Thank you, Mr. Speaker. My questions today are for the Minister of Health and Social Services. In March 2009, this side of the House passed a motion unanimously for you to go back and review the changes or, rather, go back to the drawing board on the changes that you are proposing on supplementary health at that time. In discussions following that, the Minister said that she would go back to the drawing board, that she would develop a stakeholders group and she would listen to them for options and alternatives and do some research around that.
Since that time it has become clear that she had been working off a policy that was approved by Cabinet on September 30, 2007, which indicates that there is only one option. It is an income test model. Given that, at the time, there was a significant amount of public outcry about what was being proposed by the Minister. The motion was clear: go back to the drawing board. I saw letters; I heard people on the streets; there were rallies out there. The Minister couldn’t have missed all that. Given that she must have heard all that and given that, in the policy itself, under Section 5, paragraphs 2(b)4, there is actually a clause that says that the Minister may recommend revision to this policy to the Executive Council. Given that all that information was out there and all that concern exists, can the Minister tell me when she went back to Cabinet seeking possible revisions of the policy which would allow her to actually consider other options and alternatives rather than just relying on the income test model that we are now faced with today?
The Minister of Health and Social Services, Ms. Lee.
Thank you, Mr. Speaker. The Member is right; there is a provision there that would allow me to go back to the Cabinet for revision. We heard and analyzed and reviewed the feedback that we got from the public, and based on the analysis we had, we did not conclude that we had to go back to Cabinet for revision, but we did go to the Cabinet with options on what we have heard. Thank you.
Mr. Speaker, I would like to know which public she was listening to. Thank you, Mr. Speaker.
Mr. Speaker, the fact of the matter is, the Minister and this Cabinet and this Legislature has to consider supplementary health benefits in the context. As the Member for Sahtu has mentioned, and others, the government is responsible for insured benefits as well as non-insured. Supplementary health is non-insured. The government has a priority to use its money on insured services. For non-insured services, it is to come up with a program that is as fair and as equitable as possible. We have to realize that there is some personal investment that has to be made into this program. We are asking the people to do that in this context. Thank you.
I still didn’t hear an answer to my question. I’m not sure which public she is listening to. Clearly, there’s a significant amount of people out there who have concerns.
I want to go back to the policy for just a second. The statement of the policy is that the Government of the Northwest Territories will provide certain supplementary health benefits to non-aboriginal residents and their families who are not eligible for either -- and it’s an or question -- either supplementary health benefits available to aboriginal people or for supplemental health benefits available through employer programs. Aboriginal people are entitled to top-up for things such as specified medical conditions, the catastrophic conditions. Under this new program that she’s proposing, people with insurance who have catastrophic conditions are completely out of luck. I’m curious how we can ignore those people with catastrophic conditions who happen to have insurance, given that the statement of the policy actually would cover those individuals. Thank you.
Thank you. The proposal that we have, that’s under discussion and we will continue to have that discussion to hear out what the Members have to say. This policy has a suggestion for a cap, and also we are working on a catastrophic drug coverage and other programs, Mr. Speaker. Thank you.
Final supplementary, Mr. Abernethy.
Thank you, Mr. Speaker. I am listening, but I’m not really hearing any responses. So I’m just going to ask a related question slightly different.
Consistently the Minister talks about a program that is generous and equitable. Clearly, there are people excluded from this. Anybody with insurance in the Northwest Territories is excluded completely from any top-up. In some cases, most people, if costs aren’t high, that might be alright, except in some cases people do have catastrophic conditions where the costs are clearly high, and I think those numbers are larger than the Minister is accepting. I’m curious if she could explain to me in detail how a system that clearly excludes people who have insurance and catastrophic conditions is in any way, shape or form, generous or equitable? Thank you, Mr. Speaker.
Because, Mr. Speaker, I think that the one thing that we need to remember is that all governments try to have a program that supports the residents on low income, or seniors, or a person with disabilities, those people who need the government for non-insured health benefits. So in that way, this program that we have designed is very generous and much more comprehensive than any that is available in the rest of the country.
The fact of the matter is, Mr. Speaker, we have to put this in the context of other obligations that the Department of Health and Social Services and the government has to provide health care services to the people across this Territory. Thank you.
The honourable Member for Weledeh, Mr. Bromley.
Thank you, Mr. Speaker. I have questions for the Minister of Health and Social Services, and I’d like to look at a consultation process following up on my questions on Monday. When I asked the Minister why the NWT Pharmaceutical Association’s offer of advice and AGM appearance to the department was not taken up, the Minister replied saying she didn’t invite Mr. Dolynny’s offered input because he was not the current association president, and that five-day notice of the AGM was too short for her staff to make the meeting. I’ve gathered information from the association which paints quite a different picture of the facts.
