THE STANDING SENATE COMMITTEE ON NATIONAL FINANCE
EVIDENCE
OTTAWA, Wednesday, November 2, 2022
The Standing Senate Committee on National Finance met with videoconference this day at 6:45 p.m. [ET] to study the subject matter of Bill C-31, An Act respecting cost of living relief measures related to dental care and rental housing.
Senator Percy Mockler (Chair) in the chair.
[English]
The Chair: I wish to welcome honourable senators and ministers, as well as the viewers across the country who are watching us on sencanada.ca.
[Translation]
My name is Percy Mockler. I am a senator from New Brunswick and Chair of the Standing Senate Committee on National Finance.
I would now like to ask my colleagues to introduce themselves, starting on the left.
Senator Gignac: Clément Gignac from Quebec.
[English]
Senator Smith: Senator Larry Smith, Montreal.
Senator Duncan: Senator Pat Duncan, Yukon.
Senator Pate: Kim Pate, from the shores of the Kitchissippi, the unceded, unsurrendered territory of the Algonquin Anishinaabeg.
Senator Boehm: Peter Boehm, Ontario.
Senator Bovey: Patricia Bovey, Manitoba.
Senator Osler: Flordeliz Gigi Osler, Manitoba.
[Translation]
Senator Saint-Germain: Raymonde Saint-Germain from Quebec.
[English]
Senator Yussuff: Hassan Yussuff, Ontario.
Senator McCallum: Mary Jane McCallum, Treaty 1, Manitoba.
[Translation]
Senator Marie-Françoise Mégie: Marie-Françoise Mégie from Quebec.
Senator Dagenais: Jean-Guy Dagenais from Quebec.
[English]
The Chair: Today, honourable senators, we resume our study on the subject matter of Bill C-31, An Act respecting cost of living relief measures related to dental care and rental housing, which was referred to this committee on October 20, 2022, by the Senate of Canada.
Honourable senators and viewers, to help us with this study, we have with us today three ministers: the Honourable Jean-Yves Duclos, P.C., M.P., Minister of Health; the Honourable Ahmed D. Hussen, P.C., M.P., Minister of Housing and Diversity and Inclusion; and the Honourable Diane Lebouthillier, P.C., M.P., Minister of National Revenue.
[Translation]
Thank you for accepting our invitation. We appreciate it.
Ministers, your testimony will help us, on behalf of all Canadians, focus on our committee’s four principles: transparency, responsibility, reliability and predictability.
[English]
You are accompanied by senior officials, who will support you during the question period. I will ask them each to introduce themselves if they are invited to speak.
[Translation]
I am told that Minister Duclos will make his opening remarks, followed by Minister Hussen and Minister Lebouthillier.
Mr. Duclos, the floor is yours.
Hon. Jean-Yves Duclos, P.C., M.P., Minister of Health: Thank you, Mr. Chair.
Honourable senators, on behalf of my colleagues, I thank you for the opportunity to speak today to Bill C-31, An Act respecting cost of living relief measures related to dental care and rental housing.
Today, I am pleased to be joined by Lynne Tomson, Associate Assistant Deputy Minister, Strategic Policy Branch.
As the cost of living continues to rise in Canada and around the world, one of the goals of this bill is to help Canadian families struggling to make ends meet. Accordingly, Bill C-31 proposes the introduction of the Canada Dental Benefit, which, if approved, will be available to eligible families with children under the age of 12 by the end of this year.
[English]
Dental care is essential to maintaining good oral health, especially for our younger citizens whose teeth are still developing. Yet, the reality is that professional dental care is out of reach for too many Canadian families.
Seeing a dental professional can be expensive, and approximately one third of Canadians do not have insurance to cover the cost. This means that many parents have to postpone or forego important dental care for their children at a time where their teeth are developing.
Unsurprisingly, research has shown that Canadians from low- and middle-income families have worse oral health outcomes than those from higher-income families. This is a type of health inequality that Bill C-31 is also designed to address.
In 2018, about 7 million Canadians reported avoiding dental care because of the cost. The consequences of putting off dental care, or worse, avoiding it completely, can be severe. Left unchecked, dental problems can lead to many health issues, including chronic diseases like diabetes and heart disease. This, in turn, increases the public’s dependency on cost-intensive areas such as cardiac, cancer and emergency services.
It is clear that poor oral health places a significant burden on society as a whole. These direct and indirect costs affect us all, and we all stand to benefit when we improve access to dental care professionals.
[Translation]
Once the bill receives Royal Assent, if it does, the benefit would first be made available to eligible families with children under the age of 12. It would enable these families to receive direct payments of up to $1,300 per eligible child over a two-year period, and up to $650 per year for dental care services. The benefit would also be tax-free. Parents will be able to apply for the benefit through the Canada Revenue Agency’s My Account portal or the Canada Revenue Agency’s contact centre. If eligible, they will receive an initial payment they can use to take their child to the dentist.
[English]
In conclusion, in Canada, we believe that costs should not be a barrier to proper health care, including oral health care. If passed, the Canada dental benefit will provide more equitable access to dental care for children so they can enjoy the benefits of positive oral health.
Our hope is that the proposed legislation will be passed quickly so that eligible families can start receiving the Canada Dental Benefit in 2022. There can be no doubt that such an investment will pay dividends for many years to come. Thank you.
The Chair: Thank you, minister. As chair, I will recognize Minister Hussen to receive his comments.
Hon. Ahmed D. Hussen, P.C., M.P., Minister of Housing and Diversity and Inclusion: I am pleased to have the opportunity to appear before you today to talk about one of the affordability measures we introduced in the House of Commons on September 20. This is the one-time top-up to the Canada Housing Benefit.
Our government believes that every Canadian deserves a safe and affordable place to call home. That’s why we’ve adopted legislation that enshrines housing as a human right and we’ve made key investments to the National Housing Strategy to form partnerships with all orders of government in the non-profit sector and the private sector to ensure we build more housing for Canadians right across the housing spectrum.
[Translation]
However, we know that there is a long way to go to make housing and living more affordable for Canadians. Inflation in Canada is at its highest level in almost four decades after the pandemic. Canadian families are finding it increasingly difficult to make ends meet. That is why we are proposing to establish a one-time top-up payment to the Canada Housing Allowance — a $500 tax-free payment to provide direct support to low-income renters facing housing challenges.
