Cost of Living Relief Bill, No. 2 (Targeted Support for Households)

Third Reading--Debate

November 17, 2022


Hon. Hassan Yussuff [ + ]

Moved third reading of Bill C-31, An Act respecting cost of living relief measures related to dental care and rental housing.

He said: Honourable senators, I rise today on third reading of Bill C-31, An Act respecting cost of living relief measures related to dental care and rental housing. I want to thank the members of the National Finance Committee for their work on the study of this bill, and the witnesses who appeared to give testimony on it.

Honourable senators, the bill before us is simply about helping people who need our help — from helping low-income Canadians deal with the increase in rent, to ensuring low-income and middle-income families have the financial means to provide basic oral health care for their children. I want to be clear that both the rental and dental benefits are meant to be short-term measures — not long-term solutions. The rental benefit is a short-term measure to help deal with the increase in rent that many low-income Canadians have experienced in the past year, and the dental benefit is an interim measure to bridge the gap to a permanent national dental solution for children. These measures are needed now. The sooner we pass this bill, the sooner Canadians who need help and assistance will take care of their children’s teeth and health and, of course, put a roof over their head to do so.

Today, I want to talk about what these two benefits are — which is just as important as what they’re not — and how they can make a difference in the lives of low-income Canadians and working families. Let me start with the rental benefit, and what it is not meant to solve. It is not a benefit intended to address the long-term affordable housing problem that the country faces. What it’s meant to do is provide short-term relief to an acute problem of rental increase resulting, in part, from a record 40‑year inflation rate.

According to Rentals.ca’s November report, the average rent in Canada has increased about $100 per month from the pre‑pandemic level in the fall of 2019. The one-time tax benefit of $500 is intended to assist low-income renters with the increase in rent they have experienced. Most of all, Canadian renters have had to dig further into their pockets to pay their rent. However, the rent increase experienced by low-income renters have hurt them disproportionately. The rental benefit is estimated to help 1.8 million low-income renters across the country, and deal with the increase in rent they have experienced. This includes an estimated 17,000 low-income renters in Newfoundland and Labrador; 570,000 in Quebec; 60,000 in Manitoba; and over 700,000 in my home province of Ontario. These are not just statistics. These are individuals who are struggling to deal with rental challenges and to pay their rent on a monthly basis.

While the rental benefit is a targeted, short-term measure, the government, through the National Housing Strategy, has many other long-term initiatives in order to address the challenges associated with ensuring housing is a right — not a privilege — in this country. One such program is the Canada Housing Benefit which the rental benefit is a top-up for. The Canada Housing Benefit is a $4 billion long-term program that provides an average of $2,500 per year in direct support to families and individuals with housing needs. Both of these programs will make a significant difference in the lives of Canadians who are struggling with paying their rent on a monthly basis in this country.

Now I’d like to focus on the dental benefits that will help an estimated 500,000 children under the age of 12 in low-income and middle-income families. This benefit is not meant to cover all the dental care needs of our children, nor is it meant to replace the current provincial, territorial or private plans. It’s also not meant to be a permanent long-term solution for a national children’s dental program. What this dental benefit is meant to be is an interim program to bridge the gap until a permanent national program is put in place. In the interim, the government intends to take the necessary steps to build a comprehensive, long-term program that includes engaging with key stakeholders — including the provinces, the territories, Indigenous organizations, dental associations and industry — to help inform their approach in implementing a long-term Canadian dental care program.

The intent of the dental benefit is to ensure children under the age of 12 in low-income families immediately have access to basic dental care that is not provided through provincial, territorial or private dental plans across this country. The benefit also intends for parents — who do not have the ability to pay out of pocket for their children’s dental care — to apply up front for this through the Canada Revenue Agency, or CRA. I know there are some senators who believe that the interim benefit could have been better. Some are considering amendments to try and make it so. I first want to remind everyone that this is an interim measure, and I expect the final long-term program that is developed through the consultation I mentioned earlier will not only make a difference in the debate here today, but also a better program in the end. It’s through the consultation process that I would encourage both senators and stakeholders who have ideas on improving the program to make their opinions known — not by holding up the benefit that can help children now.

