Bill 11 threatens to make access to necessary medical treatment depend on patients’ ability to pay
Bill 11 encourages physicians and surgeons to work in the public system and private-pay market at the same time, charging patients for medically necessary health care, including surgeries already performed in for-profit facilities.
Nearly a year after Alberta opened up Canada to private-pay health care, income will increasingly determine access to necessary surgeries like hip and knee replacements.
Bill 11 directly and unequivocally breaks the Canada Health Act, the federal legislation that ensures cleaners on Bay Street have the same access to health care as bankers working in the same building.
But the federal government is missing in action.
What’s at stake? A legal opinion shows that Bill 11 violates five sections of the Canada Health Act.
Alberta’s legislation contravenes the requirements that all medically required services are publicly insured (section 9), that people have “reasonable access” to insured services without financial barriers (section 12), and that they are entitled to them on “uniform terms and conditions” (section 10).
It also violates prohibitions against user fees and extra billing (sections 18 and 19), which prevent patients from being charged for services already covered by the provincial health plan.
In September, federal Health Minister Marjorie Michel told the Toronto Star that she had written Alberta Health Minister Adriana LaGrange to express concern that the legislation could not work within the Canada Health Act.
But Bill 11 not only may break the law, it does break the law. Concerns from legal experts, medical associations, nurses, unions, researchers and civil society organizations make this clear.
Meanwhile, Alberta is moving quickly. Close to 400 specialists and surgeons expressed interest in working in both the public system and private-pay market in August.
Many procedures available to wealthy patients require nurses and anesthesiologists already in short supply in public hospitals, making longer public wait times likely.
The legislation also opens the door to a U.S.-style private health insurance market that could end public health care as we know it. Time is of the essence to oppose this.
The federal government must initiate the formal review process
If the federal government truly believes that health care is a right, not a business, as the Liberal Party campaigned on in spring 2025, it must immediately initiate a formal review of Bill 11 under the Canada Health Act.
Under section 14, the health minister must send Alberta a letter initiating a 90-day consultation process over the province’s failure to comply with federal law. If Alberta does not repeal Bill 11, the minister must refer the matter to cabinet for possible penalties.
Ottawa can withhold Alberta’s entire share of the Canada Health Transfer—$9.2 billion in 2026-27—until the province comes into compliance.
Premier Danielle Smith will undoubtedly relish another fight with Ottawa, but public opinion is on the federal government’s side.
A recent survey shows that Albertans overwhelmingly oppose Bill 11 and the shift to private-pay health care. More importantly, Albertans rejected the Alberta government’s proposal to opt out of federal programs like health care and give priority to provincial laws over federal laws such as the Canada Health Act.
Public health care is one of Canada’s most popular social programs. If Ottawa fails to enforce the Canada Health Act now, it will abandon not only its legal responsibilities but a fundamental Canadian principle: access to health care based on need, not wealth.
The federal government must act before a U.S.-style system takes hold across the country. Otherwise, Canadians will have every reason to believe Ottawa is prepared to sell out medicare to investors and insurance companies, just as it is prepared to sacrifice other vital public assets.
Andrew Longhurst is a senior researcher and political economist at the Canadian Centre for Policy Alternatives, and author of Not Adding Up: Surgical and Diagnostic Privatization in Ontario.
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