[English]
We know that Canadian families and individuals need this support now. We are hopeful that we will get this money into the pockets of those who need it most by the end of the year, pending the passage of the legislation.
This $500 one-time top-up will support close to 1.8 million Canadian renters. The new federal benefit will be available to applicants with an adjusted net income below $35,000 for families or below $20,000 for individuals, and for those who pay at least 30% of their adjusted net income on rent.
We have mobilized the Canada Revenue Agency to process applications and payments and to make it easier and faster for everyone involved. This payment will really complement the existing $4 billion Canada Housing Benefit that’s already delivering an average of $2,500 in rental support across Canada in 10 provinces and 3 territories. This will also compliment other programs and services that we have created to help Canadians with their housing needs.
This payment is a crucial element of our government’s overall plan to make sure that housing is more affordable for Canadians. It is part of our National Housing Strategy toolkit, which is about making sure that more and more affordable housing is in place and that each and every Canadian has access to safe and affordable housing and the services they need to access that housing.
I want to close by reiterating that making life more affordable for Canadians who need it the most is a top priority for our government. This one-time top-up to the Canada Housing Benefit will help us in delivering on this important priority.
I urge all senators to support this legislation so that we can get this payment out to those who need it the most, as quickly as possible.
I want to thank you, Mr. Chair, for giving me this opportunity to speak. I’m happy to take any questions from senators after my colleague’s remarks.
[Translation]
The Chair: Thank you very much, Minister Hussen. I will now give the floor to Minister Lebouthillier. Minister, go ahead.
Hon. Diane Lebouthillier, P.C., M.P., Minister of National Revenue: Honourable senators, thank you for the invitation to appear today on important matters.
I am pleased to join my colleagues to discuss the application process for the Canada Dental Benefit and the one-time top-up to the Canada Housing Benefit. If the bill receives Royal Assent in both cases, the Canada Revenue Agency will be responsible for the administration of these programs.
As you know, the agency has been at the heart of our government’s response to the COVID-19 pandemic by administering the various emergency programs. Once again, we are stepping up to help the most vulnerable Canadians with the rising cost of living. The agency’s experience in administering credits such as the Canadian Dental Benefit and the one-time top-up to the Canada Housing Benefit will be a great asset. The agency is well suited to continue this work, given its ongoing relationship with taxpayers through the annual filing of tax returns and the regular payment of several government benefits, including the GST/HST credit and the Canada Child Benefit.
The Canada Dental Benefit and the one-time top-up to the Canada Housing Benefit would be available to eligible Canadians through the agency’s My Account portal. Recipients could receive their respective payments within five business days if they are enrolled in direct deposit.
The agency is encouraging taxpayers to register for the My Account portal prior to the launch of these programs to ensure timely payment. I can assure you that the agency will rely heavily on its experience and best practices with similar benefits to administer the two benefits in question.
In particular, the agency would provide a secure, user-centric experience, and potential claimants would receive efficient, fair, and effective services through its philosophy of “serving people first.”
In closing, I would suggest that, while the vast majority of Canadians are honest and trustworthy, the penalty provisions contained in the current Bill C-31 will provide the agency with the necessary tools to prosecute those who submit false claims.
I will now be happy, as will my colleagues, to answer your questions.
[English]
The Chair: Before asking and answering questions, I would like to ask ministers, senators and members in the room to please refrain from leaning in too close to the microphones or removing your earpiece when doing so. This will avoid any sound feedback that could negatively impact the committee staff in this room.
Now we will proceed to questions. I would like to share with senators that you will have a maximum of five minutes each for the first round and, if time permits, a maximum of three minutes each for the second round.
[Translation]
Senator Gignac: Welcome, ministers. I think we have a precedent tonight in having three ministers here at the same time at the National Finance Committee; hats off to them. I will direct my first question to Minister Duclos.
As I understand it, the Dental Benefit Act, as proposed through Bill C-31, is still an interim measure, a first step toward a national public dental program. It’s interesting because it’s a historic move. I think you have to go back to the mid-1960s, when the Royal Commission on Health Services was held, and they talked about dental care being an essential service.
That said, minister, I am curious about this: How do you see this new program co-existing with provincial programs? Our colleague Senator Seidman made a list of all the provinces and their programs and, at the end of the day, the provinces already have that jurisdiction. You know, these are provincial jurisdictions, at least from their perspective.
I’d like to hear from you on that: How is this going to co-exist with provincial plans and private insurance plans?
Mr. Duclos: Thank you very much for the question, Senator Gignac.
You are absolutely right: The idea of integrating oral health care into the health care continuum dates back to the creation of medicare in the 1960s and 1970s.
From the very beginning, it was planned, but it wasn’t implemented at that time because, as I understand it, there was a belief that the dentists and dental hygienists working at the time could not provide sufficient dental services. So essentially, there were not enough dentists to provide those services.
You also mentioned that this is an interim benefit because medicare does not work like the proposed benefit. People won’t have to claim an amount from a government before they go to their doctor or go to the hospital, so there’s only one step. They will claim the care they need and will get the care they need, without that interim step that’s part of this benefit.
You also made a very good point that all of this is from the perspective of complementing dental care services already covered by the private or public sector. For the public sector, it is worth noting that current provincial and territorial government coverage is modest, with approximately 4% of oral health care expenditures covered by provincial and territorial public plans, while 40% of oral health care expenditures are covered by families with their own money.
So there is indeed a complementarity issue, but what is being achieved here is rather modest.
Senator Gignac: Minister, you are in contact with provincial health ministers, who you will be meeting with soon, in the next few days or weeks, and who have asked you to increase transfers in health — we won’t resolve the issue tonight, and I don’t expect an answer from you on that.
However, my understanding is that they are going to ask you to have an option to opt out of the plan, since some people have multiple plans. In Quebec, for example, children aged nine and under already have coverage. In the medium term, if we look at the national dental care plan, is that something you are willing to consider? If the provinces meet certain conditions that would be set by the federal government to avoid duplication, in a context of flexible and asymmetrical federalism, as you say from time to time, is it your opinion that the option of opting out of the plan could be considered, with compensation?
Mr. Duclos: Thank you for the question, senator.
