Some local refugees and their kids fall through health insurance gap after federal policy changes
Claire Dickenson is photographed in her home in Windsor on Friday, November 30, 2012. Dickenson is concerned about not having health care coverage after her refugee claim was denied. (TYLER BROWNBRIDGE / The Windsor Star)
Nov 30, 2012 – 9:44 AM EST
Last Updated: Dec 02, 2012 – 5:18 PM EST
Claire Dickenson is due to deliver her baby the day after Christmas, but without any health coverage, she’s expecting a hefty medical bill after Boxing Day.
Dickenson is a refugee claimant and single mother from Haiti who arrived in Windsor in 2007. Her asylum claim was refused in 2009. She’s since been waiting for approval to stay in Canada on humanitarian and compassionate grounds with her three children, plus the baby on the way.
But because of changes to the federal program that provides interim health insurance to refugee claimants, Dickenson and her kids currently have no health care coverage and she is not eligible for any social assistance. She has no idea how long it will take her humanitarian claim to go through, she said, so until it does, she and her kids are in limbo.
Dickenson faces a hospital bill of about $2,050 per night at Windsor Regional Hospital plus the doctor’s fees. She agreed a special rate with her doctor so she will pay for her cesarian section, she said, but when it comes to the hospital costs, she’ll just have to wait for the bill and then figure out a solution.
“What can I do?” she said. “I know they’re going to send me the bills.”
On June 30 this year, the federal government made changes to the Interim Federal Health program, which provides temporary health coverage for refugee claimants, protected persons and others not eligible for provincial health coverage.
Under those changes, some refugee claimants like Dickenson saw cuts to their coverage. Those whose refugee claims are rejected are now eligible for medical care only if their condition is deemed a risk to public health or safety, such as tuberculosis.
Government-assisted refugees, which make up a separate category, are still entitled to full interim health coverage. There are several other sub-categories of asylum-seekers whose eligibility will vary. The rationale for the changes, the government explained this past spring, was to deter bogus refugee claims meant to take advantage of Canada’s free public health care.
Critics, including local doctors and medical students, protested that the changes would end access to prenatal, mental health and preventive health care for many refugees. To deny medical care to refugees goes against Canada’s compassionate approach, they argued, and is actually a poor public health strategy.
Partway into her pregnancy, Dickenson had to start paying for prenatal visits and she will also have to pay to have her doctor there in the hospital when she delivers her son. Paradoxically, once her son is born, he will be entitled to OHIP as a Canadian citizen.
What troubles her the most, Dickenson said, is that her other three kids – all between eight and nine – cannot see the doctor or get their vaccines without having to pay. Her son’s school called to tell her that her son needs an eye exam, and her daughter has teeth problems, she said, but she can’t afford the optometrist, glasses and the dentist right now that she is not able to work.
It’s one thing to subject adult refugees to medical fees, she said, but refugee children should at least get some kind of coverage.
“If you need to punish, punish the mother, punish the father, but don’t punish the kids,” Dickenson said. “They shouldn’t have to suffer for their parents.”
Going back to Haiti is certainly not an option. Dickenson’s family in Port-au-Prince was targeted by thugs, she said, and Haiti has only grown poorer and more unsafe over the years. Her children have basically grown up in Windsor, Dickenson said, and this is their home.
Grace Rosete-Lasala, a nurse practitioner at the Multicultural Centre in Windsor, said that the changes to the IFH really pose a dilemma for those refugees whose claims are still in progress or whose claims have been rejected.
Refugees can have medical problems and chronic illnesses that don’t pose a threat to public health but that, if left untreated, will land them in the emergency room, Rosete-Lasala said, to say nothing of the psychological trauma many asylum-seekers have. Chronic conditions like diabetes or high cholesterol can be costly for some people to treat and not every refugee has the money to pay for diagnostic tests, doctor’s visits or medication, she said.
She’ll see a patient regardless of their IFH coverage, Rosete-Lasala said, but if they need treatment, it often requires some creative solutions with help from good-willed health practitioners and pharmacists.
Since the summer, Rosete-Lasala has seen half a dozen refugee patients without health coverage. In some of those cases, she said, their inability to pay for tests or treatments led to delayed diagnoses and that just made their health conditions worse.
“It’s a recipe for disaster,” Lasala said of the the IFH changes. While the new regulations came into effect just five months ago, Windsor will feel the effects in the longer term, she said. “This is just really the beginning.”
Some local health clinics and practitioners are trying to help out by occasionally waiving fees or covering the costs through special funding envelopes.
For the example, the Windsor-Essex Community Health Centre’s Sandwich neighbourhood clinic, which has a large proportion of refugees on its patient roster, has some special funding to help uninsured refugees which predates the IFH changes, said Lynda Monik, the WECHC CEO. If the demand for the funding pool grows, however, they’ll have to find a way to make that funding grow, too, she said.
Charitable donations and in-kind donations of drug samples from pharmaceutical companies help somewhat, Monik added, but they aren’t sustainable solutions in the long run. Since the summer, they have noticed more refugee patients coming in without health coverage, she said.
“If (refugees) can’t access the care they need they’ll get sicker,” Monik said, and then land in the hospital – the costliest health care option. Some of them do try and pitch in what they can for tests and prescriptions, she said, but the solution is piecemeal.
The recent case of a cancer patient in Saskatchewan also shows how a federal policy change is putting financial pressure on provincial health systems. When the man, who was diagnosed with stomach cancer after fleeing to Canada, was denied coverage for chemotherapy under the IFH because of his refugee status, the province stepped in to cover the cost, but criticized Ottawa for refusing to help.
Dickenson is careful to point out that she is grateful for everything Canada has done for her and, with a whole lot of faith in God, remains hopeful her application to stay on humanitarian grounds will go through at some point. But with the latest changes to the IFH, she said, she can’t help worrying for her children and those of other refugee mothers like her who are stuck in this grey zone of health care coverage.
“If the mother doesn’t have money how are they going to do it?” she said. “My concern is the health (care) for the children.”
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