The federal government says any future negotiations about boosting health funding to provinces will be tied to talks on sexual and reproductive health services — including abortion.
That commitment was written into the Liberal government's new budget, which Finance Minister Chrystia Freeland tabled in the House of Commons Monday.
"The government is committed to collaboration with provinces and territories to strengthen our health care system, ensuring equitable and appropriate access to a full suite of reproductive and sexual health services, in any upcoming Canada Health Transfer funding discussions," says the budget document, referring to the federal government's fiscal contribution to health care costs in the provinces and territories.
The 700-page-plus document mentions New Brunswick's Clinic 554, the province's only private abortion clinic — which has been at the centre of a fierce political debate about abortion access and is the focus of a recent court challenge.
New Brunswick does not fund out-of-hospital abortions and the Fredericton clinic has said it can't keep operating without provincial funding.
The province's legislature has been at odds about a push to change Regulation 84-20, which states that the province won't pay for abortions not performed in a hospital.
The majority government led by New Brunswick Premier Blaine Higgs blunted the motion by removing a reference to Clinic 554 and rewording it into a request for provincial health authorities to determine whether the province's abortion policy violates the Canada Health Act.
Higgs has argued that his province is providing adequate access to abortion services at three hospitals in the province — two in Moncton and one in Bathurst.
The Canadian Civil Liberties Association filed a constitutional challenge earlier this year aimed at forcing the New Brunswick government to fund abortion services in private clinics.
"Examples like Clinic 554 — New Brunswick's only private abortion clinic — show us that lack of funding puts access to sexual and reproductive health care at risk," says the federal budget.
"All Canadians should have access to a full suite of sexual and reproductive health resources and services, no matter where they live. Currently, women, youth, LGBTQ2 people, racialized Canadians and Indigenous populations face the highest sexual and reproductive health risks and the greatest barriers to accessing support, information, and services. Too often, they do not receive the same quality of care, particularly if they are from marginalized communities."
Higgs calls federal approach 'very unfair'
Responding to the budget, Higgs — who is personally opposed to abortion — accused the federal government of delivering an ultimatum and said that if Ottawa feels his government isn't respecting the Canada Health Act, it can take it to court.
"We're talking about the health care of every citizen in this province and the funding model. And every premier is talking about that in every aspect of what their health care delivery services look like. So I think it's a pretty unfair comparison or certainly a very unfair position to try to put me into personally, or as a provincial leader," Higgs said Monday evening.
"If they really believe that we are not meeting the access requirements, which we understand are necessary and appropriate to do so, then they would be taking us to court on it and solve it the way the program is identified. If we're violating the Canada Health Act, then there is a mechanism to deal with that."
The move to tie health transfers to abortion access isn't new. The federal government withheld $140,000 from New Brunswick in health transfer payments early last year. Federal Health Minister Patty Hajdu argued at the time the province was contravening the Canada Health Act by refusing to cover out-of-hospital abortions.
Ottawa later gave the money back as the COVID-19 pandemic ramped up.
The NDP says the budget doesn't go far enough in promoting abortion access, especially in rural communities.
"The so called 'feminist' prime minister cannot continue to state he is pro-choice while impeding women's access to safe abortions," said Lindsay Mathyssen, the NDP's critic for women and gender equality.
"Justin Trudeau's refusal to enforce the Health Canada Act has made it very difficult for women to access abortion clinics, especially in rural settings ... More needs to be done to expand the access to birth control and Mifegymiso. Especially in rural communities where there are no abortion clinics nearby, this abortion drug, administered by midwives, is a safe and effective way for women to have an abortion."
The budget proposes spending $45 million over three years, starting in 2021-22, to fund community-based organizations that "support activities such as producing inclusive training materials for sexual and reproductive health care providers, carrying out public awareness activities, and providing travel and logistical support to individuals who have to go long distances to access abortion care."
The budget directs another $7.6 million over five years, starting in 2021-22, to Statistics Canada to develop a national survey on sexual and reproductive health that includes data on race, household income and sexual orientation.
A spokesperson for Hajdu said the government won't rule out using the Canada Health Act to defend abortion access.
"Our government has been clear that women have a right to access reproductive services. We will use all options available to defend a woman's right to choose, including those that exist under the Canada Health Act," said Cole Davidson.
No major Canada Health Transfer boost in budget
Provinces and territories have been asking for massive increases in the federal contribution to health funding for decades. Monday's budget didn't offer one.
The federal government promised last month to bump its health transfer contribution by $4 billion — well short of the $28 billion boost premiers have requested.
The provinces spend about $188 billion on health care annually and the federal government covers roughly 22 per cent of total costs. The premiers have asked for a permanent increase in the federal share of health spending to 35 per cent cent, which would bring the total federal share to $70 billion.
Prime Minister Justin Trudeau promised to increase health care funding to the provinces — but not before the immediate pressure of the pandemic subsides.
"It's going to be important that the federal government steps up and increases its share of the cost of health care with the Canada Health Transfer," Trudeau said after a first ministers' meeting in December.
"We are going to do that and I look forward to conversations over the coming months about how we can increase it."