Federal funding for autism therapy, without touching the CHA
Last month Scott Corbett wrote a great piece about this same topic.
I wanted to take some time to reinforce and build on what he said, because there’s some strong evidence to support this line of thinking has potential.
If you’ve read some of my previous pieces (on the Auton trial from the early 2000s, then some history on attempts at a National Autism Strategy from 2006 onwards), you know that the quest to get autism therapy funded by the Federal Government has been fruitless and frustrating so far.
A common ask from the bills put forward through the years involved amending the Canada Health Act. The closest attempt was Bill C-304 in 2007, which made it to Second Reading before being voted down by the Conservatives and the Bloc.
Conservative MP Mike Lake, first elected in 2006, was part of that vote, and voted against the bill. He made a public statement afterwards, explaining his decision. FEAT BC (Families for Early Autism Treatment of BC) released an annotated response to Lake’s statement, seen below:
I encourage you to read his whole statement, but I wanted to highlight a few of Mike Lake’s quotes:
The problem is this. Bill C-304 is bad legislation. It proposes an ad hoc amendment to the Canada Health Act that changes the entire meaning of the document. It would set a precedent that would eventually undermine the entire Canadian health care system when taken to its logical extension.
When discussing funding for ABA therapy, he had this to say:
In my opinion, it is completely unacceptable for any province not to fund Applied Behavioural Analysis (ABA) for those who need it. If voters feel as strongly as I do about this, they must let their provincial governments know and then hold them accountable at election time.
So he wasn’t against ABA therapy (very much the opposite), but suggested its funding should remain a provincial responsibility. As we know, though, the provincial budgets are largely insufficient in their ability to provide that therapy in a timely manner, or at the level needed. There is also a vast difference in what each province may be able to offer.
Lake went on to state that the bill gave “false hope” to families, suggesting they were being used as pawns in a political game. This phrase is pretty triggering for Ontario autism families, as MPP Lisa MacLeod (formerly the Minister in charge of the Ontario Autism Program) used it often to attempt to defend her disastrous version of the Ontario program, which is currently being completely reworked.
So if the Canada Health Act is potentially off limits as a viable solution to fund autism therapy, how can it be done?
Looking at some recent federal legislation from the current Liberal-led government may help light the way.
Shared Health Priorities
In August 2017 the provinces and territories agreed to a Common Statement of Principles on Shared Health Priorities, with a focus on mental health.
Each jurisdiction then had to negotiate and sign a Bilateral Agreement with the Federal government to detail how the funding would be spent.
From the announcement:
Budget 2017 confirmed an investment of $11 billion over ten years to provinces and territories specifically targeted to improve home and community care and mental health and addiction services.
So basically: Federal dollars, going to each province, for specific health initiatives.
National Dementia Strategy
In June 2019, Ginette Petitpas Taylor, Federal Minister of Health, announced the release of A Dementia Strategy for Canada: Together We Aspire.
Budget 2019 proposed funding of $50 million over five years to support the implementation of the Strategy through actions in four areas: awareness, treatment guidelines, early diagnosis, and surveillance.
As a mental health issue, dementia initiatives are something that could be included in the bilateral health accord agreement between the federal government and the provinces, and provinces like Newfoundland did just that.
A National Dementia Strategy can work alongside the bilateral funding agreement to both facilitate the sharing of best practices, as well as making federal money available to take action provincially.
National Housing Strategy
Announced in 2017, the National Housing Strategy (NHS), titled “A Place to Call Home,” came with a $40 billion investment over 10 years.
It included cost-sharing bilateral agreements with the individual provinces/territories.
As an example, you can find a release on the agreement the feds made with the Ontario government here, announced in April 2018.
So basically: The Federal and Provincial governments working together on shared priorities.
Sensing a pattern yet?
National Pharmacare Strategy
Now this strategy is still in its infancy, with a report from the Advisory Council on its implementation just released this spring.
Enhanced Pharmacare passed as a policy resolution by the Liberals in 2016, then again in 2018, and the concept has been supported by both the NDP and Greens.
Andrew Scheer’s views take on more of a Liberal-bashing approach:
“I don’t believe anybody thinks that when Liberals announce multi-billion dollar spending programs that they’re going to save money,” he said. “The fact of the matter is, they’ve been making this promise since 1997 and in the dying days of a scandal-plagued government, they’re trying to bring this forward.” He said a Conservative government would take steps to lower drug prices and improve access for those who can’t afford it, addressing “gaps” in the system.
Here’s a good article from June 2019 talking about the current status of the Pharmacare program, for those interested:
Bilateral agreements still have to be negotiated, and as Dr. Joel Lexchin (physician, drug researcher) described in the article, that likely won’t be a simple thing:
Another predictable challenge will be funding. This week’s report included no proposed cost-sharing agreement, only that pharmacare will be negotiated with the provinces, a process destined to be fractious. The provinces would be all for a national plan if the federal government pays for it, says Lexchin. “But when you get into these cost-sharing agreements, how much do you have to bribe the provinces in order for them to participate? That might discourage some provinces from coming into the plan.
As far as its implementation, when it comes to dealing with the Canada Health Act, here’s a useful excerpt from the advisory report:
Then, within their list of 60 recommendations, there’s a few important points to consider:
Then skipping ahead a few …
So how do we tie this all together?
The high-water mark so far regarding federal funding for evidence-based autism therapy (ABA) has been the 2016 Liberal Policy Resolution:
An important point from part one of the resolution is the use of the word or.
This resolution wasn’t contingent on an amendment to the CHA. There was, and is, another way: A bilateral agreement between the federal government and provinces to negotiate full funding for ABA therapy for autism, outside of the CHA.
So if you take recommendations 50/51 from the Pharmacare Report, and change a few words:
Compel the federal government to enshrine the principles and national standards of evidence-based autism therapy into federal legislation, separate and distinct from the Canada Health Act, to demonstrate its ongoing commitment to partnership on a national autism strategy, and provide for a dedicated funding arrangement. Then have the federal legislation outline how governments will work together and share costs, list federal responsibilities and include the steps required for provincial and territorial governments to fully fund medically necessary autism therapy.
These recommendations could work well in conjunction with a more broad National Autism Strategy, to help address other important issues in ASD like employment, housing, research, etc.
In April of this year, CASDA (Canadian ASD Alliance) released their blueprint for a National Autism Strategy:
CASDA also recently tweeted a letter from MP Judy Sgro, urging her fellow Liberal MPs to support a National Autism Strategy in their platform, using the CASDA blueprint as the foundation:
The huge hole in the blueprint though is that it doesn’t go into specifics on treatment funding, but does include the line “Build leading ASD support into federal health systems” as an Affordability & Access initiative.
Most people can get behind the idea of a National Autism Strategy, but those words need to have meaning.
In Senator Munson’s 2007 Report: Pay Now or Pay Later: Autism Families in crisis, the crisis was not a lack of bureaucracy, it was a lack of real funding and support for therapy.
If the federal parties can finally put politics aside and make real autism support a reality coast-to-coast, they need to get serious about how to make that happen.
The Canada Health Act doesn’t need to be amended.
By looking to the recent past, and the government successes in moving forward on other national strategies, a National Autism Strategy that includes federal funding for therapy is possible.
The time to act is now.
