Signs are pointing to the federal and provincial governments having made progress toward an agreement that would see Ottawa cover a bigger share of health-care costs.
Canada's mostly Conservative-leaning premiers have repeatedly insisted over the last couple of years that Prime Minister Justin Trudeau's government contribute more money to the health-care system.
Bilateral discussions have barely budged since the premiers, collectively as the Council of Federation, shot obtaining more financial support for health care up their list of demands from the federal government in 2020 — at least so far as provinces' public posturing has shown.
But comments in recent days by Trudeau and Ontario Premier Doug Ford, as well as insight shared by a senior provincial source, indicate negotiations have gotten closer to a deal being reached.
At separate press conferences on Thursday, Ford and Trudeau both described recent deliberations in a positive light.
"I've had some very constructive conversations with premiers, including Premier Ford and Premier (Francois Legault)," Trudeau said. "Our ministers and their counterparts are working very closely and I'm hopeful that we're going to be able to come to an agreement soon."
While still insisting — as the Council of Federation has repeatedly — that Trudeau needs to meet with the premiers as a group, Ford said "I'm still confident we're going to get a deal."
"I really am. I'm very, very confident. So we're going to keep working at it," Ford added.
The day before, Wednesday, Ford had responded "yes" when asked if he could live with additional health-care funding from Ottawa being conditional.
"Do we want a little bit of flexibility? Yeah, and I think they're (the federal government) willing to do that," Ford added.
Other premiers — including Alberta's Danielle Smith and Winnipeg's Heather Stefanson — have rejected strings-attached funding in recent weeks. Asked if he'd split from the premiers' group and seek a unilateral deal for Ontario, Ford said he "always (believes) in sticking with other premiers."
Also on Thursday, an Ontario government source with insight on the negotiations said "there's been some good progress" in the talks. While they emphasized there's no deadline to the negotiations, the source said a "very optimistic" timeline could lead to an agreement in weeks, although it is more "realistic" that a deal will be decided within months.
QP Briefing promised this source anonymity so to allow them to disclose information they wouldn't otherwise be able to.
Ford is also understanding of other premiers' differing positions toward strings-attached funding, given their provinces' unique circumstances, the source said. For the Ford government, it's understood that Trudeau's government would almost certainly require strings attached to any new health-care funding, which it is OK with because of the range of areas within the system that it could be put toward — hence Ford's caveat of needed "flexibility," the source said.
The CHT is the primary means through which the federal government chips in on health-care costs.
Under the terms of the current CHT, federal contributions rise in line with a three-year average of nominal GDP, with a floor of three per cent. That means high inflation will leader to significantly higher payments to provinces, even without a new deal.
CHT funding is doled out to provinces on a per-capita basis. For Ontario, that means a health transfer payment of over $19 billion, up from about $17.5 billion in 2022-23, according to federal government figures. These numbers don’t include a few one-time top ups over the last few years.
Around when the COVID-19 pandemic started, the federal government's CHT payments covered about 22 per cent of publicly funded health-care costs in Canada. Since 2020, the premiers have repeatedly pressed Trudeau's government to take on 35 per cent of the system's cost.
The federal and provincial governments split health-care costs about 50-50 when Canada's publicly funded health-care system was founded in the 1960s. Due to various governments' decisions and agreements since then, the provinces gradually took on a bigger load.
It was also in 2020 that Trudeau initially said he would work with the premiers to increase the share of health-care costs covered by the federal government. Although the federal and provincial governments have maintained their positions — as well as sniping — up in the time since, no multi-year deals have materialized.
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The provinces and territories are responsible for the delivery of health care in Canada.
Health care is a major expense for both the provincial and federal governments, however.
Health care is each province's costliest spending item. For example, 40 per cent of the Ontario government's planned spending in 2022-23 was on health care.
The federal government's financial contribution to the health-care system is more complicated. Excluding some pandemic-related programs and costs, Trudeau's government allocated 15 per cent of its budget this year to covering the Canada Health Transfer and paying for the entities within the health portfolio, which includes Health Canada, the Public Health Agency of Canada, and more.
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