The Canadian Association of Emergency Physicians (CAEP) is deeply concerned about the Ontario Ministry of Health’s plan to end healthcare coverage for patients without health insurance on March 31, 2023. Since March 2020, everyone living and working in Ontario has been able to access medically necessary care without financial barriers. If this coverage ends, people’s health will suffer, with potentially fatal consequences. This has a disproportionate impact on the most marginalized, including temporary foreign workers, humanitarian claimants, non-status migrants, and those experiencing poverty or homelessness.

Emergency care providers are witness to the improved access and efficiency afforded by this program, which responded to unmet health needs and alleviated burdens on hospital staff. At a system level, this program has prevented delays in care and acute complications of avoidable illnesses that are more costly to manage than timely access to community, preventive and hospital services. Ending the program for uninsured persons would place further strain on hospital budgets and their ability to offer high quality care.

CAEP asks for the Ontario Physician and Hospital Services for Uninsured Persons program to be made permanent. Alongside this, we welcome meaningful consultation to develop strategies to ensure that access to health services and provincial health insurance are available to all who live and work in Ontario.

As emergency providers, we are the health safety net for people who face social vulnerability and lack of access in other avenues. We are deeply concerned that the proposed plan to access care for people without health insurance from Minister Sylvia Jones and the Ontario government relies on emergency departments to access care. At a time when our emergency departments are facing widespread closures, we are facing increased wait times, and having challenges to staffing, relying on emergency care for people who are uninsured is an inadequate response to an upstream problem to ensure access to healthcare. Passing the costs onto hospitals also means that only the most acute and necessary care is undertaken at hospitals, alongside taking away strapped funds from other programs. This is poorer care at higher costs.

Moreover, the needed essential care falters as we are unable to arrange follow up after emergency treatment to primary or specialist care without coverage. We routinely witness ongoing deterioration of health when our patients are unable to connect to adequate follow up and manage their illness. Unmanaged treatable illnesses become more complicated without adequate care - people with diabetes or mental health conditions come to our emergency departments in more advanced stages and require lengthier hospitalizations.

Three years ago, the government made the right decision to ensure that any person living in Ontario could receive essential care. Rolling back this coverage is cruel and will have catastrophic health consequences.

Prior to March 2020, an estimated half a million children and adults living in Ontario did not have health insurance.

These groups face significant challenges navigating and obtaining provincial healthcare insurance. CAEP calls on the Ontario government to stop the cuts and make this program permanent. Alongside, we need to introduce steps to help make it easier for people to access OHIP coverage for those that face institutional barriers in enrolling and maintaining their provincial health insurance due to social precarity.

Sincerely,

Michael Howlett MD CCFP(EM) Sahil Gupta MD FRCPC

President Chair Health Equity Committee

Alan Drummond MD CCFP(EM) Atul Kapur MD FRCPC

Co-Chair Public Affairs Committee Co-Chair Public Affairs Committee

*** If you would like more information about this topic, please contact Christina Bova at 613- 523-3343 x17 (office), 613-793-0926 (cell) or email at cbova@caep.ca