Children are not born from a flower: the health of the mother is intimately linked to that of the child. The pretty formula used by Doctors of the World summarizes well the inconsistency of refusing to mothers what we have kindly agreed to grant to their unborn children, namely health coverage cemented by unconditional access (other than that of being present on the territory for more than six months) to health and drug insurance plans, regardless of their place of birth or the immigration status of their parents.
It is worth recalling that Bill 83, which made this progress possible, was unanimously adopted by the National Assembly in June 2021. Guided by objectives of “equity and solidarity” , the parties had then not failed to claim the same thing for future mothers. It is well documented that the absence of pregnancy monitoring comes with increased risks, notably of miscarriage and caesarean section, but also of prematurity, fetal distress and low weight in newborns.
In addition to their deleterious effects on the humans concerned, these elements weigh heavily on our overcrowded health care system, in addition to costing us collectively more in the long term. Sensitive to all these ethical, health and economic arguments, the Minister of Health, Christian Dubé, immediately mandated the Régie de l’assurance maladie du Québec (RAMQ) to assess the options available to fill this breach.
Tabled last June, his report presents four solutions, including the status quo, which goes against parliamentary will. In view of the heartbreaking cases reported by the media in recent months, and whose number is growing visibly, it is clear that this option is not one. In Quebec, a delivery without complications after a normal pregnancy follow-up will have cost between a little less than $10,000 and up to nearly $20,000 for those who do not have health insurance. For many pregnant women with precarious status, a bill of this magnitude acts not only as a brake, but also as a terrible impoverishment accelerator.
Those who raise the bogeyman of medical tourism in this case are not completely wrong. This phenomenon does indeed exist in Canada, fueled in particular by what could be called a dual citizenship of convenience. Quebec is no exception, it has a successful history in obstetrics tourism, recalls the RAMQ. But that’s not what it’s about here.
What we are talking about is health insurance coverage for sexual and reproductive health care accessible to all women who live in Quebec (and not those who transit through it to get the best out of it before leaving. with their little luck under their arm), regardless of their migration status. Several countries already offer this kind of formulas, such as France, Belgium, Germany and even some states of the American neighbor, yet little known for its generosity in terms of health care.
Quebec can do the same for the approximately 2,000 women concerned per year, according to the RAMQ’s assessment. It has retained three formulas that could have significant benefits in the trajectory of these women and their unborn children. This ranges from the elimination of the 200% surcharge on incurred costs currently imposed, to free admission for all, and free admission for migrant women who meet vulnerability criteria (such as poverty and under-education).
Minister Dubé said he was waiting for the conclusions of the working group supposed to weigh these options and assess their feasibility in order to decide. The matter is not simple: it will be necessary to be fair while preventing all possible abuses in order to maintain sound management of the plan. We hope, above all, that it does not delay.
By dint of tearing ourselves apart on Roxham Road, we ended up losing sight of a cardinal value dear to Quebecers, that of taking care of our people. Regardless of the number of immigrants that Quebec wants or can take in—and that will have to be defined one day—women without status are pregnant here, now. It’s unfortunate, but a pregnancy does not go on ice.