The Ontario government is winding down a pandemic-era plan to pay hospital and physician costs for the uninsured, a move some critics charge will leave vulnerable residents without necessary medical care.
Doug Ford’s provincial government brought in the Physician and Hospital Services for Uninsured Persons program in March 2020. Under the plan, hospitals and doctors were allowed to bill the government for “medically necessary” treatments provided to patients without OHIP coverage.
The program was timed to COVID, but it was never COVID-specific; all medically necessary care was eligible for reimbursement.
Advocates who deal with the undocumented and the homeless say it closed a crucial, long-standing gap in Ontario health coverage. Shutting it down now, they argue, is “devastatingly cruel.”
“We are now talking about a health system in Ontario where unhoused, newly landed permanent residents, temporary workers and international students run the risk of major medical bills and debt,” said Dr. Andrew Boozary, a primary care physician and executive director of population health and social medicine at Toronto’s University Health Network on Twitter. “The mirage of universality is over.”
Ontario hospitals were informed of the coming change, effective April 1, in a Ministry of Health memo. (The version sent to the Star is undated.) Many physicians only learned of it Friday night when the Ontario Medical Association sent out a note to its membership.
“It was a shocking Friday evening email,” Boozary said.
The ministry memo described the program as an effort “to help reduce the spread of COVID-19 by allowing uninsured persons in Ontario, including those without Ontario Health Insurance Plan (OHIP) coverage or other health insurance, to access medically necessary physician and hospital services.”
But all that, the government says, is no longer necessary.
“Ontario continues to wind down COVID-19 response measures that are no longer appropriate or necessary,” the memo said. “As part of this, please be advised that the (Physician and Hospital Services for Uninsured Persons) funding announced in … March 2020 will end on March 31, 2023.”
According to the OMA, the total cost of the program was about $15 million over three years. That broke down to about 400,000 individual patient services delivered by 7,000 Ontario doctors since March 2020.
Many of those captured by the program may actually have been eligible for OHIP, according to the OMA’s president, Dr. Rose Zacharias, but for whatever reason they’ve never been able to sign up or to keep their information current with the government.
“We know that many people are falling through the cracks and don’t easily access coverage,” she said. “Anyone who has a language barrier or a mobility issue or is homeless, or even a migrant worker, these are people who have particular stressors and barriers that get in the way of going to get their OHIP card.”
There are still programs available in Ontario to help those not covered by OHIP. But for Boozary, they aren’t nearly comprehensive enough.
“When you look at the elements here around health equity and health economics, this is terrifying on both fronts,” he said. “We’ve known about these health-care gaps and who has borne worse health outcomes for many decades pre-pandemic … We have seen the most glaring lessons of the obstacles and barriers that are in place for far too many people. And now pulling the (program) back and imposing the (barriers) again is very cruel and unwise health policy.”
In a statement, the Ministry of Health said that “with lower rates of COVID-19 and the ending of public health restrictions, the province is winding down its pandemic response measures to focus resources on delivering services Ontarians need the most …
“As was the case prior to the pandemic, from April 1, those who are not eligible for the Ontario Health Insurance Plan (OHIP) and do not have any other form of health insurance coverage are encouraged to speak to the treating hospital and/or physician to develop plans for future care.”
The OMA note went out to its approximately 44,000 members just before 7 p.m. Friday night and quickly began to spread online. Maggie Keresteci, the executive director of the Canadian Association for Health Services and Policy Research, called it “a horrid affront to the values inherent in Canada’s universal health system” on Twitter.
In the note, the OMA said that it had asked the ministry to extend the program temporarily. The organization added that the OMA had not been meaningfully consulted about the change.
“This definitely was a Band-Aid during the pandemic, but there’s no good reason not to continue it. It works. It’s important,” said Marit Stiles, the leader of the Ontario NDP. “It’s not a humane system if people who are sick don’t get the care they need.”
The New Democrats originally charged in a statement that eliminating the program would mean refugees from Ukraine would no longer have access to health care in Ontario. Hannah Jensen, Health Minister Sylvia Jones’s press secretary, insists that’s not the case.
“Perhaps instead of making partisan attacks, (the) NDP should pay attention to the facts,” she said in an email. Last April, the government amended the Health Insurance Act to extend OHIP eligibility to people who have been granted emergency authorization to enter and remain in Canada for humanitarian reasons, she said. That should include Ukrainians fleeing the war, she said.
But Stiles said that doesn’t mean everyone in Ontario who needs medical care will still get it. “A lot of people fall through the cracks. They’re not acknowledging that,” she said.
“There are many, many people who end up in our communities who are undocumented … And we really can’t afford to make sure that they don’t get the care they need when they need it.”
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