A federal court judge questioned Thursday whether provincial governments have truly filled in the gap left by cutbacks to health-care coverage for refugee claimants announced 18 months ago.

Justice Anne Mactavish is hearing a legal challenge launched by Canadian Doctors for Refugee Care and the Canadian Association of Refugee Lawyers.

Government lawyers have argued refugee claimants can still access health care through other programs, including those put in place by some provinces to reinstate access to essential and emergency care.

But though Alberta, Manitoba, Saskatchewan, Nova Scotia, Quebec and Ontario have all taken steps to bridge the gap, not all offer the same level of coverage.

While Ontario has put forth a "coherent program," Mactavish said, Quebec offers assistance on an ad-hoc basis, which can leave refugee claimants dependent on the "whims" and "charity" of officials.

"Is that filling the gap?" the judge asked. And "is it humane to put people through that?"

Neeta Logsetty, who represents Citizenship and Immigration Canada, said many refugee claimants had also received donations from pharmaceutical companies and help from doctors, as well as provincial assistance.

Of those involved in the court case, "everyone got the treatment they required, at little or no cost," she told the judge.

What's more, she argued, many Canadians also face hurdles in accessing health care.

"The reality is the health-care system isn't perfect in Canada," she said.

"Many Canadians and permanent residents, they face many similar issues" as refugee claimants, she said.

If the [Immigration] Minister is so confident in the righteousness of his position he will accept our challenge for a public debate and honest discussion based on the facts. - Dr. Philip Berger for Canadian Doctors for Refugee Care

Ottawa trimmed medical benefits for newcomers in 2012, leaving most immigrants with basic, essential health care but without supplementals such as vision and dental care.

However, rejected refugee claimants — and refugee claimants from countries the government considers safe — will be eligible for care only when they pose a threat to public health.

Ontario reinstated the benefits Jan. 1, a move that drew strong criticism from Ottawa, which accused the province of intruding into an area of federal responsibility.

Doctors challenge immigration minister

Canadian Doctors for Refugee Care challenged Citizenship and Immigration Minister Chris Alexander to a public debate this week.

"All we want is a chance to respectfully and rationally discuss the federal government’s refugee health policy,” said Dr. Meb Rashid, medical director of the Crossroads Clinic at Women's College Hospital in Toronto, in a press release Monday.

“We have witnessed the devastating impact of these cuts on the frontlines and fear the federal government’s ongoing pigheadedness could lead to tragic consequences.”

The group's call for a public debate with the federal minister comes on the heels of a federal-provincial spat over health care for refugees.

Alexander publicly scolded the Ontario government for reinstating health care to all refugee claimants regardless of their refugee status, calling the decision "scandalous and irresponsible."

“If the Minister is so confident in the righteousness of his position he will accept our challenge for a public debate and honest discussion based on the facts," Dr. Philip Berger, medical director, Inner City Health Program at Toronto's St. Michael’s Hospital, said in the same press release.

Ontario has estimated it will cost the province $20 million a year to fill the gap in health-care coverage for refugee claimants.

Health Minister Deb Matthews has said she will send the bill to Ottawa.