Federal gov't underfunding of medical travel for Nunavummiut 'glaring,' says health minister

A federal government insurance benefit for Indigenous Canadians is costing Nunavut more than $74 million annually, according to Health Minister George Hickes — and after years of trying to negotiate a new deal, he says he's had enough.

Last year, the Nunavut government says it paid $78 million to administer Non-Insured Health Benefits to Nunavut Inuit. Of that, it was reimbursed $3.7 million by Canada.

Non-Insured Health Benefits is a federal program all Indigenous Canadians can use to help pay for health expenses not covered by their work, or through provincial and territorial healthcare. It might be used for dental or eye exams, and travel escorts for expecting mothers.   

The program is also meant to cover travel expenses for appointments outside of a community. But Hickes says it's not happening like that in Nunavut. 

"It's costing us more in medical travel to provide for their program, Non-insured Health Benefits, than I receive through the Canada Health Transfer," he said. "The inequity is so glaring it's unbelievable ... we want to recover the costs that we're putting in."

The territory administers the program for the federal government, and booked around 30,000 one-way flights last year for eligible patients, according to Hickes.

For many of those flights, the territory was reimbursed $125, a number that's gone unchanged since 1999, he says.

That's even for medevacs, which could cost over $20,000. Flights to routine appointments are priced in the thousands of dollars. 

In 2018, the federal government put $490 million over two years toward the nationwide program. Non-Insured Health Benefits does cover boarding home stays, taxis and food per diems in full when needed. 

Minister says he won't extend expired agreement any longer 

Nunavut's contribution agreement for the program expired in 2017. The department has been granting extensions to that agreement ever since while the two governments negotiate a new plan. 

Last week, in a letter from his federal counterpart, Hickes says he was given the same offer he refused last year. That increase wouldn't even cover half of the annual expense, he said.  

"The federal government acknowledged decades ago that it has a responsibility to Indigenous people to provide healthcare. They need to acknowledge the responsibility that they've committed to," he said.  

Hickes also expected to have the new payments backdated to when the agreement expired. That's not being offered anymore. He called this "an injustice" and said the territory can't afford to keep administering the program, though he does believe the territorial government must keep the program in-house in order to offer the best services for residents. 

"We are best suited to continue to deliver medical travel. We've been doing it for years," he said.

Travel refunds too low, Hickes says

Nunavut's health care program does pay for medical travel, and public servants have access to their own medical travel benefits. 

His critique, Hickes said, is both to the amount of travel compensation and the criteria for who is eligible for that money. 

While a flight for dental work would be covered by the program in full, he says one for surgery isn't. The benefit pays flight costs for escorts for expectant mothers, but the territory only sees a $125 travel refund for the mother herself. 

"We're responsible for our portion," said Hickes. "But when there's a federal program that gives us access to recoverables, let it be compensated appropriately ... we're one jurisdiction that has a majority Indigenous population."

The benefit came up in the legislature last week, while MLAs reviewed a money bill to add $50 million to the healthcare budget, for money spent during the current fiscal year. 

The territorial government spent over $100 million on medical travel last year. Next year's budget adds $17 million to the medical travel budget to meet existing costs. 

Hickes said a new airline contract for government flights has led to medical travel costs going down for some communities.