Second, the government intends this benefit to be ready and implemented in two weeks: on December 1. They have made it clear that to do so, this bill needs to receive Royal Assent by tomorrow. Any delay now risks parents having to wait longer to access the dental care benefit for their children.

I want to use a very personal example, colleagues, to explain how this benefit can help young children. A little over a year ago, my nephew and his wife both died very tragically. They left behind four orphaned boys, all under the age of 12. As our family struggled to take care of them, I know the challenges in raising these four boys to have a decent life will not be easy. Their grandparents, who are old, now have to take on this responsibility. I know this benefit will touch their lives. It will equally touch the lives of many children across this country. The fact of the matter is that in my family, people do their best to help these four boys become responsible adults as we struggle to deal with all of the needs they will encounter in their young lives. It is not easy. It is not easy for the many families who struggle with these challenges to provide basic needs for their children.

As a senator, I came from modest means, so I understand what struggle is all about. For all of us in this chamber, I’m sure each one of us have family members, friends and colleagues who are going to be touched by this benefit.

In conclusion, I hope you have a better understanding of what these two benefits intend to achieve and what they do not intend to achieve. The housing benefit is intended to assist low-income renters with the rental increase they have experienced because of the acute problem of high inflation and not with the systemic problem of the lack of affordable housing in this country. Likewise, the dental benefit is an interim program, not a permanent program, to cover the basic dental needs of children under the age of 12 not otherwise covered under existing plans, while a long-term national solution is developed through consultation.

Colleagues, the short-term and interim measures in the bill can make a real difference right now for low- and middle-income Canadians with the financial pressures of rent increases and ensuring children have access to basic dental care.

Honourable senators, we are approaching the holiday season, when the times are always a little tougher for those in our society who struggle with affordability issues. It is in these times when people worry about their finances and their kids’ well-being. I therefore urge you, colleagues, to keep this in mind and pass this bill quickly so we can assist Canadians who need our help.

I will be available for any questions. Thank you very much.

Hon. Yuen Pau Woo [ + ]

Senator Yussuff, would you take a question?

Senator Yussuff [ + ]

With honour.

Senator Woo [ + ]

Thank you so much for your third reading speech and especially for sharing that personal story on the importance and necessity of the Canada dental benefit.

The $1 billion or so that will be spent will indeed benefit hundreds of thousands of children. The money, of course, is going to address dental decay, and there is no money set aside for preventative dental care. It is not part of this bill, and I’m not about to move an amendment to include prevention, but can you talk a bit about the thinking for the longer-term plan, the more permanent dental care plan, and whether that might include something as basic and beneficial as fluoridation of our water? In this country, about 60% of Canadians don’t have access to fluoridated water, including in my home city of Vancouver. In the United States, it is the opposite, only 40% of Americans do not have access to fluoridated water.

I wonder if it is possible for the federal government, in its longer-term plan, to think about a way of incentivizing municipalities to invest in fluoridation because fluoridation is as much a health investment as it is an infrastructure investment.

Senator Yussuff [ + ]

Thank you, Senator Woo. I think you raised a very important point for us all to consider.

As you know, the science on fluoridation is well known. It has been documented to be extremely important in dealing with cavities and the challenges in keeping our teeth in healthy order. We live in a federation. As I keep saying constantly, it is unique in the world. We love each other very well, but we don’t do the same things throughout this land. I’m hoping that at the end of the day, as the government develops a national program, working with the provinces and territories and Indigenous organizations, this will be a serious consideration, because the responsibility of provinces to make this mandatory in their jurisdictions remains with them and them alone. The federal government cannot impose, but it can incentivize the provinces to make this a reality. Equally, I think the education that our citizens need to understand about fluoridation is important for us to put in front of them.

There are still those who argue fluoridation should not be a regular feature of our water system. The evidence is quite clear. I do hope as we debate a national program, with the federal government working with the provinces and territories, this will become part of the debate that certainly can make this country a better place for us, to keep tooth decay at bay and helping young children to have a brighter future.