You are right to talk about the medium term. Indeed, this will happen quite quickly, since we have committed as early as the end of 2023 to move to the next step, which is a true oral health insurance plan. In that medium-term perspective, there will necessarily be a more sustained collaborative exercise, even more sustained than the one that led to the current dental benefit, for all sorts of reasons that you mentioned.
One of the reasons is not only that the system already exists in every province and territory... There are plans that exist, and I mentioned that they were pretty modest, but they already exist.
Second, provinces and territories may want to take advantage of this commitment by the Canadian government to revisit their ambitions, and therefore their actions, on oral health.
Finally, third, when we talk about treating people’s oral health, certain populations need to receive this dental care in a particular context, and often in a more medicalized context than that found in private clinics or hospitals, for example, or in public clinics. They include people with disabilities, seniors, people with mobility impairments, and others who have particular comorbidity issues. These people need a physical environment that is often better provided by the facilities that already exist in the provinces and territories.
[English]
Senator Smith: Welcome to our ministers. Minister Duclos, we heard from Dr. Walter Siqueira, Dean and Professor at the University of Saskatchewan, who raised some concerns about the impact of this bill on dental schools. He noted that dental schools would have a hard time attracting new clients as a result of this program, given that dental schools are already providing much-needed care for underserved populations, especially in rural and remote regions. From his testimony, it seemed that dental schools were, possibly, not adequately consulted on the creation of the program.
I’m just wondering if you can explain or address these concerns and explain why dental schools across the country were not properly consulted.
Mr. Duclos: That’s a fair question. We, obviously, wouldn’t and didn’t speak to the entire set of dental schools in Canada. We did have consultations with quite a few of them, including the Association of Canadian Faculties of Dentistry and a number of deans, experts and researchers found in those different faculties.
Perhaps equally as important, their concerns are legitimate. That is, we are there to supplement, to complement, and therefore improve on the work they do. Dental schools, as you have pointed out, provide a training opportunity to their students and an environment — sometimes a socially appropriate and anchored environment — in which marginalized Canadians and those who find difficulties in going beyond barriers of all types feel comfortable and appropriately treated.
It’s certainly something that matters very much, and we’ll keep working with them to make sure this is supplementing and adding to the value they already provide.
Senator Smith: Sir, could you provide some insight? This seems to be step one. Will there be a step two? What would you be looking for to measure the success of the program?
Mr. Duclos: That’s a great question. I would love to have all the time needed to talk about data, research and evaluation. Some of you might know I was very much involved in that before 2015.
But there has to be a very strong data, research and evaluation framework. This is a natural experiment of a type we have rarely seen in Canada. Investing so significantly in the oral health of so many Canadians, we believe, is going to change health outcomes and other outcomes for a lot of Canadians. We have asked the department — and Deputy Minister Lucas was there — we had a conversation on that today. We have asked the department to make sure that we are going to be able to monitor and therefore improve upon the benefits that this might be bringing.
Senator Smith: Thank you, minister.
Senator Yussuff: Thank you, ministers, for being here today.
I’m honoured to be sponsoring this bill, because in terms of my history and background, I recognize the importance of what this bill will do for the assistance of working people who struggle with things those of us who are fortunate enough to be parliamentarians take for granted. I didn’t always have the privilege I have today in terms of coverage, but that’s the reality of my life. I know that far too many people who wake up in the morning in this country still don’t have the privilege to say that if their kids require dental care, they will get the care they require. For many who are struggling with housing, they have a place they can call home, a permanent place. As rents go up and challenges to pay those rents increase, especially with inflation, it’s not easy.
Ministers, I have two questions. One is to do with the housing allowance. A colleague of mine, Senator Miville-Dechêne, during the debate yesterday in the Senate asked a question about the rental benefit not benefiting a number of Quebecers who live in low-income housing because they spend less than 30% of their income on rent. She asked why the 30% threshold should not have been lower to include more needy families and tenants in Quebec.
Mr. Hussen: Thank you very much, senator, for that really important question.
I couldn’t agree with you more that the rental and dental supports are very crucial for people who will be assisted by them. It’s important to keep that in mind as we discuss this piece of legislation.
I want to set the stage that we are already investing, as a government, $450 million in the Canada-Quebec housing benefit. That’s already delivering rental supports to 145,000 households in Quebec. This $500 is a top-up to that, we estimate the families in Quebec and individuals who will receive the $500 top-up payment to be about 467,000.
In terms of measuring whether households are spending more than 30% of their income on housing, we use this metric to ensure that each eligible Canadian, no matter where they live, have equitable access. This is a metric that’s used widely and is recognized in terms of measuring housing affordability and ensuring that every Canadian can receive this.
I just wanted to set the context that even before this top-up, 145,000 Quebec households received the Canada-Quebec housing benefit, and this $500 top-up to that benefit will reach 467,000 families and individuals in Quebec.
Senator Yussuff: Minister Duclos, the dental care benefit, as you announced, is going to make a difference for children who are under 12, which is, in many provinces and territories. However, a good number of children will not be covered because the age threshold currently excludes them from access to the benefit.
One of the challenges that I’m trying to reconcile is that we also know that, in every jurisdiction across the country, there are far too many families who are on social assistance. They’re non-tax filers. Those are the people who require the most assistance. I recognize this is a challenge for our federal government, because the municipality has those data and the provinces to some degree have access to those data. We have no access to that data at the federal level.
Is there a way to help those families, because they’re most in need, to access this benefit because they’re on social assistance? It’s no fault of their own. They are non-tax filers because they’re low income to begin with. Fundamentally, does this benefit make a significant difference to those children at an early age in terms of helping them get an early start in oral health but, equally, the preventative opportunity they may have going forward?
[Translation]
Ms. Lebouthillier: Thank you for your question, which is very important to me.
Even though families are on an income assistance program or welfare, they are required to file income tax returns. The connection is made between the Canada Child Benefit program and the Canada Revenue Agency because even families who are on welfare receive the Canada Child Benefit. So the work is done jointly, so that when people apply, they can access dental care.
[English]
Senator Yussuff: Thank you for your response.
We do know from the data that’s available — I’ve looked at it myself — that a significant number of families in this country, despite the generosity of the Canada child benefit, do not access it. A lot of it is to do with the fact that they don’t know about it and they are non-tax filers.