First, I’m told that the stakeholders panel, set up by the Minister to advise her on the proposed changes, requested the participation of the Pharmaceutical Association, but the department specifically refused to include them in that process. Can the Minister tell me why the advice of these front-line providers was declined in participation of the panel? Thank you.
The honourable Minister of Health and Social Services, Ms. Lee.
Mr. Speaker, I just need to correct that. I was not in any way suggesting that anybody couldn’t put an input into this unless they wore a title. So if the Member understood it that way, I do apologize. What I meant to say yesterday in answering the question why have you not consulted with the pharmacy association or Nurses’ Association or any other medical related health care professionals, and my answer was yes, we did. We wrote a letter to the pharmacy association. I have actually asked the staff to put that on the website. I have consulted with many people about this supp health plan. My point is, the pharmacy association did not respond to that, but Mr. Dolynny later on did respond and say you didn’t consult us. My point is that we did contact the associations and we are listening to anybody who wants to tell us. Thank you.
Thank you. Again the Minister has refused to answer the question. Why did she not respond favourably to the stakeholders panel she put together for inclusion of the Pharmaceutical Association? I also understand now about the five-day notice the department had to participate the in the Pharmaceutical Association’s AGM. The association actually invited the department quite early on in a timely way, but the department was very slow to reply. By the time the reply was received by the association office, only five days remained for the by then scheduled AGM, apparently a time too short for the Minister to arrange for a person to attend. But I have to ask the Minister to explain why is it this department, again, would have not been knocking on their door in the first place, and certainly why could they not free up a person to attend and take notes on the insights of a front-line provider like the Pharmaceutical Association of the Northwest Territories.
This is an important issue and I’m not sure if we want to talk about who sent what e-mail and when. I can assure you that I do have a chronology of the invitation from the pharmacy association and our response was prompt and swift. Having said that, Mr. Speaker, the pharmacy association is welcome to give their input, but the fact of the matter is, yes, they’re a front-line provider.
The Supplementary Health Plan we are suggesting is in place in every other jurisdiction in Canada. That’s what all the other pharmacists and pharmacies do use. So, Mr. Speaker, as a front-line provider, that’s not where the input would come. As a pharmacist, we consult with them regularly. All of the legislation we’ve had, all of the policies we have, we consult with the pharmacies and pharmacy association and other professional associations on a routine and as a regular course of business. Thank you.
Thank you. It’s sad that the Minister doesn’t realize what the main point is here, that this consultation process has been a sham and that some extremely important aspects and sources of good insight for us have been skipped over in the process. I’ve had many comments from constituents on the quality and bias, for example, of the on-line survey, and I know the Minister has received those same comments, a survey which was also difficult to fill out with complete comments. Many have noted that the survey may not have been available to seniors that don’t have computers. I’m told that the, well, I’ve concluded the results of the survey itself indicate highly equivocal responses. I’m sure the Minister must recognize that by looking at the answers, the proportions of answers, the yes or no answers provided, entirely equivocal responses, which is exactly what you would expect from a questionnaire with ambiguous questions. Can the Minister explain how she thinks this survey was at all meaningful? Thank you.
Thank you. Later today I will be tabling a document called What We Have Heard, and we outline everything that we have heard in all of our consultations and meetings we have had. We’ve had very frank and direct comments from our people. Also on the website there might have been yes or no questions, but there was always room for somebody to put in their input.
People have called us; people have e-mailed us; people have talked to me on the phone; they have called me. In the Northwest Territories we live in a very small space and we know everybody, a big space, but we know each other, and so I have had input from the people, as have the MLAs.
The challenge we have here is what we are talking about is a very, very difficult thing to talk about. When you are talking about anything to do with health benefits it is a very, very difficult thing to do. There are certain things we have to talk about: universality versus co-payment, non-insured health services versus insured health services, catastrophic drugs versus regular drug costs. All those things a lot of people don’t want us to change that at all. So I don’t think it’s necessarily true that there was a flaw in the consultation. It’s just that, at the end of the day, it is difficult to make changes. Thank you.
Your final question, Mr. Bromley.
Thank you, Mr. Speaker. Again, there’s quite a disagreement both from the public and the Members here on the Minister’s perspectives on this. The Minister continually refers that we follow a system that’s a commonly used model in other parts of the country and so on. We’re not interested in that. We want to develop a specific system for the North.