Thank you, Senator Yussuff, for your speech.

This week there was a very good op-ed in The Hill Times from a Canadian prepaid credit card group talking about how a prepaid credit card for distributing the funds would allow for the funds to be restricted to use in dentistry and eliminate the need for the paper-based audit that has been promised in the future. This financial technology tool is something that I would hope was considered in the development of this program. If it wasn’t, could you perhaps at some point ask the officials why they didn’t consider it, other than it is just something that they viewed as being more complicated and didn’t even explore it? It would be a very easy way of preventing fraud. That is a criticism of a very good program. I would appreciate it if you could just reach out to the officials at some point and see whether or not this was even explored.

Senator Yussuff [ + ]

Thank you, Senator Deacon, for the question.

As you know, there is a desire to get this program and the money that is associated with it as quickly as possible into the hands of parents who need it to help their children get access to basic dental care. In the context of doing so, the government, of course, has looked to the CRA, recognizing the experience they gained from CERB — the Canada Emergency Response Benefit — delivery to Canadians who needed it in a very short period of time. You are raising a valid point, and it should be considered in the future program delivery, working with the provinces and territories. I will certainly raise it with the minister and his staff for consideration for the future program, because I do believe clearly CRA can do this. There are processes in place to ensure they can prevent fraud. As you know, anyone determined to commit fraud can do so regardless of whatever measures you may put in place.

There is also, within the context of the CRA, delivery of this benefit to parents for their children’s needs. There are penalties should someone decide to commit fraud at the same time.

I do recognize you are raising an important point that should be thought about in a very coherent way, and I hope the government will consider that. Thank you.

Hon. Tony Loffreda [ + ]

Honourable senators, I rise to speak to Bill C-31, the government’s proposed cost of living relief act No. 2, which offers targeted support for lower- and moderate-income households in a time of high inflation.

I want to start by congratulating and thanking Senator Yussuff for such an insightful and emotional personal speech. Thank you very much.

Part 1 of Bill C-31 proposes a tax-free dental care benefit for parents with children under the age of 12 whose household income is below $90,000 and who do not have access to dental insurance. In Part 2 of the bill, it authorizes a one-time rental housing benefit for eligible applicants who paid rent on their principal residence in 2022.

It was an honour for me to study this bill at the Standing Senate Committee on National Finance. For our work we held four meetings with witnesses. Twenty-five witnesses appeared, including public officials, the Parliamentary Budget Officer, and representatives from dental associations and the housing sector. We also had the privilege of receiving three ministers.

Today I will take a few moments to address four topics that were explored during our meetings.

The first issue I want to address is inflation. In my view, the sums being injected into the economy with Bill C-31 should not have a noticeable impact on inflation. I spoke about this during my second reading speech on Bill C-30, the GST tax rebate, and I stand by those comments.

The Parliamentary Budget Officer, or PBO, estimates that the dental benefit will cost $703 million, while the cost of the one‑time top-up to the Canada housing benefit program will increase federal spending by $940 million. In a $2.8 trillion economy, the injection of an addition $1.6 billion is nominal.

As I said a few weeks ago, the doubling of the GST tax rebate in Bill C-30 along with the measures in Bill C-31 amount to 0.1% of Canada’s GDP in additional costs. This amount is not insignificant, but it is a fraction of the country’s GDP.

I appreciate these measures increase government spending at a time when fiscal restraint is needed. However, I think the dental benefit could unclog our emergency rooms, and end up being a cost-saving investment. Our committee was told that 1% of emergency room visits made by patients with non-urgent dental conditions cost the health care system an estimated $1.8 billion in 2017.

Not only will this benefit help our youth access proper dental care, but I hope it will have the added benefit of encouraging better overall oral health and prevention. We know that more than one in five Canadians avoided dental care because of cost. This interim benefit is expected to allow some half a million children to finally have access to basic dental services.

