criteria and conditions that provinces and territories must fulfill to receive full cash contributions under the Canada health transfer. Provincial health insurance legislation and regulations, including those of Quebec, mirror and in some cases go beyond the requirements of the Canada Health Act.
That leads me to my first concern regarding the proposed legislation. By accepting this legislation and exempting Quebec from the Canada Health Act's conditions, we would weaken the foundation of Canada's universal health care system. The act establishes the objectives and values underlying universal, single-payer health care. For provinces to receive full health care transfer payments, provincial health insurance programs must be in compliance with five broad principles: universality, portability, comprehensiveness, accessibility and public administration. Provinces have not requested that these conditions be repealed.
Moreover, I would like to remind the hon. member from the Bloc Québécois that since the creation of the Canada Health Act, Quebec has broadly complied with the act's principles. Indeed, the discretionary penalty provisions of the act, which give the government discretion to withhold the Canada health transfer contributions to provinces in contravention with these five principles, have actually never been used. There have been some instances of non-compliance in Quebec and other provinces with respect to extra billing and user charges, where mandatory deductions under the Canada Health Act have been applied.
It is also important to note that the principle of asymmetric federalism renders the proposed amendments to the Federal-Provincial Fiscal Arrangements Act unnecessary for Quebec. As part of the 2004 health accord, the federal government and the Government of Quebec signed a bilateral agreement on asymmetrical federalism. Under this agreement, Quebec supported the overall objectives and general principles set out by first ministers, while respecting Quebec's desire to exercise its own responsibility in planning, organizing and managing health services. This agreement has continued to shape the federal approach to bilateral agreements with Quebec, notably the 2017 agreement on home and community care and mental health and addictions services and funding.
Importantly, the asymmetric agreements with Quebec in the area of health care have been applied within the parameters of the Canada Health Act principles. For example, the communiqué from the 2004 health accord on asymmetric federalism that respects Quebec's jurisdiction states as one of its preambles, “noting that its commitment with regard to the underlying principles of its public health system—universality, portability, comprehensiveness, accessibility and public administration—coincides with that of all governments in Canada....” Stated differently, the government entered into asymmetrical health agreements with Quebec because the province already adhered to the Canada Health Act principles.
Historically, provinces other than Quebec have recognized the benefits of federal spending power. In 1999, all provinces except Quebec agreed to the social union framework agreement, which recognizes a set of social policy principles and ways to allow the exercise of the federal spending power in areas of exclusive provincial jurisdiction, provided that a majority of provinces agree.
That agreement recognizes, “The use of the federal spending power...has been essential to the development of Canada's social union.” Its continued use is important to ensure access to “essential social programs and services of reasonably comparable quality” for all Canadians, wherever they live or move in Canada, to promote their full and active participation in Canada's social and economic life.
It should also be acknowledged that the federal spending powers during the pandemic have delivered results for Quebeckers while continuing to recognize Quebec's unique place within the federation.
The government remains committed to working with the provinces and territories and key stakeholders to advance shared priorities for the health care system and to improve health outcomes for Canadians. One of those commitments, for example, is to ensure that Canadians who require long-term care get the services they deserve. To address this, our government has committed to providing up to $3 billion to support the provinces and territories in ensuring that standards for care are applied. The Canadian Standards Association and the Health Standards Organization are currently working to finalize national standards for long-term care by late 2022.
To summarize, we believe that Bill C-237 would undermine the government's ability to deliver health care results for Canadians if provinces are allowed to be exempt from the conditions laid out in the Canada Health Act. We also believe there is no need to amend the Federal-Provincial Fiscal Arrangements Act to allow provinces to withdraw from federal programs in provincial jurisdiction. The federal government has a strong record of establishing agreements that cater to Quebec's specific needs, such as the 2004 agreement on asymmetrical federalism that continues to respect Quebec's jurisdiction and falls within the parameters of the Canada Health Act.
For these reasons, and the others that have been mentioned, I would strongly encourage all members of the House to vote against this bill.