Mr. Speaker, when I asked whether an analysis of the cost of administration had been made, the Minister replied, according to Hansard, “we will be going for RFP to find a service provider such as Blue Cross or any other insurance company. They are equipped and trained and set up to deliver a program like this.” Mr. Speaker, Blue Cross fills forms, not prescriptions. Why are we to have any respect for a consultation process that was biased, narrow, controlled, and based on pre-determined actions? I’m asking for a new consultation process where everyone can develop the respect for it that is needed, and that would indicate that a good process has been had and a good solution has been found. Thank you.
Mr. Speaker, this issue has been discussed in and out of this House since 2003. You will hear very frank input in the report that we have submitted today. I know people are very concerned about these programs and whenever you are making changes, it is difficult. It is difficult for us to talk about what we need to do. We need to be clear about what we need to do. We need to be able to find a way to help those who are currently excluded. We need to be able to do it in a way that minimizes the impact of the changes. We need to do it in a way that we have a sustainable health care system where our resources go to insurer services, nurses and doctors and health centres, surgeries, all those things. No government has all the money they need. This is not about cost cutting at all, it’s not about dollars, but it is about sustainability. It is something that we need to work through and I’m willing to work with the Members on the other side to see how to make this work. Thank you.
The honourable Member for Sahtu, Mr. Yakeleya.
Thank you, Mr. Speaker. Mr. Speaker, my questions are to the Minister of Finance, the money man, in terms of the supplementary health benefits. In terms of this issue, I want to ask the Minister of Finance, in his understanding that if we are to continue on with the existing program as it is now, could we, in his financial forecast, can we sustain this type of program?
The honourable Minister of Finance, Mr. Miltenberger.
Thank you, Mr. Speaker. Mr. Speaker, like every jurisdiction in the country and probably in the world, we are facing an increasing and consistent rise in our health expenditures. Member Bromley said it should be at the top of our list when it comes to our priorities, but when it comes to our expenditures it definitely is and it continues to be.
We have, on the supplementary health side, a growing demand for the service. Plus we know, as the Minister has pointed out, we’re trying to capture those folks that aren’t currently captured, about 2,300 people.
As we have every budget, we are going to be pressed to make decisions. We have far more needs than we have resources and we are constantly looking at how do we control and manage our expenditures. At the same time, are there ways to boost or increase our revenues? We are talking now about trying to consolidate what we’ve done. We’re talking now -- having lived through the last two years of the most turbulent economic times since the Great Depression -- of that pressure that is still there for us to be very vigilant and frugal.
So are things sustainable? We are going to continue to have to make choices. We’ve been asked and told to look at ways of being creative, look at how we do business. The program review unit was put together to help us find those efficiencies. This has been identified back in the 14th Assembly as an issue that needs to be addressed, and we are constantly going to be, until the end of this term, working to manage our finances. Thank you.
Mr. Speaker, that’s another question I want to pose to the Minister of Finance. In terms of sustainability, in terms of the program that we offer now and what we are discussing right now through the government’s initiative to propose changes to the supplementary health benefit, there are going to be some tough choices coming down in the next couple of years in terms of what we receive from the federal government and what we want in our communities. I spoke of that very passionately about the needs in Colville Lake, for example, and many other small communities also are going to be asking about some of those basic services.
With this plan that the Minister of Health is proposing, this policy, are we able then to look at some of these basic needs that we so desperately want in places like Colville Lake or in the Sahtu?
Mr. Speaker, we’re going to be challenged with our core services, like the Member has talked about, the basic medical services in communities. We’re going to be challenged with supplementary health. What we are trying to do is reprofile some finding. We are looking at putting in on a supplementary program some income testing to assist us to do that to control the costs, to be able to provide the service to all Northerners, including the working poor that currently aren’t included. At the same time, recognizing, as we look in our budgets and we look at our strategic initiatives and the work in the small communities, that there are significant unmet issues in those communities.
Our challenge is going to be to deal, first and foremost, with our core services. I mean, that’s what we expect in every community. So we have that challenge and everything we can do, be it building an office building in Yellowknife that could free up $100 million a year, be it looking at inclusive schooling, looking at other formulas that may not be set up the most proper way and we could look at being more efficient, those are all areas we are going to be looking at that the Members have told us to go and do the work and be creative and find our efficiencies. So our challenge is going to be to do that to meet the very needs that the Members raise so passionately in this House today.
I would just like to recognize that the time for oral question has expired, but I will allow the Member to conclude his supplementary and final question. Supplementary question, Mr. Yakeleya.