My only point is that they are receiving municipal assistance through social assistance. There is a desire to figure out how we can better communicate with those individuals. The Canadian Dental Association, which came before the committee, is open to working with ministries to ensure communication is as far reaching as possible so that families will know about the benefit.
I’m simply asking for us to figure out how we can do that. Whatever the media might cover is not good enough. We need to figure out a way to communicate better so that Canadians know this benefit exists and, more importantly, it will be of help to them, should they require it.
[Translation]
Ms. Lebouthillier: Free tax clinics are one of the very important programs of the Canada Revenue Agency.
I have toured across the country and I continue to meet volunteers who are involved in their communities through community organizations, whether it’s welcoming organizations for newcomers or volunteer action centres; even in the schools, if you look at what’s going on in Quebec, there are some in CEGEPs and universities.
Last year, the free tax clinics helped more than 574,000 people. These people are not in a position to pay tax preparers or accountants. A lot of work has been done within the Revenue Agency. Money has been allocated to these volunteer groups to be able to reach even more people in the communities.
Work is also being done with our community and charitable organizations to encourage the involvement of all groups concerned. We have also engaged with municipal officials.
The Chair: Minister, could you wrap up?
Ms. Lebouthillier: In conclusion, we continue to work very hard. We will also need the senators to help vulnerable populations.
Senator Mégie: My first two questions are for Minister Duclos.
Ministers, thank you for being with us today. Mr. Duclos, the Parliamentary Budget Officer estimated the cost of the Canada Dental Benefit at $703 million over five years. Do you have any data on the current costs of complications related to poor oral health? Do you have any idea what the current costs are, if we want to compare them to the costs that the Parliamentary Budget Officer is projecting?
Mr. Duclos: There are financial costs and social and health costs.
The costs estimated by the Parliamentary Budget Officer are very similar to those estimated by Health Canada. Of course, we are pleased with the numbers matching up because that may not have been the case. The hypotheses are different, but the final estimates are the same.
Some of the costs that are associated with not having access to oral health care are known and some are not. One figure that is well known is the $2-billion cost of emergency surgery for people with poor oral health. This happens, for example, if they have neglected their oral health and therefore have to go to a hospital emergency room to have abscesses, cavities or systemic infections treated. These emergency room visits can cost between $12,000 and $25,000.
There are also the costs associated with high a risk of cancer, diabetes, and gastrointestinal or cardiovascular problems. These are human costs that people must incur if they do not have good oral health. These expenses eventually become health care costs. The estimated value of these costs exceeds the $2 billion I just mentioned.
Senator Mégie: Thank you. You know that in health, we say that an ounce of prevention is worth a pound of cure.
The Canadian Oral Health Roundtable identified fluoridation of water as a priority. Currently, all scientific data proves that fluoride is truly useful and effective, but only 37% of Canada’s drinking water systems include it.
What plan is your department thinking of developing to help Canada’s municipalities fluoridate water?
Mr. Duclos: There are two points. First, over the long term, along with experts, we could concentrate more on the issue of fluoridating water and municipal investments. The costs are rather modest in relation to the significant advantages documented by experts over the years.
Second, if this dental benefit is implemented quickly, it will help families give their children preventive dental care. This includes applying fluoride and sealant, cleaning and scaling. These costs are low, compared to what happens when accessibility to preventive health care is lacking, especially for children. Prevention is the key to success in many aspects of human health.
Senator Mégie: Thank you, minister.
Senator Dagenais: My question is for Minister Duclos.
I managed a dental care program for eight years, and I can tell you that it was not easy.
First of all, I agree with the part of the bill relating to housing assistance. However, the dental care program should have been presented in a specific bill. I find it regrettable to include two bills in one.
Canadian public servants, MPs and senators all have access to dental care provided by Sun Life. This program has fee schedules to control costs. I did not find this provision in Bill C-31.
I know dentists well, you know, and it will be difficult to control costs. I understand that the liberals committed to a dental program. However, between you and me, a certain rigour could have been applied.
Why aren’t there any measures to curb such a significant cost in the years to come?
Mr. Duclos: The bill still contains a relatively high number of control measures, conditions and criteria to meet in order to be eligible for the dental benefit. For example, one’s income must be below $90,000.
To avoid any copayment, one must earn less than $70,000. These criteria exclude approximately 75% of children in the relevant age category. From the outset, three quarters of eligible persons are excluded as well, because we’re targeting families who do not have access to private dental insurance. The maximum payment is $650 a year, with a copayment of 40% or 60% for people earning between $70,000 and $90,000.
The criteria are therefore subject to external control measures. The Canada Revenue Agency will also apply control measures to ensure that those who are entitled to this benefit receive it for the stated reason, which is to offer oral health care to one’s child.
Senator Dagenais: As Senator Gignac noted previously, many provinces already have dental care programs for children. You did indeed say that this benefit intends to round out provincial programs. Have you discussed your intentions and what you call a “first step” with your provincial counterparts? Aren’t you worried that you’ll be accused of infringing yet again on an area of provincial jurisdiction? Or have you decided to do it anyway and move forward?
Mr. Duclos: Yes, we discussed it several times. I forget how many times over the last months. I’ve had a total of 11 meetings over the last year with my fellow provincial and territorial ministers. The subject has been raised several times over the last months. Officials are maintaining regular contact. The conversation has therefore already started and will be ongoing, as we discussed earlier.
In terms of displacement or crowding out of public oral health care programs, I noted earlier that provincial and territorial programs cover 4% of total oral health expenditures, whereas households cover 40% of these expenditures themselves. In any public intervention, almost by definition, there is some form of displacement or partial crowding out. We’re talking here about the health sector as such, as well as health care where the provincial and territorial presence is currently rather modest.
Senator Dagenais: Thank you, minister.
[English]
The Chair: Before acknowledging Senator Bovey, I would like to recognize that we have two senators who have joined us: Senator McCallum and Senator Osler. Thank you, senators, for joining the Finance Committee this evening. Yes, you will have time to ask a question.
Senator Bovey: Thank you, ministers for being with us. It’s an honour to be able to address our questions to you directly.
I’d like to pick up, Minister Duclos, on the question posed by my colleague Senator Smith about the 10 dental schools across the country. I’m delighted to hear that there were consultations with at least some of them.
