National funding models for autism therapies should follow Pharmacare’s lead and workaround the Canada Health Act
Last month I read Patrick Monaghan’s article National Autism Strategy – A History, that left me both fascinated and frustrated.
Calls for a national autism strategy tend to cover a multitude of issues covering the lifespan of those on the autism spectrum, however the specific issue of therapy not being treated as a healthcare issue is particularly frustrating given the science behind evidence-based therapies like Applied Behaviour Analysis (ABA).
To date, calls for amending the Canada Health Act as a means to have ABA and other therapies covered as medically necessary under Canadian Medicare (Canada’s publicly funded healthcare system), have proven fruitless.
The Act sets the broad principles for Provinces and Territories universal healthcare systems, but does not get into specific treatments.
At a high level, people look at this and cannot believe that autism therapies are not covered under Medicare. And they’re right, it really should be.
A 2004 Ipsos-Reid poll confirms this. Following the Supreme Court ruling that provinces are not legally bound to cover the cost of ABA, the poll found that 84% of Canadians believe the therapy should be paid for by their healthcare programs anyways.
Here’s the thing, the end goal of having publicly funded autism therapies covered under healthcare, can be achieved without amending the Canada Health Act. In fact, I’d submit that the most politically viable way of getting federal financial support for autism therapies is through agreements with the Provinces and Territories with legislation separate from the Canada Health Act.
The political realities of the Canada Health Act
Going forward, it’s important that autism advocates learn from past attempts, why they didn’t work, and also learn from the successes of other health initiatives.
2007’s Pay Now or Pay Later: Autism Families in Crisis report by the Senate of Canada warns against going down the Canada Health Act route:
The Committee recognizes that the Act is not an appropriate mechanism to ensure federal funding for ABA and IBI therapies. The reality is that the Act does not refer to any specific disease, condition or treatment. Moreover, the medically necessary services defined under the Canada Health Act are those provided by physicians or other health care practitioners either in hospitals or doctors’ offices, which is not the case for autism therapy.
These very arguments were used by politicians to shutdown Bill C-304 National Strategy for the Treatment of Autism Act which called for amendments to the Canada Health Act.
In a nutshell, the politicians argued that the purpose and structure of the Canada Health Act makes it the wrong instrument to achieve the goal.
They also argued that the inclusion of specific autism therapies as insured services under the Act, would be perceived as an intrusion on the discretionary responsibilities Provinces and Territories have in delivering their healthcare.
To understand how challenging it would be to make changes to the Canada Health Act, consider how Quebec fiercely defends its jurisdictional independence as a “nation within Canada”. Quebec would likely view such changes as a threat to their autonomy. Of note, the Bloc Quebecois voted against Bill C-304.
Also consider who is footing the Medicare bills. Provinces and Territories are the primary payer. The Canada Health Transfer started out as a 50–50 Federal/Provincial cost sharing model, but the Feds have not kept up with the rising cost of healthcare.
Ontario for instance is on the hook for about 75% of its healthcare costs, with about 25% coming from the federal Canada Health Transfer. The provincial share continues to climb, with some estimating that by 2024 the Feds will only be covering 18% of healthcare costs.
Generally speaking, you don’t unilaterally dictate an increase in expenditures when you’re only paying a quarter of the costs, which is what the federal government would be doing if they amended the Act.
Provinces are acutely aware of this. It’s also likely they’ll receive a better federal-provincial cost sharing deal with a separate autism therapy agreement.
Politically speaking, amending the Canada Health Act specifically for autism is not a viable way to go. Not for the Feds, or the Provinces and Territories.
Following Pharmacare’s Lead
Dr. Eric Hoskins, the architect of the Federal Government’s Pharmacare strategy is calling for the Pharmacare extension of healthcare via legislation outside of the Canada Health Act. Here’s the rationale:
The Pharmacare plan also has recommendations that can serve as a model for a National Autism therapies agreement:
Autism advocates should take note. Here we have something as big as Pharmacare, a healthcare issue that impacts all Canadians, steering clear from amending the Canada Health Act, instead opting for it’s own legislation as an extension of Canadian healthcare.
An extension of healthcare is still healthcare
Extending healthcare by working around the Canada Health Act is a very politically viable option. For example, in 2017 the Government of Canada signed Shared Health Priorities agreements with the Provinces and Territories to tackle a variety of health issues including mental health and addiction.
Putting in place such a model for autism will certainly facilitate a mentality shift from viewing autism as a social services issue, to a health issue. Also, progress to regulate ABA across Canada will serve as an important step in perceiving therapists as health professionals.
A Federal/Provincial-Territorial agreement may be the short term answer in extending autism therapy under healthcare. Longer term, it may very well serve as a stepping stone to the inclusion of autism therapies under Medicare as medically necessary services. The end goal achieved, without amending the Canada Health Act.