Health Minister and lawyer Ted Flemming knowingly permits New Brunswick to contravene the Canada Health Act, the federal law regulating payment of health services. New Brunswick doctor Adrian Edgar says this indicates Flemming is “willfully incompetent” and has called for his resignation.
The Canada Health Act ensures that eligible Canadian residents can access health services approved by Medicare on a prepaid basis, without direct charges at the point of service. Most doctors across Canada operate from private facilities, billing their provincial government for Medicare services. In New Brunswick, the province pays for all Medicare services provided by doctors in private facilities, except abortions.
Several weeks ago, federal Health Minister Ginette Petitpas Taylor sent a letter to provincial health ministers asking them to respect the Canada Health Act requirement to pay for surgical abortions. However, Regulation 84.20, Schedule 2, paragraph (a.1) of the New Brunswick Medical Services Payment Act specifically excludes abortions performed outside of hospitals. Only three hospitals in the province, in Bathurst and Moncton, provide abortion services.
A panel of experts discussed the government’s contravention of the law at an event, “Intersections of Gender, LGBTQIAP2S+ Health & Reproductive Justice” in Fredericton on August 13 organized by Reproductive Justice New Brunswick (RJNB) and Fierté Fredericton Pride. Panel chair Jessi Taylor, a reproductive justice activist and formerly Education Program Manager at AIDS NB, explained that “reproductive justice” is bigger than pro-choice and refers to the ability to have children in a safe and healthy environment.
Panel speakers included Adrian Edgar, the doctor at Clinic 554, an award-winning centre of excellence for queer and reproductive health care. At the panel, Edgar said “We’re tired and sad that the government is, mindfully and purposefully, derelict in its responsibility.” He said Health Minister Ted Flemming is “willfully incompetent” and called, again, for his resignation. Edgar believes the government’s position is rooted in blatant discrimination and misogyny because reproductive health services are valued less if the patient has female reproductive organs.
As an example, Edgar said the fee for a vasectomy is billable at 132 units whereas the fee for an abortion is 18 units, which does not cover the costs of staff or facilities required for the service. Thus the low fee structure is specifically designed to make it difficult for doctors to perform this medical service. As a comparator, a specialist waiting on hold for 15 minutes while a telemedicine service is delayed for technical reasons is entitled to bill 20 units per each 15 minutes they sit waiting.
Why is there a fee for abortion if it is not allowed outside hospitals? This is another example of government incompetence, says Edgar. Schedule 2 of the Regulation under the Medical Services Payment Act specifically excludes “abortion, unless the abortion is performed in a hospital facility approved by the jurisdiction in which the hospital facility is located.” However, recently a new service code for “Medical management of non-viable/unwanted pregnancy” for family doctors to use, apparently outside of a hospital, is classified as an abortion, billable at 18 units. Edgar said, “If that seems confusing given the explicit restriction in the Act, it’s because it is. The Department of Health is trying to suggest that medical abortions are not abortions,” adding that the government is “persisting in their multi-decade attack on the services offered at Clinic 554 and the previous Morgentaler Clinic in every way they conceive of – even if it means contravening their own regulation.”
Jenica Atwin, the federal Green party candidate for the Fredericton riding in the upcoming October election, was the only political representative to attend the panel event. She said that clearly, “something is wrong in New Brunswick,” and noted that more than 7,000 New Brunswick residents have signed a petition calling for the government to remove funding restrictions on abortion services. Atwin called the current situation another example of “the old guard holding bodies hostage” and underlined the need for the federal government to act.
It is unclear why the federal government continues to provide health transfer payments to New Brunswick when the province willfully contravenes the Canada Health Act. In 2015, the federal government withheld $10 million in user fees from Quebec when that province began to charge fees to patients for Medicare services, and only returned the funds when Quebec changed its policy. The CBC reported that Health Minister Petitpas Taylor’s mandate letter includes to “make absolutely clear that extra-billing and user fees are illegal under Canada’s public medicare system” and to develop “recourse mechanisms when instances of non-compliance arise.”
In May, MLA Megan Mitton (Green Party, Memramcook-Tantramar) made a statement about the lack of access to abortion services in New Brunswick. Pointing out that the provincial regulation 84.20 of the Medical Services Payment Act is a violation of the Canada Health Act, she asked Health Minister Flemming if he would remove it. Flemming said he would look into the matter; at press time, three months after the request in the legislature, he has not responded to Mitton.
Increasingly in Canada and around the world, right-wing politicians are calling for legislation that would force people with a fertilized egg inside them to continue their pregnancy to term. In an interview in July, the NB Media Co-op asked Megan Mitton her thoughts on why there is an increase in anti-choice statements by politicians across Canada and the US, and what politicians can do about it.
“I don’t think that the anti-choice movement ever went away,” Mitton said, adding that certain types of behaviours and ways of speaking have become more permissible lately. “We often see this as social change happens, as we see more equality, then there’s often pushback against that, and that could be part of what’s happening. I am concerned that there’s a bit of a coordinated effort right now between politicians and anti-choice activists, and so we do need to have other politicians speaking up in favour of reproductive justice for everyone.”
“Right now Clinic 554 in Fredericton is not being funded, and this is in violation of the Canada Health Act. This makes access to reproductive health services more difficult for some people in New Brunswick and especially people of lower incomes. Clinic 554 serves women and it also serves people from the LBTQ2S+ community, and that’s a really essential service.”
The main lobby organization in the province against reproductive rights is the New Brunswick Right to Life Association. Last year they brought in more than half a million dollars in revenue, but they pay no property tax on their headquarter building valued at more than $400K in Fredericton because the province gives them a 100% exemption on property taxes. The organization has three full-time and one part-time employee.
NB Right to Life has 12 director-trustees, including women in the three officer roles. The prominent role of women in the anti-choice movement is interesting. Traditional right-wing politics is focused on preserving male authority in the family and promoting fundamentalist religious views, including opposing abortion. Andrea Dworkin wrote in her 1983 book, Right-Wing Women: The Politics of Domesticated Females, that right-wing ideology had “succeeded in getting women as women (women who claim to be acting in the interests of women as a group) to act effectively on behalf of male authority over women, on behalf of a hierarchy in which women are subservient to men, on behalf of women as the rightful property of men, on behalf of religion as an expression of transcendent male supremacy.” Clearly the struggle for reproductive justice in New Brunswick will need to operate on many fronts. Unlike the handmaidens in Margaret Atwood’s tale, women are not incubators and need to have choices.
Susan O’Donnell is a member of the NB Media Co-op Editorial Board