We heard yesterday that the dental schools charge 10% to 50% of the regular dental fees, on average, across the country. Many of the people they’re seeing would fall into the category that you’re looking at in this program.
We also heard that many of these children who come in for the first time need four, five or six fillings, which the $650 will not cover with a private dentist. If they decided to use this money in a dental school situation, where they would pay less for the service, could they get all those fillings done? Will there be a communications plan that will include the dental schools? They are offering a service which I think in many ways complements what you’re trying to do.
Mr. Duclos: First, on the communications plan, communications are key here. One of the biggest barriers to accessing oral health care is information. That’s true in all sorts of ways, including the benefits that good oral health bring in the mouth but, obviously, more broadly too. I spoke earlier about the incidence of various chronic diseases which can basically be increased with bad oral health. Communication is key.
Another barrier that we need to acknowledge is a barrier that dental schools are quite good at alleviating, namely, the barrier of physical and social accessibility. Some marginalized populations feel safe and respected when they go to visit dental schools. That’s a strength we want to build on. We spoke about this earlier.
Now, another part of your question was about the fees. When they visit dental schools, as you said, the fees may be significant, even if the percentage they pay is small. They may not have visited a dental school or a dental hygienist for some time. So if the children have to pay a fee, they would be eligible for the benefit.
Senator Bovey: Thank you for that.
Minister Lebouthillier, I have a question about accessing the housing top-up through the CRA.
You mentioned that people can access it through their CRA My Account. The financial capabilities of people for whom this program is designed are such that many of them may not have either the technical or technical capabilities to be able to get into My Account. I guess I’m coming back to communication again. How do we cross that bridge?
[Translation]
Ms. Lebouthillier: Indeed, this issue is especially important to me. Between 70% and 75% of people file tax returns. Tax returns are filled by a third party. We know that it’s not easy to do. Even if we work on simplifying tax returns, people need help and support.
Last year, during tax season, 94% of people filled out their tax return electronically. The My Account portal has made significant inroads with communities. Thanks to all the work done by volunteers, people who fill out a paper version of their tax return can access the benefits to which they are entitled. Important work is being done, and communication outreach will also be done within communities.
[English]
Senator Bovey: I have one second to follow up on this, if I may. My concern is for those people who are afraid — afraid of filing taxes, afraid of computers and afraid of technology. Yes, they want the $500, but they’re afraid that it might be worse for them if they were to get it because it will open a can of worms. It’s those people who are so financially compromised that I am concerned about. How are we going to get over that? Those are the people who need the money.
[Translation]
Ms. Lebouthillier: As I said earlier to Senator Yussuff, we are trying to draw in locals, community organizations, municipalities and mayors. We really want people to get involved so that everyone feels that they have a responsibility to help those who are the most vulnerable. Our goal is to reach 100% of people. That is my goal. I know full well that people who do not have access to benefits are often those who are older or younger. We’re also working with tax preparers. There is still work to do. As I said earlier, we would like senators’ help and support. You are natural caregivers and key players in your communities.
[English]
Senator Pate: Thank you to all of you, ministers and officials, for joining us. A special thanks to ministers, individually and collectively, for the work you do now but also for the work you did before coming to this place that informs so much of what we’re talking about today.
You’ve mentioned two things I’d like to pick up on. First, you mentioned this is a first step. It’s a great first step forward. Each of you is well aware of the research that’s been done, some of the longitudinal studies about the benefit of cash transfers to low-income families. Particularly for Indigenous individuals, as they age, we see better health outcomes, less access or less risky illegal behaviour — so lower health care costs — as well as lower cost in terms of criminalization or imprisonment of groups that would often be in that category. We also see better educational outcomes. So long-term mental health, physical health, education and other criminal legal systems are impacted. I’m curious what the next steps are.
Before we get to that, however, one of the things that has been raised — and, Minister Duclos in particular, I know you’ve also expressed concern about this — is that in some of the step-by-step transfers that have happened — for example, the CERB, the child benefit — the provinces and territories are, sometimes, gaining money from the top-ups. They’re experiencing windfalls and clawing back from people on social assistance. In the long term, the very families you’re trying to assist will not, necessarily, get this assistance. That is also something Senator Yussuff raised.
What kinds of guidelines and agreements are being negotiated with the provinces and territories? Admittedly, this is a smaller amount of money, but it could also be subject to the same problems.
I’d like you to answer both of those questions, namely, what the long-term strategy is, if you’re able to speak to that; and how you plan to deal with ensuring no clawback. Also, in the future, do you see the potential for a more streamlined process?
Mr. Duclos: I can start on the benefit of direct cash transfers, as you said.
Just speaking to the Canada child benefit, or CCB, which was also a national experiment — it was introduced in July 2016 — it dramatically changed the lives of approximately 9 families out of 10. It certainly affected the lives of the bottom 40% of the children on the income ladder, because those 40% of children who used to live in poverty are now out of poverty. Essentially, the Canada child benefit reduced child poverty by 40%. That is the equivalent of 450,000 children lifted out of poverty every month, plus their parents, who also benefit from the cash transfer.
These are data; these are numbers. Behind those numbers are the lives of people who, by living outside of poverty, from an income perspective, can also escape many other non-income poverty traps. That points to all sorts of qualitative impacts of that type of cash transfer.
There is serious research work on the non-quantitative impact of transferring cash to families.
My qualitative direct measurement of that is when I went to visit an organization in my riding, which is called Le Pignon Bleu. Senator Clement might know about it. They told me that the days after families received the Canada child benefit, the lunch boxes and the food children brought in their lunch boxes changed dramatically. On the 20th of every month, parents receive the CCB, and for a few days and weeks after that, snacks and lunches are full of fruits, vegetables and more expensive food because the parents can afford to spend on them than they otherwise could.
I can expand a lot on this, but I know the chair won’t allow me to do that, but these impacts are substantial.
On the clawback, we have had a serious conversation with the provinces and territories. Everyone agrees that the rental and dental benefits will not be clawed back by provinces and territories. At the federal level, this is defined as a non-taxable benefit, so they will not be clawed back for federal benefits. It is understood and agreed that it will not be clawed back at the provincial or territorial levels, either.
[Translation]
Senator Saint-Germain: Good evening, ministers. My first question is for Minister Hussen. It focuses on cost estimates for the second part of the bill, namely the one-time benefit for rental housing.
