OTTAWA— The federal government won’t make public its multibillion offer to the provinces on health care until Prime Minister Justin Trudeau meets premiers and territorial leaders in Ottawa next week.
Behind the scenes, however, federal and provincial officials are number-crunching to ensure the “working meeting,” as Trudeau called it, ends with no blow-ups, a solid overall number the premiers can work with, and enough goodwill to move on to signing individual federal-provincial deals.
Those “bilateral” agreements would see billions of federal dollars flow to provinces that agree with the federal government to spend on “shared priorities” to improve the health system.
The Star has learned the federal government is looking to build into those agreements a mechanism to review the health spending, what results are achieved and what gaps show up, before the expiry of the deals to ensure ongoing funding keeps pace with needs.
That’s similar to what the Liberals did in the $10-a-day child-care agreements with provinces. For example, Ontario’s agreement included a data and reporting provision that agrees to “use evidence-based data to evaluate and improve how the child care system supports children and families,” and to report regularly on progress toward meeting federal requirements.
A kind of review mechanism was also built into 10-year agreements struck in 2017 with provinces for increased federal funding for home care, and mental health and substance use. In those agreements, provinces and territories agreed to a common statement of principles, and each jurisdiction established five-year action plans for how they’d spend federal dollars in those two areas. At the five-year mark, the provinces were to provide renewed action plans for the remaining five years of spending.
Now, one week away from the Feb. 7 federal-provincial meeting, any other details on what an ultimate settlement will look like are held very tightly among a handful of officials.
Federal Intergovernmental Affairs Minister Dominic LeBlanc quipped “a lot of magic happens in the week before Valentine’s Day,” suggesting there are breakthroughs still to be made.
In the meantime, federal officials continue to downplay expectations and are looking to stage a low-key affair with the provinces .
“We’re not going to be signing deals” at the Feb. 7 meeting, Trudeau said last week.
At the same time, Trudeau and Health Minister Jean-Yves Duclos have been clear that the federal government wants to ensure improvement in several areas: expanded mental health services, reduced surgical and diagnostic backlogs, hiring and training more doctors and nurses, boosting access to family doctors, and modernizing Canada’s health data system.
Long-term predictable federal funding provided via the Canada Health Transfer — the largest envelope of money Ottawa sends to provinces — is not a mechanism by which Ottawa can insist on any conditions, and provinces can move the money around within their own budgeted spending however they see fit.
By the same token, Ottawa does not need the consent of provinces to determine how much the transfer should rise, or for how long.
Transfer increases are tied to economic growth and currently contain a guaranteed minimum annual increase or “escalator” of three per cent a year. That level was first set by the Harper government, and was continued by the Trudeau government.
For the fiscal year 2022-23 that ends in March, Ottawa is spending $45.2 billion on the transfer, and that number is forecast to rise in 2023-24 to $49.3 billion.
That scheduled increase, according to the federal fall economic statement, already provides provinces and territories with $18.1 billion more over the next five years than was expected in the 2019 Economic and Fiscal Update, prior to the pandemic.
Nevertheless, the premiers are continuing to press their case for a massive increase.
On Monday, Manitoba Premier Heather Stefanson, chair of the Council of the Federation, an umbrella group representing provincial and territorial leaders, issued a statement saying they “expect” an increase to the transfer to bring the federal share of health spending up to 35 per cent.
A federal government official, speaking on background, said the federal share is “already technically at” or “very close to” 35 per cent. That’s if you look beyond the current and planned funding levels to include the direct taxing power Ottawa gave to the provinces decades ago to cover health costs — along with the $72 billion the federal government sent to the provinces to deal with the health and social costs of the COVID-19 pandemic.
Several sources described the current mood in ongoing federal-provincial talks behind the scenes as “collaborative.”
However, it was also clear the federal government saw Ontario Premier Doug Ford’s movement away from the premiers’ demand for more money-with-no-strings-attached as helpful.
One senior federal source said Ford “showed, quite frankly, leadership and backbone” in saying he could “live with” some conditions attached to increased federal funding.
Contrary to Ontario’s late settlement of a child-care accord with Ottawa, officials close to Ford do not want Ontario to be the last to sign on to any bilateral health agreement with the federal government.
That’s because the Ontario government knows there is urgency around bolstering health-care funding for a medicare system battered by three pandemic years and an increasing impatience for improvements.
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