The CHA and Beyond The Role of Legislation in National Reform in Health Care
This paper is centred on the use of legislation as a tool of public action in health policy. We suggest that as with the Canada Health Act of 1984, this option should be considered to direct future reform efforts and pursue our collective aims of health and wellness.
The CHA is the legislative expression of the federal government’s exercise of its spending power, serving to consolidate key national agreements governing the circumstances under which the federal government contributes to the costs of medically necessary health services delivered by the provinces and territories.
Two features of the CHA merit highlighting. The first is that its core provisions – in particular, the five criteria often referred to as Canada’s “national standards” for health care – were not new or original to the CHA. The CHA was nonetheless an important step in the development of Canada’s health system because it enshrined together, in one statute, longstanding commitments. A second feature of the CHA worth highlighting is that it does not stand alone. The CHA is one of 13 statutes across the country, including one in each province and territory, that serve together to establish the basic legal infrastructure of Canada’s health insurance system.
The CHA’s powers to make regulations and issue policy interpretation letters offer important potential to achieve needed health system reforms without needing to “open” the Act. Even where these powers are unrestricted by an express requirement for consultation with the provinces and territories, however, this would undoubtedly be required given the fundamentally consensual nature of the CHA.
Finally, the federal government’s legislative options are not limited to the CHA. Jurisdiction over health and health care in Canada is shared between the federal and provincial and territorial governments. The various federal powers with health aspects allocated by the Constitution Act, 1867 are significant, including the residual “federal health power” to make laws “for the peace, order and good government of Canada” (POGG). It therefore makes good sense to consider federal policy objectives in the health domain with regard for the full spectrum of federal legislative competence.
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