Should Manitoba follow the lead of Ontario? Premier Doug Ford recently threatened to end government health coverage for emergency services outside of Canada. He faces a $10.3 billion deficit, and doing so would supposedly save nearly $12 million.

Should other provinces do the same? Or should they increase their coverage for health claims outside of Canada? After all, Manitoba’s deficit is only $470 million. The answer is far from simple.

Manitoba Health, Seniors, and Active Living pays up to $100 for each outpatient or emergency visit outside of Canada. For inpatients in hospitals of at least 500 beds, the maximum payment is $570 per day (even ICU). Other provinces pay less. For example, the maximum per day is $400 for Ontario (unchanged for 20 years), $100 for Alberta and Quebec, and only $75 for British Columbia. Most government health plans reimburse only the rate that physicians would have received in that province. All urge travellers to obtain private travel insurance.

However, many cannot qualify or afford it due to severe pre-existing illnesses or a change in the dose of their medications within 3-6 months of travelling.

Existing provincial coverage is admittedly only a small percentage of potentially catastrophic hospital bills in the United States. Yet many overlook that not all Canadians who leave on business or vacation travel to the United States or Europe, where medical and hospital charges are indeed much higher than in our country.

Nearly 9% of Winnipeg residents are Filipino. Vancouver, Toronto, and Montreal attract immigrants from South and East Asia, the Caribbean, and Latin America. Thus many of these new Canadians may travel to visit relatives and friends in countries where daily hospital charges are surprisingly low. In many cases, their existing provincial health coverage would have been sufficient to cover most or all of these bills. This would permit many to travel with government coverage not dependent on previous good health.

There is another unintended consequence: If this loss of coverage dissuades new Canadians from visiting relatives back home, some may instead ask their parents and grandparents to come for a prolonged stay in Canada. Many of these elderly patients have pre-existing conditions, and may not be adequately insured. This would put an added burden on our own healthcare system. It follows that unless Canada required most visitors to have adequate private health insurance, it might make sense for certain provinces to actually significantly increase their out-of-country health coverage.

Ontario NDP Health Critic France Gelinas has written to Federal Health Minister Ginette Petitpas-Taylor asking whether Ontario is indeed violating the Canada Health Act. Yet penalizing Ontario would put her and the Prime Minister in a most difficult situation.

Justin Trudeau might consider intervening. After all, on February 8, he stated (Ottawa Citizen), “We have acted in the past when provinces have not aligned themselves with the Canada Health Act.”

However, if he is to be seen to be fair and consistent, he should also address Quebec’s longstanding violation of a different part of Section 11 of the Canada Health Act (CHA). That province pays only its own rate when its residents receive medical care in another province, although the CHA clearly indicates that the host-province rate is to apply. As a result, few MDs in Manitoba or elsewhere in Canada will accept a Quebec medicare card.

This affects persons in West Quebec who seek specialized services in Ottawa and Quebecers who are treated for unexpected accidents or illnesses while on vacation or a business trip elsewhere in Canada. It also impacts Quebecers during the first three months after a permanent move to another province or territory. Sadly, they are only “covered” by a Quebec health card that few MDs in most of Canada will accept. They are usually required to pay out-of-pocket, and then wait several weeks or months for partial reimbursement.

Trudeau should not criticize the Doug Ford government if he is unwilling to also urge Quebec Premier Francois Legault to obey all parts of the CHA. Persons deserve to be treated equally under federal law in every province and territory.

Dr. Charles S. Shaver was born in Montreal. He graduated from Princeton University and Johns Hopkins School of Medicine. He is Past-Chair of the Section on General Internal Medicine of the Ontario Medical Association.