When Health Care isn’t universal: the case of migrants with precarious immigration status in Manitoba

While Canada has a universal healthcare system, many residents who aren’t citizens or permanent residents are excluded from public healthcare coverage. In Manitoba, migrant workers with work permits of less than one-year, international students, family sponsorship applicants on temporary visas, denied refugee claimants, and undocumented residents do not have access to provincial health insurance. Most of these individuals are racialized, low-income residents.

In Canada, the number of people entering the country through temporary migration pathways has exceeded that of permanent residents since the mid-2000s. While most of these new migrants arrived through established temporary migration programs, they are classified as having precarious immigration status. Precarious status is an umbrella term for all migrants who have less than guaranteed, permanent immigration status. People under this status likely came to Canada as temporary and seasonal workers, international students, refugee claimants, and other individuals on temporary residency or visitor visas. They might have lost their authorized status if they stayed in Canada after their permits had expired due to financial constraints, conflicts in their home countries, delays in processing their paperwork for permit applications, or the termination of their employment relationships.

Unfortunately, this situation restricts their access to fundamental rights, including public healthcare. Temporary immigration status is a social determinant of health and contributes to poorer health outcomes for this population. Exclusion from public health care coverage creates a system where precarious-status individuals are vulnerable to labour exploitation and have no social safety nets. Not being covered by public health insurance significantly hinders their ability to receive timely healthcare services.

Migrants unfairly bear the costs of healthcare

Individuals with precarious immigration status often avoid seeking healthcare services due to concerns about uncertain and high medical costs. Many recent migrants typically work in low-wage jobs that provide minimal benefits. While they pay taxes to support healthcare for other residents, they end up paying for their own healthcare out of their own pockets.

Although most migrant workers and international students have private health insurance, these plans do not serve as a substitute for public health insurance. Private insurance plans are typically paid for by the individual and do not offer coverage for all potential health needs covered by public health insurance. Individuals must pay for health expenses upfront, with no guarantee of coverage by private insurance, and may have to wait weeks or months for reimbursement. Pregnant migrants with precarious status incur significant debt when paying out of pocket for labour, delivery, and perinatal care. In Winnipeg, local hospitals are currently requiring a deposit of $20,000 – $30,000 for pregnant residents without public health care coverage to be admitted to hospital for labour and delivery. If unable to pay this deposit, the only other option is to just show up at the emergency room once in labour where the hospital will have a duty to provide care. Still, the costs afterwards are exorbitant, putting new parents deep into debt and further into poverty.

Privacy & the Threat of Detention and Deportation

Those individuals with temporary and precarious immigration status experience chronic stress, worry, and uncertainty in accessing health and other services, both in regard to potential exorbitant fees, and due to fear of detention and deportation. Multiple incidents have been reported during the COVID-19 pandemic in which regional health authorities reported hospitalized international students to the Canada Border Services Agency (CBSA). Under the Personal Health Information Act (PHIA) all personal information collected, including immigration status, should be kept confidential. Disclosure of this information to legal authorities should only take place when a court order has been obtained. But healthcare institutions are regularly reporting individuals with precarious status to federal immigration authorities, even in the absence of a court order. This raises critical questions about the sharing of personal health information with other levels of government and concerns about privacy. It also causes harm to those accessing health care. A 2021 report by Amnesty International and Human Rights Watch outlined the devastating effects of detention on the mental health of individuals detained in Canada. As one of the few countries without a legal limit on the length of detention, individuals may be held indefinitely. Immigrants with mental health conditions and people of colour, particularly those who are Black, are often held for longer periods of time, and held in provincial jails, despite not serving criminal sentences. Many who are detained live with psychosocial disabilities, developed during their incarceration, for months and even years after their release from detention, in turn affecting their children, families, and communities.

Healthcare for All

The COVID-19 pandemic showed everyone that extending medically necessary services such as vaccines and COVID-19 testing to uninsured individuals is pivotal in managing public health crises. Manitoba is a popular destination for migrant workers to settle; provincial data indicates that 9,095 temporary foreign workers entered the province in 2020. The number of immigrants will keep on increasing in the coming years, with the federal government aiming to bring in 1.5 million migrants by 2025.  Extending public health coverage to uninsured migrants will lead to greater social cohesion and higher standards of public health.

Healthcare institutions in Manitoba, ranging from community health centres to hospitals, must also urgently develop Access Without Fear policies to ensure that those with precarious immigration status can access health care without the threat of detention and deportation. The United Nations Human Rights Committee asserts that it is a violation of the rights of irregular migrants to withhold essential healthcare services from them. The Province of Manitoba should ensure that healthcare is available to all residents irrespective of their immigration status, as healthcare is a fundamental human right that should be accessible to everyone.

This guest post was written by Janhavi Srivastava, a social work student interning at OHC for the 2022/2023 year. We’re so grateful for their support and perspective over the last year!