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Third Reading, Bill C-31, An Act respecting cost of living relief measures related to dental care and rental housing

Honourable senators, I also rise to speak to Bill C-31, and, before I make my comments, I would like to thank Senator Yussuff, the sponsor of the bill; Senator Seidman, the critic of the bill; and all my colleagues who have spoken to the bill.

This bill will provide financial assistance for two unrelated programs. The first is to provide a dental program for children under the age of 12 years old if their families meet the criteria defined by the act. The second is a rental program to provide financial assistance to individuals and families who rent if they meet the criteria defined by the act.

Since the two programs are unrelated, I will begin by commenting on the dental program for children under the age of 12 years old. The dental program outlined in Bill C-31 is phase one of a national dental program, which was announced in Budget 2022. That budget proposed to provide funding of $5.3 billion over five years, beginning with $300 million this year, and $1.7 billion annually thereafter to provide dental care for Canadians.

The program will start this year with children under the age of 12 years old, and then expand next year to children up to 18 years of age, seniors and persons living with a disability.

Full implementation of the national dental program will occur in 2025. For this year, the dental program is restricted to families with an income of less than $90,000 annually, with no copays for those with an annual income of less than $70,000.

Health Canada officials told our Finance Committee that this program for children under the age of 12 years old is estimated to provide dental services to half a million children across the country.

Budget 2022 estimated that the cost of this dental program for children under the age of 12 years old during this fiscal year would be $300 million — compared to the estimated cost of $247 million, as disclosed by the Parliamentary Budget Officer.

However, the Parliamentary Budget Officer, in speaking about the estimated cost of the dental program, told us it would be to the advantage of legislators to have much stronger projections than we currently have with respect to not only Bill C-31, but also to the dental program as a whole. He said that Bill C-31 is only a down payment on a program that is supposed to be much larger and permanent. To emphasize this point, he went on to say that, in his opinion, he does not think it is normal that we do not have better information.

Another major issue discussed at committee was the harmonization of the dental program with existing programs — or should I say, the lack of harmonization. During testimony at our National Finance Committee, we could not get a clear description of how the proposed federal dental plan will be harmonized with provincial plans and private insurance plans.

A 2019 study by the Canadian Agency for Drugs and Technologies in Health, or CADTH, identified over 80 different public oral health programs across federal, provincial and territorial jurisdictions with significant variations between these programs in terms of eligibility criteria, services covered and reimbursement rates.

While this indicates that there is public sector funding for dental care in Canada, most dental expenses are either paid using private dental insurance, or paid for out of pocket by individual Canadians or their families.

Mr. Giroux, the Parliamentary Budget Officer, said in his testimony that he did not see any provision in the legislation that seeks to harmonize a new dental program with existing programs. Rather, children whose parents have private dental insurance are not eligible, and those who are covered by a provincial plan are eligible only to the extent that they have out-of-pocket expenses. Provinces and private plans are first payers, and the federal plan comes in after. He said he has not seen any intention to harmonize the plan.

The Canadian Dental Hygienists Association, or CDHA , in their testimony, expressed concern that Canadian employers will repeal private dental plans to offload coverage to the federal plan. Similarly, there’s also a concern that provincial plans will be scaled back once the federal plan is implemented. However, Minister Duclos, the Minister of Health, has assured the committee that no displacement or crowding out of existing plans is anticipated.

Dr. Walter Siqueira, Dean of the College of Dentistry at the University of Saskatchewan, told our Finance Committee that dental students at the 10 dental schools across the country provide professional dental services to many patients, including some patients who will benefit from the proposed dental program. These services are provided at a lower cost, and dental students are provided with practical experience before they graduate. Dr. Siqueira indicated that dental students at the dental schools are concerned they may lose some of their patients to the new program, and this would be a big loss to the students and the dental schools.

Several senators were interested in determining the results of the dental program, which would include a comparison of the cost of the program with cost savings in health programs which are left to deal with the problems resulting from poor dental health in children. I have spent a significant amount of time studying Departmental Results Reports in which many government departments and agencies cannot even meet half of their self-imposed performance standards, so I’m doubtful that any cost-versus-savings analysis will be done.

Mr. Giroux, in responding to the question, said the following much more eloquently than I can. He said that it’s essential to try to capture the benefits and measure whether they have meaningful results. However, he had not seen or heard anything to indicate the government intends to measure the benefits of the dental program, and if the past is any indication, he said he’s not confident it will be done. He concluded that “. . . it’s unlikely we’ll see the government measuring the impacts of Bill C-31, which is unfortunate.”

Incidentally, Health Canada in its 2020-21 Departmental Results Report indicated it had met only 42% of its performance indicators, while the Public Health Agency of Canada indicated it had met only 29%.

Honourable senators, I support a dental program for children, whether it be federal or provincial or a combination of the two. As a former elementary school teacher, I have seen first-hand the results of poor dental hygiene in school children under the age of 12 years. It is not only the poor condition of their teeth but the pain and discomfort the children must endure when they have dental problems but no access to dental services. Dental day surgery for children is not uncommon. In a country such as Canada, all children should have access to a dentist and receive regular dental care.

