A federal program to provide health care for refugees is — once again — sparking a fiery debate

The Conservatives trust the be of the meantime union soldier wellness Program (IFHP), which provides health-care benefits to refugee and asylum claimants living in Canada, needs to be curtailed. And the Liberals might not entirely disagree — in last fall's budget they announced plans to require claimants to cover a share of some costs.

But the Conservatives are pushing much further, both in proposed action and rhetoric. 

In a social media post this past weekend, announcing his party's intention to put a motion on the IFHP before the House of Commons, Conservative Leader Pierre Poilievre explained that he wanted to cut "deluxe benefits" for "fake refugees." As laid out in the party's motion, the Official Opposition wants a full review of the program and for the federal government to cover only "emergency life-saving health care" for those whose claims are rejected.

The foundation for the Conservatives' criticism is a recent report from the Parliamentary Budget Officer. From 2021 to 2025, the annual cost of the IFHP grew from $226 million to $896 million, driven by an increase in the number of people claiming asylum. Without changes, the PBO estimates the annual cost of the IFHP could reach $1.5 billion by 2030. 

A sixfold increase in the cost of any program might prompt questions — even if there are far more programs that cost much more. But during debate in the House on Tuesday, Liberal MP Yasir Naqvi assailed the Conservative Party's rhetoric and motion.

"What this motion would do has nothing to do with facts or how we can perhaps reform a system," he said. "It completely has to do with dividing Canadians, trying to use the Trumpian sentiments that we are seeing south of the border to bring that level of debate to our country."

The Conservative motion was defeated on Wednesday evening, with Liberal, Bloc Québécois and NDP MPs voting against.

The stated concerns, the rhetoric and the disagreement are reminiscent of the last time changes were made to the IFHP — an episode that ended in a rebuke from the Federal Court.

Fourteen years ago, Stephen Harper's Conservative government reduced the coverage provided by the IFHP, arguing that "illegal immigrants" and "bogus refugee claimants" should not receive "gold-plated health care." Advocates for refugees objected, but so did doctors, medical associations and provincial governments, several of whom established programs to cover people who lost their federal coverage. 

"It's unbelievable," Brad Wall, the Saskatchewan premier at the time, said after it came to light that the federal government would not cover the cost of chemotherapy for a refugee claimant suffering from lymphoma. "The decisions that have been taken federally have been having this impact on people who are clearly the most vulnerable."

A legal challenge was eventually filed by multiple parties, including two refugee claimants. 

One was an Afghan man whose refugee claim was denied, but who could not be deported because Afghanistan was not considered a safe country. He suffered from diabetes and had lost coverage for insulin. The other was a man whose refugee claim was denied, but who was seeking permanent residence via his wife. The federal government was refusing to cover the cost of surgery for a detached retina that could have resulted in a permanent loss of vision.

Justice Anne Mactavish of the Federal Court ruled in July 2014 that the changes to the IFHP constituted "cruel and unusual" treatment by the federal government and thus violated Section 12 of the Charter — particularly as the changes might impact children who had come to Canada with their parents.

"The 2012 modifications to the Interim Federal Health Program potentially jeopardize the health, the safety and indeed the very lives, of these innocent and vulnerable children in a manner that shocks the conscience and outrages our standards of decency," Mactavish wrote.

She also quibbled with the Harper government's argument about "fairness," countering that the benefits received by refugee claimants were roughly equivalent to those provided to low-income Canadians by provincial health-care plans.

Poilievre asks Carney to support Conservative motion to cut refugee health-care spending

The Harper government appealed that ruling, but that appeal was abandoned after Justin Trudeau's Liberals came to office. 

The Conservatives argue now that their proposals do not go as far as the 2012 changes and that some of the objections raised by Mactavish would not apply. A full committee study of the IFHP might better explore both the program and proposals to change it (though the Conservatives have accused the Liberals of blocking further scrutiny).

But the lesson of the earlier debate might still apply: that, beneath the rhetoric, policy proposals needed to be carefully scrutinized for their actual impact on the lives and health of vulnerable people.

Even before the Conservative motion, there were concerns about the Liberal changes to the IFHP.

"I know the government has portrayed these policy changes as co-payments, but the reality is a 30 per cent co-payment on counselling service really means that those services are not available to refugees or refugee claimants," said Dr. Meb Rashid, director of the Crossroads Clinic in Toronto, noting that he has seen refugees who have fled war zones or who are victims of torture and who are thus in need of mental-health services.

Rashid, who was part of the organized pushback against the Harper government's changes in 2012, also says that the cost of basic services tends to be smaller than the eventual cost of handling untreated illnesses.

The phrase "bogus refugee" is thrown around without much specificity — a point Liberal MP Doug Eyolfson, a doctor, poked at during debate on Tuesday.

But on the question of restricting coverage for "rejected" claimants, Rashid points out that some of those claimants could subsequently win approval in an appeal and eventually become Canadian citizens (it's unclear whether the change proposed by the Conservatives would apply after the first denial or only after someone has exhausted all avenues for appeal).

While the Conservatives have framed their arguments around larger concerns about access to health care in Canada, it might be asked whether refugee claimants — and "failed" claimants, specifically — should be blamed for what ails provincial health systems.

It might not make for snappy social media videos, but, rather than reducing the health care available to people in Canada, would it be more impactful to reduce the number of people who are waiting to have their asylum claims ruled on?

As the Conservatives themselves note, the backlog of claimants has increased exponentially. The Carney government is currently proposing to change the rules for asylum claimants who had been in the country for more than a year.

Much has been made — understandably — about a significant drop in public support for existing immigration policies.

"Under the Liberal government, we have seen a dramatic drop in public support for immigration in Canada," Conservative immigration critic Michelle Rempel Garner noted in the House on Tuesday.

And underneath that drop there has been an uptick in suspicion about those claiming refugee status — an Environics poll last fall found that a plurality of Canadians agreed that "too many refugees are not real refugees."

Politicians can choose how they respond to and talk about those concerns. But beyond even the rhetoric involved, the 2012 fight was, most of all, a reminder that when policies involving health care are being contested, it is the actual lives of real people that can be impacted.

Senior writer

Aaron Wherry has covered Parliament Hill since 2007 and has written for Maclean's, the National Post and the Globe and Mail. He is the author of Promise & Peril, a book about Justin Trudeau's years in power.

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