No, Canada Will not Cover Your Preexisting Condition

With the recent vote for the American Health Care Act (AHCA) to repeal and replace the Obama era Affordable Care Act (ACA), there has been a lot of discussion on who the AHCA will hurt. One of the (many) concerns is that the new legislation should it pass in the senate will roll back rules guaranteeing coverage for people with preexisting conditions. These changes if enacted would disproportionately affect disabled people. This has spawned the online protest #IAmAPreexistingCondition to put a human face on the people who at risk of losing their healthcare or who will see its cost skyrocket.

The changes have also spawned a lot of Canadian smugness and this meme has been making the rounds.

Trudeau Preexisting Conditions

Image description: Canadian Prime Minister, Justin Trudeau, a white man with darkĀ  hair in his forties gazes into the distance with his fisted hand touching his lip in a pensive expression. Text on the image reads “Hey girl, I’ll cover your preexisting condition”

The thing is the meme is a lie. In terms of how healthcare works in Canada, the language of preexisting conditions is generally meaningless. There are simply services that are or aren’t covered. If you’re in the system, you’re in the system. Canadians generally don’t talk about preexisting conditions the way Americans do because it’s a system we were either born into or gained access to simply by being Canadians.

The thing is though, even though we don’t generally use the language of preexisting conditions to discriminate in our healthcare system, there is still a lot of discrimination. As I mentioned, rather than excluding people based on preexisting conditions, there are simply services that are or aren’t covered. Whether a service is covered depends on whether it is considered essential. Many services largely associated with the care of disability are not considered essential. As such they either not covered and people who need them either have to pay out of pocket or seek private insurance or coverage is given at the whim of individual provinces.

This creates a second class access to the healthcare system for disabled people. We either may not have access to things that we need or our access to them depends entirely on where we live.

One of the primary principles of Canadian healthcare is that it’s supposed to be portable. You’re supposed to be able to get service regardless of your province of origin. This, however, does not apply to services that are not considered essential. So while I as a Saskatchewan resident have been able to get X-rays in BC (for an injury) and an ultrasound in Ontario (oddly enough for the same injury). I do not have access to consistent care related specifically to my disability because Saskatchewan may cover things that other provinces do not or vice versa and I can only access what is available in Saskatchewan.

This creates a couple of issues. There’s the fact that depending on your province of residence you may have less access to covered disability specific care. So the system is inherently unequal. There is also the fact that interprovince bureaucracies make it difficult to determine which services you should have access to while out of your home province or who to bill if you can figure it out. The outcome is that disabled people end up paying out of pocket for things that should be covered.

So for people within the Canadian system, there are still access inequalities. Inequalities that largely target the same groups of people likely to be disadvantaged if the AHCA passes.

The thing is, that isn’t the end of how the Trudeau meme fails. There is a scenario where access to the Canadian healthcare system does consider preexisting conditions. Immigration. Having a preexisting condition pretty much excludes a person from being able to access immigration to Canada. Which why this corrected meme needs to hopefully go as viral as the original (H/T Alex Hagaard)

Trudeau Meme corrected

Image description: The same meme as before except that text has been added over Trudeau’s face which reads “Except Canada doesn’t let disabled people immigrate #StopAbleism”

Immigration is pretty much the only circumstance where Canada considers preexisting conditions. So the meme is a lie. Canada will not cover your preexisting condition. If you have access to the system you are covered for a set of predefined essential services and the services that are most often considered inessential are those associated with disability.

So, no, Canada doesn’t cover preexisting conditions and flaunting healthcare access does nothing to address the very real dangers being faced by disabled people in the United States right now. This meme just taunts the people most negatively impacted by a potential adoption of the AHCA with lies.

*Note: I do not want to get into an oppression olympics competition here so comments along the lines of “suck it up Canada is still better” will not get through. They are reductive and also don’t address the disingenuous smugness over Canada’s healthcare system.

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Open Letter to Justin Trudeau: We Need a Canadians With Disabilities Act

Dear Justin Trudeau

You have just been elected as our new Prime Minister. Since Monday’s election, you have been in the news a lot. Today, I came across a story about how you helped carry a wheelchair user down the stairs to a subway station platform. I assume this was necessary because the station elevator was broken, though the Montreal Metro is notoriously inaccessible so it could really be anything.

While the media is applauding your “random act of kindness”, I can’t help but be more convinced that we really need a Canadians with Disabilities Act. I know we disabled people were thrown a legislative bone when we were explicitly included as a protected group under Section 15 of the Charter of Rights and Freedoms (after a lot of activism to fight governmental unwillingness, I might add). The Charter is however clearly not sufficient to meet the needs of disabled Canadians.

Physical access is still a huge issue. As are issues of social and economic access. I want to know that you and your government will work to help disabled people even when we aren’t right in front of you. I want legislation that will specifically address the needs of disabled Canadians, yet when I search the Liberal website, you have no specific policies dealing with disability. If you search for it, you will find only a statement on Veteran’s Pensions (which is important). I would however like to point out that by only dealing with disability directly when it is to do with veterans.

By doing this, you are basically creating classes of disabled people. This is likely not your intent but it is the result.

Ideally in a country where disabled citizens are truly equal, a story about a man having to be carried down the stairs–even if it is by Justin Trudeau–would be met with shock and outrage at the inherent inaccessibility of society. Not by celebrating a “random act of kindness” that should never have been necessary in the first place.

A few things I humbly think a CDA should cover,

Increased funding to ensure public transit is accessible, so that we don’t have to repeatedly hear how renovations are delayed due to budget restrictions. If you can afford to get able-bodied people on the subway, you better do the same for disabled people.

Limit bureaucratic barriers to services. As far as I’m concerned, I should only have to continuously prove that I have permanent brain damage if and when you produce peer-reviewed and repeated studies proving the existence of widespread medical miracles. Barring that, requiring constant documentation should only be required for people whose conditions are not permanent and then only at intervals suggested by their doctor not an arbitrary bureaucratic timeline.

Don’t allow provinces to penalize disabled students who travel out of province for school. We shouldn’t have to worry that we won’t be able to get a service in Ontario that we get without question in Saskatchewan.

Disabled Canadians deserve better, so do better,

Kim