Montreal, November 19th, 2020
Dear Prime Minister,
Dear Minister of Health and Social Services,
Dear Members of the National Assembly,
On the eve of World Children’s Day, we, the undersigned organizations, health care professionals, human rights advocates, and academics are writing to ask the Quebec government to accelerate the implementation of its commitment to provide public health insurance through the Régie de l’assurance maladie du Québec (RAMQ) to Quebec-born children, regardless of their parents’ immigration status. The urgency of our request is underscored by the context of the current pandemic so as to address immediately the situation facing thousands of children and their families, already vulnerable, who have no public health insurance because of their immigration status.
Following its July 23, 2020 announcement, the government of Quebec confirmed on October 28, during a hearing before the Public Administration Committee, that it would table a bill to end its long-standing practice of refusing public health insurance coverage to children who are Canadian citizens but whose parents are not themselves covered because of their precarious migrant status.
This announcement has been pending for 20 years. Quebec’s Health Insurance Act had been amended in 1999 to say that children would be considered domiciled in Quebec if the child has “settled” in Québec. The amendment was specifically intended to ensure that children who are born on Quebec soil and who live here would receive access to health insurance based on their independent status, and not that of their parents. According to Guillaume Landry, Director General of the International Bureau for Children’s Rights: “As human beings who themselves have rights, children should be treated autonomously and not subordinated to their parents’ status.” In short, the best interests of the child should always prevail.
The result of the current practice has left hundreds of Quebec-born Canadian children without access to healthcare, despite the sustained advocacy of families, organizations, health care professionals and lawyers who have consistently denounced RAMQ’s practices. RAMQ’s practice has also been criticized not only as contrary to Quebec law, but also Canadian law and international law. It is inconsistent with recognized good practices in child development and successful integration of migrant families.
In 2018, Quebec’s ombudsperson Marie Rinfret issued an investigative report urging RAMQ to register all children born in Quebec for public health insurance, provided that they are residing here and that they meet the rules that all Quebecers must respect. After years of inaction by successive Quebec governments and in light of the desperate circumstances of many families, the Montreal law firm Trudel Johnston & Lespérance filed a class action lawsuit on July 9, 2020 on behalf of Canadian children excluded by RAMQ’s discriminatory practice.
To date, Quebec-born children continue to be refused provincial healthcare coverage and are thus denied access to healthcare unless their parents can personally pay the significant costs. For example, on October 26, 2020, RAMQ sent a written decision to the parents of a Canadian child, confirming its ongoing refusal to grant eligibility for public health insurance. It appears clear that such obstacles will remain until the new law is in place; that may take months, during which time, more children will be born and more families will fall into debt.
To make matters worse, many of these parents have found themselves pursued aggressively for payment of tens of thousands of dollars for costs related to childbirth and follow-up medical care. As well, many brothers and sisters of Canadian children who are living in Quebec with their families but were born outside Canada, as well as their parents and grandparents in Quebec, have no access to public health insurance. For these individuals, just as for Quebec born children, there is overwhelming evidence and expert opinion showing the importance of providing public health insurance.
In April 2019, the Chagnon Foundation’s Obervatoire des tout-petits published an extensive research file documenting the troubling impacts of lack of access to healthcare for children, for women, for families, for health care providers and for Quebec society at large. In particular, the research demonstrated that children without access to healthcare or whose mothers have not received appropriate medical treatment during pregnancy are at greatest risk of long-standing, lifelong problems. Following the publication of this research, Quebec’s Commission of human rights and youth rights issued a communiqué denouncing lack of access to healthcare for children of migrant families.
According to Dr David-Martin Milot, president of Doctors of the World Canada, and a specialized physician in public health and preventative medicine: “In the context of the pandemic, it is unacceptable and counterproductive for RAMQ to continue to exclude tens of thousands of people living in Quebec from access to public health insurance, including children and pregnant women. If public health is a priority area of concern, the government should stop making these families even more vulnerable and should be ensuring that they are not falling between the cracks of the system.”
The presidents of the Canadian Pediatric Society and the Association of Quebec Pediatricians, together with the heads of pediatric services from four Montreal hospitals have demanded in an op-ed that children living in Quebec have full access to publicly funded health services in our public system.
That is why the Caring for Social Justice Collective has launched its #RAMQpourTLM (“RAMQ pour tout le monde” campaign – “RAMQ for everyone” at the beginning of the first wave of the pandemic in April. In light of the inaction of the government of Quebec and now facing the second wave of the pandemic, the organization Doctors of the World Canada launched a public petition, demanding access to healthcare for everyone living in Quebec, regardless of their immigration status, just as Ontario had done in March 2020.
The signatories of this letter are delighted that the Minister of Health and Social Services plans to end this unacceptable practice of excluding Canadian citizens. However, we are also compelled to highlight to the government and parliamentarians the urgency of not only making this change, but of addressing the lack of access to public health insurance that affects a much larger segment of the population than the hundreds of children who are Canadian citizens.
In closing, the undersigned human rights organizations, healthcare professionals, community organizations, academics and activists respectfully request that the government:
- take immediate measures during the interim period pending the enactment of a new law to ensure immediate coverage for public health insurance for children born in Quebec;
- consider the possibility of retroactive reimbursements or the creation of a public fund for families who, for 20 years, have been forced to pay for essential health care services to which they should have had a right under the public health system.
- Prioritize the urgent study of health care insurance coverage not only for children but also for all persons living in Quebec, as Ontario has done since the month of March 2020.
We thank you for your attention, and are available for any further information or questions that you may have.
Amnistie internationale Canada francophone
Adelle Blackett, Full Professor, Canada Research Chair in Transnational Labour Law, Faculty of Law, McGill University
The Caring for Social Justice Collective
Center for Research-Action on Race Relations
Centre Sino-Québec de la Rive-Sud
Chinese Family Service of Greater Montreal
Chinois progressistes du Québec
Concordia Student Union Legal Information Clinic
Arielle Corobow, lawyer (Montreal)
Pearl Eliadis, lawyer (Montreal) Adjunct Professor, Faculty of Law and Max Bell School of Public Policy, McGill University
Festival Accès Asie
François Crépeau, Full Professor Hans & Tamar Oppenheimer Chair in Public International Law, Faculty of Law, McGill University
International Bureau For Children’s Rights
Julius Grey, lawyer (Montreal)
Melpa Kamateros, Executive Director, Shield of Athena Family Services
Médecins du Monde Canada / Doctors of the World Canada
Robert Leckey, Dean, Faculty of Law, McGill University
Geeta Narang, lawyer (Montreal)
Ouellet Nadon et associé.es, (Montreal)
PINAY (Filipino Women’s Organisation of Quebec)
Claude Provencher, lawyer (Montreal)
Nandini Ramanujam, Full Professor (Professional) Executive Director & Program Director, Centre for Human Rights and Legal Pluralism
Leslie Seidle, Research Associate, Institute for Research and Public Policy
Samir Shaheen-Hussain, Emergency pediatric physician and Assistant Professor, Pediatrics Department, Faculty of Medicine and Health Sciences, McGill University
Colleen Sheppard, Full Professor, Law Faculty, McGill University
Cory Verbauwhede, lawyer (Montreal)