As Senator Mégie put it so well, when it comes to health, an ounce of prevention is worth a pound of cure. Lynne Tomson, Assistant Deputy Minister at Health Canada, also stressed the importance of prevention, which, over time, would result in significant savings. Prevention and early intervention will also be less expensive to the system as a whole. Moreover, Minister Duclos recognizes that putting off or completely avoiding dental care can have serious consequences for people’s health.

This in turn can increase the public’s dependence on costly sectors such as cardiology, cancer and emergency services.

The second issue I want to address is the displacement risk. In other words, will this publicly funded dental benefit encourage employers to cancel or reduce dental coverage for their employees? It is an important question that cannot be glossed over.

Last week, I met with representatives of the Canadian Life and Health Insurance Association, which shares my concerns about a risk of displacement. Consider the following statistics: In 2021, personal insurers in Canada provided coverage for more than 29 million insured and paid out more than $30 billon in extended health benefits, including $9.5 billion for dental care.

The association is concerned, as am I, that employers will opt to reduce or cancel their coverage, given that the state is prepared to intervene. It would not be prudent to transfer these amounts of money to the public. Naturally, this issue will have to be resolved when the government undertakes to enhance the current dental benefit or create a permanent program.

Health Canada explained that it does not anticipate a displacement at this time, but acknowledged that it is an element of concern that will be taken into consideration as it designs the longer term program.

I strongly encourage the government to consider ways of incentivizing businesses to keep their current coverage. It is not realistic to penalize corporations for dropping plans. Incentivizing is the way to go.

The third point I want to discuss is the labour shortages in the industry. Naturally, the expectation is that the dental benefit will finally allow some of our kids to receive proper dental care. I’m sure this is a huge relief for many parents who are unable to afford dental fees. I hope these kids will soon book their appointments and get the care they deserve.

But will the industry be able to manage an influx of new patients? The short answer is yes. But it will not necessarily be easy. Human resource challenges also exist in the sector, especially with respect to dental hygienists and dental assistants.

Dr. Lynn Tomkins, President of the Canadian Dental Association, assured our committee that there is not a shortage of dentists. Rather, there is a distribution issue. The association would like to see more young dentists going to remote and rural areas. But as she said, “We will deal with the influx of new patients that come in.”

I’m also reassured that within the definitions in the bill, “dental care services” means the service that a dentist, denturist or dental hygienist is lawfully entitled to provide. Ondina Love, CEO of the Canadian Dental Hygienists Association, reminded our committee that her industry counts over 30,000 hygienists among its ranks, and that they offer care in innovative ways such as stand-alone clinics, community clinics, daycares, schools and mobile settings.

Unfortunately, while dental hygienists are captured in the bill, the 10 dental schools across the country are not. Dr. Walter Siqueira, Dean of the College of Dentistry at the University of Saskatchewan, who also serves as President of the Association of Canadian Faculties of Dentistry, feels they have been left out.

Dental schools see around 350,000 patient visits per year, and they could help with the increase in new patients. He explained, for example, that “In the north of Saskatchewan, basically 80% of dental care is provided by our dental school clinics.”

Dental schools already have a network of clinics and programs tailored to the people Bill C-31 targets. As he told us, with the proper support, dental schools could double the number of patients they see since they are well placed to become a core element of a much larger network of community and institutional clinics for the provision of dental care to those most in need.

It is clear that the government must collaborate with the schools as it expands and elaborates the permanent program. Minister Duclos appears to be open to engaging with them.

Finally, the last issue I want to address is the permanent dental program that the government is looking to establish. As a reminder, the government’s 2022 Budget sets out an investment of $5.3 billion over five years. The government is proposing that the benefit, which we are currently studying, would initially cover those under the age of 12. The intention is to then extend the benefit to those under 18, seniors and persons with disabilities in 2023. Finally, full implementation of a new permanent plan is slated for 2025.

As the government undertakes the study, development and implementation of a permanent program, a few issues deserve further consideration. Data collection will be key in assessing the success of the temporary benefit.

The government will have to evaluate the uptake rate, identify who benefits from this subsidy, identify any gaps and measure to what extent the amount of the benefit is in line with the cost of dental care. This may be difficult to accomplish, and there are certainly some privacy considerations. However, this is something that should be considered before we implement a more robust and hopefully data-driven, longer-term program.