I’m trying to understand the distinction made between the government’s estimates and those of the Parliamentary Budget Officer. Originally, in Budget 2022, the government projected that the program would cost $475 million. But the program expanded, and the government later announced that the program’s cost would be $1.2 billion. Furthermore, if I understand correctly, the Office of the Parliamentary Budget Officer’s analysis estimated the total expenditure for the one-time top-up will be $940 million.
How do you explain the gap between $940 million and $1.2 billion?
Mr. Hussen: Thank you for your question, senator.
[English]
Through Budget 2022, you’re right that we did commit $475 million to provide this one-time $500 top-up to the Canada Housing Benefit. Since that time, we’ve seen an increase in terms of rental costs faced by Canadians, so we felt that we needed to do more. That’s why you’re now seeing the announcement in September accompanying this piece of legislation that we intend to spend $1.2 billion to reach 1.8 million Canadians to make sure that even more people can be helped. That explains the difference between the $475 million to the current estimate of $1.2 billion.
Senator Saint-Germain: And what about the distinction between the PBO’s estimation about $940 million and your estimate of $1.2 billion?
Mr. Hussen: You’re absolutely right, senator. We acknowledge the valuable work of the Parliamentary Budget Officer and the work presented in their legislative costing note. We do remain satisfied that costing estimates provided by CMHC on this benefit are an accurate portrayal of the true program costs, given the information available to us at that time.
Senator Saint-Germain: That was a sub-question. Do I have another question?
[Translation]
Ms. Lebouthillier, I did note in your opening remarks that Canada will benefit from the CRA’s expertise in managing these two programs, which I describe as “sociofiscal.” Clearly, the most vulnerable members of this eligible clientele will face a challenge, which is to be well aware of the information and services offered.
With this in mind, I am interested in your negotiations with dentists, denturologists and dental hygienists. Are these fees regulated and subject to standards? Within the scope of this program, have there been negotiations to ensure that the standardized fees are honoured? As for facilitating access to reimbursement, have there been discussions with these health professionals? Without doing the work in place of beneficiaries, will they be able to inform them properly, as well as provide receipts and appropriate proof to facilitate beneficiaries’ reimbursement?
Ms. Lebouthillier: I am inclined to say that, when it came to negotiations with dentists, the Minister of Health was more involved on that side. Furthermore, our concern was to ensure that the money would go into children’s mouths. Thanks to the programs put in place during the pandemic, the Agency developed expertise. This means that, for example, we can set up measures to obtain the name of the employer, if applicable, the name of the dentist, and the time and day of the appointment. These measures will ensure that people will have to provide proof before they can access reimbursement.
Senator Saint-Germain: Does any other minister from Quebec want to add anything to this answer?
Mr. Duclos: On the issue of fees and standards, dentist fees are regulated by the Order of Dentists. It is not a prescriptive fee structure. Dentists have a certain amount of freedom, but they usually follow the official fee schedule published by their representatives. That is what we are expecting for the additional visits children will make over the coming months.
[English]
Senator Boehm: My initial question is for Minister Duclos. I’m following up on an earlier point made by my colleague Senator Mégie.
When the Parliamentary Budget Officer was here last week, I asked him to look into his proverbial crystal ball. I asked him if it was really enough money being proposed and how it was going to be administered. He indicated that there are too many unknowns regarding the format and program design.
We do know that the dental benefit is an interim measure until a full program is put in. We’ve seen in our history interim measures before, like income tax during World War I. It stayed. So this is designed to be a partial program that will lead into another one.
Do you have mechanisms within your department to take into account, shall we say, greater inflation, or other unknowns that might be coming from outside or arise in the cost of dental fees, for example, as you do the transition to June 2024?
Mr. Duclos: The answer is yes. Some of the officials could, if you wanted, provide more guidance. Obviously, the interim benefit is the focus of today’s meeting.
But you’re correct. We also have in mind and we have pointed to the fact that there will be a longer-term benefit implemented before the end of 2023, which is in about a year and a bit more from now. In the meantime, lots of work remains to be done. Some of that work, as you correctly point to, will involve assessing the possible evolution of dental fees in the next year.
Senator Boehm: Thank you. My other question is for Minister Hussen. We’ve seen that research by Canada Mortgage and Housing Corporation from 2021 shows that 25% of Canadian households live in unaffordable housing. Of course, it’s even worse for renters. This is not an isolated Canadian phenomenon. I’m wondering whether you and your team have looked at other jurisdictions, other governments around the world as to what measures they are taking in this rather unprecedented crisis where we’re hopefully coming out of a pandemic but dealing with real inflationary pressures.
Mr. Hussen: Thank you, senator. That’s a very important question. I would highlight a number of things that we’re doing simultaneously. One is, obviously, the Canada Housing Benefit that’s now active in all provinces and territories and provides an average of $2,500 in real support to vulnerable renters across the country.
The amounts are quite significant in terms of the actual deliverables. We’re talking about in Ontario, for example, 50,000 households receiving it. In British Columbia, 25,000 households. In Alberta, it’s 35,000 households. In Quebec, as I indicated earlier, 145,000 households. We are already providing that real support to renters who just need a little more support to stay in their housing or to actually access housing that meets their needs better.
Simultaneously, as you know, Budget 2022 was the sixth consecutive budget where we’ve increased investment to go into affordable housing and building that faster. Then if you look at what we rolled out during COVID to house the most vulnerable members of our community, to permanently house them, one of the successful programs we’ve rolled out is the Rapid Housing Initiative — 10,250 homes built in 12 months or less across the country, targeting the most vulnerable members of our community.
If we look at the housing accelerator fund that we’ve proposed to work directly with municipal and regional governments to accelerate the building of more housing across the spectrum, including affordable housing, you see there a lot of ambition, a lot of investments and a lot of willingness to work with partners across the board to really build more housing supply.
I think we have a huge problem in Canada with respect to housing supply because we have the fastest-growing population in the G7 but don’t have the supply to keep up with that demand. Our job is to build more housing but also to incentivize other orders of government to work with us to accelerate the approval of housing but also the delivery of housing. And while we build more housing, also help folks directly through rental supports, as we are doing with this piece of legislation.
Senator Duncan: Good evening and thank you very much to the ministers for their attendance here this evening. I’d like to address the dental benefits of Bill C-31.
