An interim arrangement for the federal government to cover more of Nunavut's non-insured health benefits has not prevented a standoff over how a long-term agreement will work.
The two levels of government have been at loggerheads for years over costs for medical travel among Nunavut Inuit. The Government of Nunavut has reluctantly paid the bulk of the bills while demanding that the Government of Canada take it over.
After the GN received a commitment from Ottawa to cover more of the co-pay at a value of $20 million last fall, Health Minister Lorne Kusugak told his colleagues in the legislative assembly on March 16 that the GN expected the federal government to eventually assume the full burden of medical travel flights for Inuit permanently. That hasn't happened.
“Canada's continued stalling shows disrespect to Nunavut's Inuit and is harmful to the long-term health of our territory and the sustainability of our growing health-care system,” Kusugak said. “We have made it clear that unless full reimbursement occurs for medical travel, we will transfer the program back to the federal government.
“This matter is not going to go away. The federal government has to pull up their socks and start paying for what they are responsible for, and for far too long the Nunavut government has subsidized the federal government in the care of Inuit in Nunavut and that has to come to a stop,” the minister said to a round of applause from cabinet and MLAs.
He added that, as of April 1, medical travel bills involving Nunavut Inuit would be forwarded to the federal government for payment.
On April 14, the Department of Health stated that it is following through on that strategy.
“In the absence of an agreement, Canada will be invoiced for NIHB eligible expenses,” the department stated in an email, adding that the total number of invoices and the dollar amount for the early days of April hadn't yet been calculated.
Patient medical travel has not been impacted by this dispute, according to the department.
Not designed as a replacement
Nicolas Moquin, spokesperson for Indigenous Services Canada, told Nunavut News that the GN is responsible for primary health care services for Nunavummiut, including the coordination of medical travel. He said the Government of Canada provides transfer payments to the GN to help fund the territorial health system, and that included a contribution agreement for non-insured health benefits for Inuit residents that existed since 1999.
“While the Non-Insured Health Benefits Program provides support for the medical travel needs of the registered First Nations and recognized Inuit population, it is a supplementary program designed to complement provincially/territorially provided programs and insured health services,” Moquin stated. “It is not intended, nor designed, to fully replace the medical travel component necessarily inherent in Nunavut’s current health care system.”
He also noted that in 2020-21, the federal government provided more than $138 million in new funding to the GN for medical travel and in response to Covid-19. That's aside from $53.3 million transferred to Nunavut communities and Inuit organizations to prevent and respond to the coronavirus.
Kusugak met with federal ministers on March 31, 2021 to discuss non-insured health benefits. Talks are ongoing, according to Moquin.
“We are aware this is a priority issue for the Government of Nunavut, and we are committed to ensuring that Nunavummiut continue to have well-coordinated access to health supports they need, including medical travel,” he stated.
The last Non-Insured Health Benefits Program agreement between Nunavut and Ottawa expired on March 31, 2021.
Former health minister George Hickes had also raised this issue in the legislative assembly during his tenure, pointing out that the federal government only reimburses the GN for a small portion of the expense of medical flights.
“For too long, Mr. Speaker, Indigenous Services Canada has only paid for a fraction of what it costs for the GN to deliver NIHB services on its behalf,” Hickes said at the time. “Delivering this program on behalf of the federal government has cost the territory hundreds of millions of dollars over the years. That is money that could have been spent on improving healthcare programs, services, or infrastructure here in Nunavut.”