Thank you, Mr. Speaker. Mr. Speaker, again, I ask the Minister of Finance, in your analysis as the Finance Minister, if we were to go ahead or not go ahead with what we’re talking about today in terms of long-term impact benefits, again, I will say to the people in the Sahtu, this would greatly hinge on my decision as to basic services that we do not receive in the Sahtu communities or any other small communities that we so desperately want to see in our communities. This is very important to me as a Member, as a Member who represents a community that has a facility like Colville Lake that, still today -- we talk about it -- has a honey bucket system for the washroom in their health centre. This is crazy. So, again, this is what we are faced with in terms of the Supp Health Program and issues that we have to face in our small communities when we go back to our region.
Can I ask the Minister again, in terms of is this program, again, in all his analysis as the Finance Minister, saying our current health system and as for the basic needs that we’re asking for now in our small communities?
Mr. Speaker, in my opinion, if we continue to do business as usual and if we continue just to accept the fact that we’re going to have continued expansion to programs like this, supplementary ones, when we know that we’re not meeting all our core services, that if we don’t come up with creative ways and if we don’t recognize that the issue of universality in areas like supplementary programs is not affordable in any jurisdiction including ours, then it will limit our ability to meet the needs that we have in the core service areas that currently we are struggling to meet. Thank you.
Your final question, Mr. Yakeleya.
Thank you, Mr. Speaker. The Minister indicated that over the years we are going to have to look at the list of priorities in terms of how we spend our money, how we look at revenue, how we want to be able to sustain our needs in the Northwest Territories. Some of these priorities, for example, are some of the expenditures that I guess we can call in question. For example, the issue of building liquor stores in another region here over the front-line service workers. Is there some of this that we are going to look at in terms of what do we put ahead of the front-line health services in our communities?
Mr. Speaker, The Government of the Northwest Territories has responsibility that covers 360 degrees of the compass. We have to allocate money. We have legal responsibilities, mandated responsibilities. We have responsibilities that are there by choice and by need. Our challenge is going to be, as we do for every business planning process, to make those choices. There is discussion in the House that the Member for Kam Lake pointed out. We have many challenges ahead of us, unmet needs, pressures to contain our costs and control our expenditures at the same time, trying to look at revenues but not raise the tax burden on Northerners. We have to make those choices. We have been making them collectively for the 15 years I have been here and all the years before that this Assembly has been in existence. I want to point out once again that we have managed to do that successfully during the three most turbulent years in our economic history since the 1920s. Thank you.
Item 9, written questions. Mrs. Groenewegen.
Thank you, Mr. Speaker. I would like to seek unanimous consent to return to item 8 today on the Order Paper, oral questions. Thank you, Mr. Speaker.
---Unanimous consent granted
Item 8, oral questions. Mr. Hawkins.
Thank you, Mr. Speaker. On Tuesday, May 11th, I asked a question to the Minister of Health and Social Services regarding Section 5, in a very similar vein as Mr. Abernethy has. I asked the Minister of Health and Social Services, has she ever taken back some of these issues to Cabinet to revisit this change to the policy of supplementary health. In her answer on page 31, she remarked outstandingly with a clear absolutely. Mr. Speaker, of course, later during the day, I had asked if she could table those facts. Of course, she began to tell me no, how she can’t. Today in answering Mr. Abernethy’s question, when he asked the same question in a different way, of course, regarding Section 5, about what had been brought back to Cabinet for reconsideration, her answer to Mr. Abernethy was, they don’t see the need to because the analysis has already been done. Mr. Speaker, in an unclever way, I am trying to figure out the contradiction of these two answers over simply two different days.
Mr. Speaker, can the Minister of Health and Social Services clear up this clear contradiction that the House is now struggling with one way or the other? Thank you.
Minister of Health and Social Services, Ms. Lee.
Thank you, Mr. Speaker. There is no contradiction there. I don’t think it will surprise anybody that the Supplementary Health Benefits Policy has been before Cabinet more often than most issues; probably not as many as Deh Cho Bridge, but, Mr. Speaker, it has been a popular topic in Cabinet.
We take the input from the public very seriously. We understand how difficult it is to make any changes to a health basket of benefits that a lot of people hold dear. We went out with the first implementation at the end of November 2008. We heard a lot of things from the public. We took it back to the drawing board. We had somebody look at the entire program, top to bottom, upside down. We did do that and throughout the course of that review, I have gone back to the Cabinet about what we are finding, what does it mean, what are the other jurisdictions doing, what is the user profile of the people that are using it, what is our people’s ability to pay, what is a non-insured service versus insured service, what does it mean to have an income threshold of this and that and whatever, how are we going to do the public hearing, who are we going to talk to, how long do we have. We have done all of that.
