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Healthcare as (Un)Belonging: RAMQ’s Exclusion of Canadian Children due to Parental Precarious Migratory Status

Photo credit: pch.vector
October 1, 2020

Vino Landry is Global Symposium Coordinator at the Samuel Centre for Social Connectedness (SCSC) and Bachelor of Civil Law/Juris Doctor candidate at McGill University. Her main interests lie at the intersection of forced migration and health policy. This summer, Vino served as an in-house researcher for SCSC’s collaboration with Human Rights Watch on migrant detention in Canada.

The public healthcare system is a source of pride for many Canadians. Despite having room for improvement in terms of long wait times and efficiency, the ability to seek medical care without weighing the value of one’s wellbeing against the cost of services fosters far better health outcomes across the nation. By removing the barrier of cost for essential services, universal healthcare helps mitigate the effect of inequalities in accessing medical attention. Despite the strengths of this system however, there are still some vulnerable members of society that it leaves behind.

The Quebec public insurance board, or Régie de l’assurance maladie Québec (RAMQ), excludes Canadian-born children whose parents have a precarious migratory status from the public healthcare plan. It is the only province in Canada to deny healthcare to children born in the province on this basis. 

Although the World Health Organization (WHO) frames an individual’s right to health and health care as a fundamental right, regardless of their status and country of origin, these children are excluded from public health coverage until they turn eighteen, or until their parents’ migratory status is regularized. This area is governed by the Health Insurance Act, according to which one must meet one of the following conditions in order to be insured: they must either be a Canadian citizen, an Indigenous person as recognized under the Indian Act, or a permanent resident as defined in the Immigration and Refugee Protection Act. Consequently, those awaiting a decision regarding their migratory status are ineligible for public healthcare under RAMQ. Permanent residents are also excluded from coverage for the first three months following their arrival in Canada, with no exceptions being made for minor children.1

“The consequences  [of inadequate care] can be physical as well as psychological and can hinder children’s integration into daycare, school and the community.”

The impacts of reliable and affordable access to health care extend well beyond the short-term; early childhood is a critical period in human development, with extensive neural networks being formed and refined through environmental stimuli. A lack of access to healthcare during this period therefore, bears consequences on the adults these children grow up to become, and the lives they eventually lead. According to the Quebec Ombudsman’s 2018 report, “the consequences  [of inadequate care] can be physical as well as psychological and can hinder children’s integration into daycare, school and the community.”

These circumstances are further exacerbated by the fact that migrants with precarious status are particularly vulnerable. Leaving behind one’s native country often represents a simultaneous loss of vital support networks, leaving forced migrants feeling even more isolated in adapting to a new and unfamiliar host society. Studies have shown that forced migrants are often subject to lower incomes, difficult working conditions, and ineligibility for many social or financial government aid services; children in disadvantaged families are more likely to present physical health programs, cognitive difficulties, and socio-affective disorders. 

As these families endure adverse circumstances and await the decisions that will determine the course of their lives, we must ensure that the vulnerable young members of this community are not arbitrarily excluded from the health coverage that is granted to all other Canadian-born children. In a country that values accessibility of healthcare, Quebec’s unwillingness to extend public health insurance to these children born within its own borders only serves to make migrant families acutely aware of their precarious status in Québécois society. 

The public healthcare system is not an instrument with which to mediate belonging and unbelonging in a nation; all Canadian children have a right to healthcare.2,3,4 When it comes to the health and development of young children during the most formative years of their lives, the Province must abandon these restrictions on care and signal to migrant families that the well-being of children is not subordinate to or contingent upon the migratory status of their parents. 

1The Régie could take a cue from a modification of Quebec’s Education Act in 2017, which now states that preschool, elementary, and secondary school instruction are to be provided free to every person not resident in Québec, “on the condition that the person having parental authority over that person ordinarily resides in Québec.”

2Canada is committed under the United Nations Universal Declaration of Human Rights (1948) to ensure that “everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care.”

3The International Convention on the Rights of the Child (1989) also requires that “states recognize the right of the child to the enjoyment of the highest attainable standard of health and to facilities for the treatment of illness and rehabilitation of health. States shall strive to ensure that no child is deprived of his or her access to such health care services.”

4The Quebec Charter of Rights and Freedoms (1975) states that every human being has the right to personal security, inviolability, freedom and assistance; the Charter also denounces discrimination on the basis of age or parentage.