We’ve learned from a recent media story in The Canadian Press that the government plans to create a stand-alone insurance program using a private company. The details are yet to be finalized. It’s expected, though, that this program will closely reflect the existing programs for First Nations, Inuit, refugees and veterans who, as the media report stated, fall under the federal health care responsibilities. The program is NIHB, or Non-Insured Health Benefits.
Canada is really the fourteenth province at the table when it comes to health care with NIHB. The Parliamentary Budget Officer, in his forecast of the administration costs of Bill C-31 dental benefit also said that the government uses the NIHB model. I have a very detailed administrative question. I recognize it’s detailed, but I really feel I must bring to the ministers’ attention that there are significant issues with the NIHB program that must be brought to your attention, particularly the dental, as this program is used as a model. If I could, I’d like to give you an example.
In British Columbia, the province’s Schedule of Fee Allowances sets out a dental primary complete exam at $87.30. Non-Insured Health Benefits covers $65.94. In Alberta, the fee is $77.18 and Non-Insured Health Benefits covers $74. The fees in the Yukon are $118, and Non-Insured Health Benefits covers $95.97. This means that under Non-Insured Health Benefits, there is 76% coverage in B.C., 96% in Alberta and 81% in Yukon. That’s two provinces and one of the three territories. There is different coverage by NIHB throughout the country.
Is the minister aware of these challenges with the NIHB program? And how will these challenges be treated in the yet-to-be-determined system of delivery for these dental benefits?
Mr. Duclos: Thank you. That’s a great question and I should hear those questions more often. Not only is it a great question, but it’s a question that my colleague, Minister Hajdu, would certainly want to hear if you haven’t already posed it to her.
You used the word “model.” I think you implied that NIHB is certainly not a perfect model. But it’s probably one of the models we should be looking at. Although it’s not perfect, it’s a model of a public insurance plan that works better, I would suggest, according to the views that we have been gathering, than other publicly provided insurance systems in Canada.
Being a public insurance system — I don’t want to say the NIHB has nothing to be improved upon, but it has the feature of assessing the value of the services compared to the cost of those services. It’s different from an employer’s plan, which is entirely driven by a relationship between an employer and its service plan provider and the employee.
A public insurance plan, just like Medicare, also takes into account the possible additional value from a public health perspective and a health perspective that insurance can provide.
Having said all of that — and I know my answer is not as clear and as strong as your question. Having said all of that, I think we acknowledge that, regardless of where we look, there are plans that need to be improved and NIHB is certainly one whose structure and benefits can be looked at and made better.
Senator Duncan: If I could address this to Minister Lebouthillier. I apologize for my French pronunciation.
You’ve referenced the Canada Revenue Agency and individuals applying for this benefit. How will those who receive Non-Insured Health Benefits intersect with the Canada Revenue Agency in who’s paying for the dental benefits, and how will the $650 cover costs that Non-Insured Health Benefits doesn’t cover? Is that how it will work? How will CRA work with Non-Insured Health Benefits or Indigenous Services Canada to ensure that Canadians receive the maximum amount of coverage, that there is no clawback and that children who need these services will get the services?
[Translation]
Ms. Lebouthillier: I took the time to try and fill out the form myself, to make sure it’s accessible and tailored to people. We set up security systems to make sure that children benefit from this money. It’s a priority for us. We’re also establishing a link with the Canada Child Benefit. Departments can work together to ensure that money is distributed to those who need it. People sign the forms and, afterwards, the agency conducts checks, just like with the different programs set up during the pandemic. Is the program perfect? I would say that it isn’t, because perfect programs don’t exist. Unfortunately, there’s a risk that people will commit fraud. However, we have made sure to do things in the best way possible.
[English]
Senator McCallum: Thank you to the ministers and to the people with whom they work for coming here to present tonight.
I think you know that I’ve been in dentistry for 48 years. We have this one opportunity to make this a great program, but I have a lot of concerns about it, and I have spoken to your staff. The span between the $30,000 to $70,000 income groups is huge. It has the possibility of negative implications, especially for the $30,000 to $40,000 income group. In this bracket, they have a lack of resources like the internet, phones, babysitting, transportation and skills to navigate the incoming bureaucratic system, by both the health system and the Canada Revenue Agency. They had limited access to care when I was delivering care 20 years ago and they still continue to have limited access.
I worked mostly with those who were non-insured. The bureaucracy of the Canada Revenue Agency will be another major obstacle, especially if people don’t have bank accounts. Who will design the consent forms that will be needed to look at the information that you require? In yesterday’s speech, I heard that information was required for Canadians to receive their benefit payment as quickly as possible. They will get an upfront payment that will allow them to take their children to the dentist which makes sense because, with an income of $30,000 to $40,000, they can’t prepay. They don’t have the capability.
Most of the children in this income group will not have visited a dental office. In fact, most of their parents don’t own a bank account. They do not have that experience. How will that disadvantage be alleviated? How will the government ensure that this group will be able to access dental benefits equally with the group in the $70,000 income group who will have more resources? They always have had more.
What happens if they use the money to meet their basic needs like buying food? I can imagine families getting the money and thinking, am I going to do dental work or am I going to get food? I had a problem with CERB, and it did create havoc for people. You say they will go to the dentist, but a lot of dentists don’t treat First Nations because they’re a highly mobile group. It seems like the bureaucracy will add to the work of the dentists. That’s why a lot of them don’t deal with non-insured patients. It seems so complicated for this age group. I worry about that.
The Chair: Senator McCallum, there’s more than one question in there, but I’ll ask the minister to comment on them.
Mr. Duclos: There are, indeed, many important questions and many important statements at the same time. Let me try to address a few of them. I won’t be able to be complete in my answers to both your questions and your statements, but I’ll try.
First, this is an interim benefit. It’s not a full-insurance plan because of what we discussed earlier. If you go to see a doctor or if you go to a hospital in Canada, you don’t ask first for a payment and then go and see the doctor or the hospital. This is an interim benefit that will be replaced by something akin to but not exactly like the NIHB.
On the NIHB, I would like to answer Senator Duncan’s question. It’s less likely that First Nations people and Inuit will be eligible for the benefit because if they do access NIHB, there’s no co-pay. The services — which are substantial but not complete — will typically be provided with no fees. So they will not need the benefit to cover those fees.