Mr. Speaker, I do totally respect that this is a very, very difficult issue. But, Mr. Speaker, I don’t think there has been lots of discussion on this side of the table about this policy. Thank you.
Mr. Speaker, I have to admit, I think the contradiction in two answers still lies before the House. The Minister will tell us that she is looking for suggestions. It is almost as if she is pointing at us for those suggestions. Mr. Speaker, time and time again Members have said, as well as the public who is here today have said, consider this. Additional taxation, look for efficiencies, find another way.
Mr. Speaker, where is the analysis in answering those questions? Where is the proof to show that they have been considered? Where is the proof that the Minister has taken the time to listen to the public who struggled very hard with this issue that she seems to be clearly ignoring? Thank you.
This is just to remind the Members in the gallery if we can have some order in the House. We don’t usually applaud in the House, so if you could keep it down. Minister of Health and Social Services.
Mr. Speaker, the policy says if the Minister wants to make revisions, the Minister has to make specific recommendations on that. We incorporated the feedback that we had heard and if we were to decide that income test will not be used or the major items of the policy was to be changed, that would have had to go back to Cabinet.
The fact of the matter is, we did the analysis. We as a government feel that this cannot be universal. The Minister of Finance did a round of consultation on revenue options and taxation. We heard soundly from everyone that raising tax is not an option that we should look at. We heard people suggesting premiums, people suggesting other means. You do the analysis and you listen to those and you review them, but unless you are going to make a recommendation to change the policy, you don’t have to raise that specific question. Thank you.
Mr. Speaker, I think we could have saved five minutes by just saying nothing. Mr. Speaker, honestly, this is very upsetting and certainly shameful. The Minister will keep telling this House and the people of the North that the silent majority support her. Mr. Speaker, I was camped out in front of the post office, Shopper’s Drug Mart and a few other places having people sign post cards. Lots of people signed it to tell the Minister to revisit this policy, Mr. Speaker. I only had maybe one or two people said they liked the direction. Mr. Speaker, there is not a silent majority on this issue. Where are the Minister’s facts on that silent majority supported? I am not talking about the people who are covered or the people who always will be covered. I am talking about where are the people of the silent majority who won’t be covered showing you this is the right way to go? Will the Minister prove that to this House and prove that to the people in the gallery and prove that to the people of the Northwest Territories? Thank you?
Mr. Speaker, as I indicated already, I will be tabling a document later today that speaks to what we have heard. Mr. Speaker, there are people who are writing to us and telling us that, and even the Members here have said that we do need to find a way to bring in the people who are excluded. We are having disagreements about how we do that. I appreciate that. There are people who say, go universal, make this part of core service. We have a challenge to that as a government.
If I had all the money in the world, I would like to make everybody happy and pay for all the medication, equipment and no income testing, no nothing, just take care of our people to the fullest extent possible. We do not have that luxury. Yes, taxation option, we have consulted with their departments about raising taxes to pay for this, but the challenge we have is no other governments in the country would raise taxes to pay for something that is not a core service. I know some people would like us to make this a core service, but that is a value question on the government. That is something that I would differ.
Mr. Speaker, I’m not in any way suggesting that people are telling me to do this, do this, do this, that’s not what I’m saying. What I’m saying is I am listening. I do understand what people are saying, and I understand how difficult this is. We need to keep on trying to work this out. Thank you.
Final supplementary, Mr. Hawkins.
Thank you, Mr. Speaker. I’m not sure I’m going to call this a consultation, because I certainly would not define it as meaningful. Mr. Speaker, there were legitimate questions asked by the public in a way to address this situation. Certainly, find efficiencies in some form and do a strategy around that, and certainly consider the option of taxation. If it can be spread out across the Territory so we can all share in the much needed, important essence of health care. Mr. Speaker, Mr. Dana Heide, probably to his long-term regret, let it quite clearly slip that he was always given the direction, because of the policy, to do this with a co-payment. Mr. Speaker, that was never the intent from this side of the House, as the focus. Mr. Speaker, it was always about starting in a fair and equitable way.
Mr. Speaker, when will the public be able to listen to the answers that the Minister has heard in the form of questions? Will the Minister be responding in any public way before the policy is cut and dry and can never be changed? Will she give the public that one more chance to speak to it once the formal policy is made public before it’s implemented?