It is unfortunate that the federal government is not proposing a real dental program. It is a missed opportunity to ensure that the children are actually receiving dental services. What government is proposing in Bill C-31 is financial assistance to low-income families, with no assurance that children will actually receive all the dental care they need. Even the Canada Revenue Agency could not tell us what post-disbursement procedures will be carried out to ensure that a child actually receives dental services as a result of the money paid out.

My final comments on the dental program relate to the adequacy of the funding to be provided. There are two benefit periods: October 1, 2022, to June 30 of next year, and then from July 1 of next year to June 30, 2024. Benefits would be $650 per child if the family’s adjusted net income is less than $70,000; for higher-income households, $390 for each child if the family’s adjusted net income is between $70,000 and $80,000; and $260 for each child if the family’s adjusted net income is between $80,000 and $90,000.

There was some discussion regarding the adequacy of the funding and what recourse the family would have if the amount approved were not sufficient.

The Canadian Dental Association informed us that based on a representative sample of more than 109,000 electronic claims submitted in March of this year across all provinces and territories, the median claim per visit for a patient under age 12 years was $150. The association said that, overall, 95.6% of all claims submitted for children under age 12 were for less than $650. This was consistent across jurisdictions, ranging from a low of 91% to a high of 99%. So while it looks like the amount might be sufficient for most children, it still does not resolve the issue if a child’s dental services require more than the amount that’s stipulated in the legislation.

The dental program defined in Bill C-31 is not a dental program but rather a financial assistance program administered by the Canada Revenue Agency, an agency whose primary function is to administer tax laws for Canada and most of the provinces and territories to collect taxes. The dental program does not even reside in the Department of Health or the Department of Social Development.

Honourable senators, Bill C-31 is also proposing to provide a rental program of $500 to individuals who rent and meet the criteria stipulated in the legislation. Rental rates across Canada continue to increase, and the Bank of Canada’s increase in interest rates will impact the country’s rental market. According to the Toronto Regional Real Estate Board, rent in just Toronto has increased 20% compared to last year. The objective of the government’s rental program is to assist low-income renters by providing $500 in financial assistance. The government estimates that this program will provide financial assistance to 1.8 million renters.

To qualify, renters must meet several criteria, although officials from the Canada Revenue Agency told us that compliance with all of the criteria will not be confirmed prior to issuance of the cheques. They told us that the adjusted net income ceilings of $20,000 for individuals and $35,000 for families can be verified through the tax system, and the applicant will have to provide information that the rent paid during 2022 was at least 30% of their adjusted net income. So, as they put it, there will be validation up front of that calculation; however, there will be no confirmation of rent paid. Rather, the Canada Revenue Agency intends to set up audit and compliance checks subsequent to payment of the cheques, but officials could not provide us with any information regarding post-payment audit and compliance checks.

Budget 2022 estimated that this $500 benefit would cost $475 million. The government has since increased that estimated cost of $475 million to $1.2 billion, or more than twice the original estimate. I mention this because this is quite a significant increase, and I question how the government could be so wrong. The Parliamentary Budget Officer estimated a cost of $940 million for this program but could not reconcile his estimated cost of $940 million with the government’s original estimate of $475 million or the government’s revised estimate of $1.2 billion.

The Maytree Foundation, a private charity, in its brief to the committee, recommended that the requirement for applicants to pay at least 30% of their income be dropped, since the ceiling on adjusted net income for both a single person, at $20,000, and a family, at $35,000, is so low that any proportion spent on rent would be a financial burden. They also said that the section of the act which allows applicants living in multi-tenant dwellings to use only 90% of their income to determine whether they pay at least 30% of their income on rent is unfair. It is possible that by using 90%, it would just barely prevent people from accessing the benefit.

While government committed in Budget 2022 to provide financial assistance to renters, it is not addressing the issue of rising interest rates and the increasing cost to homeowners of paying their mortgages. Budget 2022 contained a number of initiatives to encourage people to buy their homes. This was accompanied by assurances from the Bank of Canada that interest rates would not increase. In fact, in June of 2020, the Bank of Canada dismissed concerns regarding interest rate hikes.

In closing, I’d like to make a general comment on the financial assistance provided to individuals and families. We have recently seen a bill providing additional GST rebates. This bill provides a dental program and rental assistance. I’m confident there will be additional assistance in the future, including those in the Fall Economic Statement 2022. Each program has its own criteria, its own income ceilings and, in some cases, staggered levels of assistance within the programming.

Has the government determined who benefits not only from each individual program but from all the programs as a group? Are the same individuals and families being assisted by each of the programs, and, if so, why not have just one program or two programs? Or is each program assisting a different group of individuals and families? If so, are these the families most in need? Finally, are any individuals and families whom the government should be helping being left behind because of the criteria being used in the various programs? Thank you, honourable senators.

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