However, for both the NIHB and for this interim benefit, there are considerable barriers for people, non-financial barriers, in accessing dental care. That includes purely geographic barriers. In rural, remote and Indigenous communities as well, sometimes it’s not possible to find a dental professional who is accessible. Geographically, it takes too long and it’s too complicated to physically go to either the dentist or the hygienist’s office.
In addition to that, as you said, there might be stigma or fear when you first visit a dentist. Even if it’s not your first visit, you might feel uncomfortable regardless of how much it may or may not cost. These things add to the other barriers that you point to, namely, having to access a formal system which, in this case, requires logging onto the CRA site or asking someone to help you access the benefit by phoning the agency. It is important to recognize these non-financial barriers and to address them. We will have to do this together, based on your and Senator Duncan’s input and, I’m sure, the input of many others.
Senator Osler: Thank you to the ministers and to the invited guests for coming here this evening. My question is for Minister Duclos.
I am an ear, nose and throat surgeon by training, so I have seen and treated some of the sickest patients from dental infection. I’m going to follow up on the questions of my honourable colleague Senator Mégie regarding prevention.
Fluoridation in water is acknowledged as an effective public health measure that reduces dental disease. I recognize we’re talking here about the dental benefit. My question relates to the national dental plan which is in the works. Will or could a national dental plan include strategies or address strategies to prevent dental disease before it occurs — strategies perhaps like incentives for municipal water fluoridation?
Mr. Duclos: That’s a great question. Ms. Tomson or Deputy Minister Lucas, be prepared to follow quickly because you might point to specific things that you know or think might be needed to support this long-term agenda. Prevention is key.
You’ve seen and acted upon the consequences of children and others not having access to preventative services in oral health and other health conditions. It’s certainly key in our agenda. On the more specific aspect of fluoridation, I will turn to Mr. Lucas.
Stephen Lucas, Deputy Minister, Health Canada: Thank you.
As we’re thinking about the longer-term program, there are mentions of both the financial barriers, as discussed, but also access, which involves engaging with the dental schools and a number of professionals where they work. It is also looking at prevention and working with public health and considering municipalities.
Those are all dimensions that are being considered, recognizing not adequate steps are being taken now, as you and Senator Mégie pointed out.
The Chair: Honourable senators, we had an agreement that the ministers — and this is also a first for the Finance Committee — would be here for 90 minutes. I’m looking at my watch, and we have only five minutes left. I’ve seen a few senators asking for a second round.
If the questions are short, we will have an answer. If not, I’ll ask the ministers to give us an answer in writing, and I don’t want to do that.
[Translation]
Senator Gignac: I’d like to come back to concerns raised by Senator Saint-Germain and Senator Dagenais about costs. Minister, you’re an economist by training, so you know that when prices and costs go down, demand increases. How do we ensure that this doesn’t lead to skyrocketing costs, that dentists don’t increase their prices and, above all, that companies don’t become less generous with dental care coverage? You can send us the answer in writing if you need more time to answer.
Mr. Duclos: The short answer, first of all, is the current fee schedule we discussed earlier. Second, there is the issue of displacing or crowding out certain systems already in place. That is a very broad question, and we will make sure to give you an answer, Senator Gignac.
Senator Gignac: Thank you very much.
[English]
Senator Smith: I have a question for Minister Hussen.
You noted earlier that there’s a supply shortage of homes in Canada. We’ve heard in our Banking Committee that labour shortages across the country are exacerbating the issue of supply in many sectors. CMHC has noted that the lack of skilled labour in the construction sector is a major factor in the slow pace of homes being built. Don’t forget — we talked about the percentage of people renting, which is going faster than the people who are purchasing houses.
Has the government looked at addressing this issue with targeted investments in training so that you have more qualified people who are able to build structures? It seems that could be important.
Mr. Hussen: Thank you very much for that important question.
I want to highlight the fact that the housing accelerator fund is the first time the federal government is not just investing in building housing in partnership with municipalities, non-profits, the private sector and so on, but we’re now tackling the systems challenges — the barriers that prevent more housing to be built. As part of that, we will be working closely with orders of government that are responsible for the permitting and delivery of housing to deal with those systemic barriers. It will be difficult to deal with all the barriers, because not all of them are under the jurisdiction of the partners that we’re working with, but access to skilled labour to build housing will certainly be part of the discussion.
I can say that I’m very much encouraged by both Minister Qualtrough and Minister Fraser in both their different portfolios in their ability to focus on this as well. The recently announced Immigration Levels Plan gives me confidence that some of those spaces will be used to absorb people who are already here, who are working to help us build more housing and make them permanent residents — give them pathways to permanent residency — as well as attracting more skilled labour. The higher the levels, the more provinces and territories can use the room within the Provincial Nominee Program to bring in skilled labour that meets the needs of their local economies. I know this because I was the Immigration Minister for three years. As a government, we have paid close attention to trying to connect the local labour market needs, including access to skilled labour to build housing, with our immigration levels.
Training is part of it, too, of course. It is encouraging more young people to take up building trades by working with the unions, the schools and the technical institutes to incentivize that. If you look at Budget 2022 and the previous budgets, there have been significant amounts of investments made by our government, including in Budget 2022, to upskill people and enable access to apprenticeships for young people. There are 50,000 spots we’re funding through support for apprenticeships, for example. I can talk more about this.
Senator Smith: If you want to send anything in writing, such as giving us a one-pager, that would be fantastic. Our clerk would gladly welcome that.
The Chair: Thank you, senators, for your questions.
To the ministers, thank you very much for giving us this laudable time of 90 minutes. It’s very much appreciated. The three ministers have been very informative. I would like to advise you that if you would like to share any further information with the committee as a result of the questions — and I heard Minister Duclos and Ms. Lebouthillier would follow up — please do not hesitate. Our deadline will be at the end of the day on November 10.
Honourable senators, our next meeting will be Tuesday, November 15, at 9 a.m., when we will resume our study on the subject matter of Bill C-31.
Before closing, on behalf of the witnesses, senators and ministers, I would like to thank the entire support team of this committee — those in the front of the room as well as those behind the scenes who are not visible. Thank you all for your hard work that permits us to do our jobs.
(The committee adjourned.)