One of the themes of the 2023 Ontario budget is that, as far as the provincial government is concerned, the pandemic is really and truly over. That isn’t to say that the health system won’t be dealing with the lingering effects of COVID-19 for years to come — in some cases literally, as patients with post-COVID syndrome will continue to need treatment for the indefinite future. But most of the special policies adopted during the pandemic to get the public, the hospitals, and the government itself through the emergency have been wound down. The most explicit sign of this is the end of “COVID-19 Time-Limited Funding” as a line-item in the budget itself: from billions of dollars to zero as of April 1.
Not all the government’s changes are quite so abstract. One measure that has Premier Doug Ford and his health minister, Sylvia Jones, on the defensive during question period this week is the end of a policy that sees hospitals care for people who aren’t insured by OHIP. At the beginning of the pandemic, to its credit, the Ministry of Health moved quickly to implement policy and create new billing codes that allowed doctors to respond flexibly to changing circumstances — for example, by allowing doctors to bill for virtual care.
But, at the outset of the pandemic lockdowns, the government also took another measure: it allowed hospitals to bill the province for care delivered to people not otherwise covered by OHIP. This was an important step in insuring that people at the margins of Ontario society could seek care even if they didn’t have a health card — either because they were homeless or undocumented or simply because they found themselves accidentally far from home after unprecedented travel restrictions had been imposed.
The government has announced that, as with so much else COVID-related, the policies supporting care for uninsured people at Ontario hospitals will end March 31. Hospitals have been told they should return to “pre-pandemic billing practices” and that uninsured patients who need medical care will still be able to rely on what passed for a safety net before March 2020.
The problem is that safety net has substantial holes in it. The government says, for example, that more than 70 community health centres across the province can provide care to patients in question. But, according to a reportreleased last week by the Health Network for Uninsured Clients, “not every CHC in the province has identified uninsured residents as a priority, and not every CHC receives funding to provide comprehensive care to these clients. As such, access to primary care depends in large part on geography, as well as on whether an individual is aware of CHC services.”
The opposition parties have slammed the government’s move; NDP leader Marit Stiles called it “callous.” Stiles, citing the Ontario Medical Association, told MPPs during question period on Tuesday that the cost for the program was a relatively meagre $5 million — a rounding error on a rounding error in the context of the province’s $81 billion in health spending, not to mention its overall $200 billion budget.
There are plausible arguments that the $5 million figure doesn’t include the full costs of making a program like this permanent; after all, the program existed only at a time when everyone, insured or otherwise, was being told to do whatever they could to not end up in the hospital. But it’s notable that, for example, the provincial government is making a big show of solidarity with foreign workers through its Bill 79, currently before the legislature, which would substantially increase fines for employers that seize passports or other personal documents. These foreign workers are precisely the kind of people in precarious employment who were, briefly, afforded access to the province’s hospitals and will now see that door closed on them. The difference between these two cases is that providing health care costs money, while punishing bad bosses with hefty fines raises it.
I won’t hesitate a guess on whether the government will plow through the opposition on this move or, if the criticism becomes too heated, reverse course, as it has more than once before. For either side of the aisle at Queen’s Park, however, this is a sign of things to come for the next year or so. Even in the context of relatively expansive growth in spending — in health care most of all, the Ford government has largely abandoned the more austere ideas from its profoundly unpopular 2019 budget — there are inevitably decisions that cause real human pain when budgets get cut. For the government, these will cause public-relations headaches. For its critics, they will score important victories when they periodically force the government to reverse course.
But not too far from the halls at the legislature, there are real people living and working at the margins of Ontario society whose fates depend on these kinds of decisions, and it’s important not to forget the human costs of decisions made on a balance sheet.
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