Minister Duclos assured us in committee that his department will monitor health and other outcomes, and improve the benefits as required. Health Canada also confirmed that it will be receiving statistics from Canada Revenue Agency to see what the uptake is by province.

The Canadian Dental Hygienists Association also calls upon the government to measure access to dental care and the provision of oral health and dental care services to determine the return on investment of this newly implemented dental care program.

Dr. Siqueira strongly believes in the value of data too. Here’s what he wrote to Minister Duclos:

As the government develops and rolls out various elements of this new national dental program, researchers in dental schools can evaluate the outcomes and provide information to make changes where necessary.

With the cost of living increasing at a rapid pace, the government should also monitor any potential increase in dental fees.

Some concerns were raised in committee about the possibility of fee hikes. While legitimate, I personally don’t expect any increases. Like the Parliamentary Budget Officer said, in fact, that the bill is targeted to specific segments of the Canadian population, it lessens the impact of undue profit-taking.

Dr. James Taylor, Chief Dental Officer with the Public Health Agency of Canada, also believes that if fees do go up, it would be due to cost of labour, cost of materials and not simply supply and demand.

In a follow-up written submission, the Canadian Dental Association provided information on the average treatment cost per visit. The association informed us that:

The median claim per visits for a patient under the age of 12 was $150. Half of all claims fell between $92 and $233 [and] overall, 95.6% of all claims submitted were less than $650.

As we know, applicants with an income of less than $70,000 are eligible for a yearly dental benefit of $650. Those who make between $70,000 and $80,000 are eligible for $390, and those who make between $80,000 and $90,000 are eligible for $260.

Some argue that the dental benefit is not generous enough. I, too, was concerned that $650 per year may not be sufficient for basic dental care. However, now that we have received these figures, I’m reassured. Of course, it won’t be enough for everyone, but it’s a great start. Let us not lose sight of what this is: an interim benefit, a starting point.

The Canada Revenue Agency should also try to monitor that the funds it distributes are being used for their intended purposes, since eligible applicants can receive the benefit before their kids receive dental care. As I often say, trust is the currency of every relationship. I trust that parents will use these funds for the health and well-being of their kids.

We were reminded by Senator Yussuff that the CRA:

. . . is also well equipped to guard against fraud and ensure the program is being accessed as intended.

The CRA will take steps to implement additional verification and security measures up front . . . .

But this is certainly something that needs to be monitored.

In conclusion, honourable senators, Bill C-31 is a good bill. I feel it is appropriate at this time for the government to invest in Canadians who are struggling the most to make ends meet, particularly for two basic human needs: shelter and health care.

I will vote in favour of Bill C-31, but I believe the hard work is still to come. Implementing a permanent dental program will be a huge undertaking.

If the government is to pursue this initiative, it will have to consult widely, budget accordingly and legislate a program that has all the accountability and transparency measures needed to ensure its success. When the time comes, I’m confident the Senate will be ready and willing to take the necessary time to review any future dental program.

Thank you, meegwetch.

Hon. Brent Cotter [ + ]

Honourable senators, I rise to speak in support of Bill C-31. I will speak only to the component related to the dental benefit for children.

I want to thank Senator Yussuff and, before him, Senator Lankin for their leadership on this bill. I also want to thank Senator Loffreda for his detailed, thoughtful and comprehensive comments about the bill. I will speak in a somewhat more environmental way about dentistry and this bill.

At second reading of this bill in early November, I heard one of the most remarkable things I have ever heard in the Senate. Speaking about her acquisition of dental benefits, Senator Simons said:

As soon as I was hired on by the Edmonton Journal, I rushed to the dentist to make up for all those years when I had no cleaning or checkups. . . .

I am 72 years old. This is the first time in my life I have heard anyone express breathless enthusiasm about “rushing to see the dentist.” Senator Simons, with that one sentence, you could become the poster person for all the dentists and dental hygienists in the country.

When it comes to dentistry — and I say this sort of humbly — I know whereof I speak. I come from a family inundated with dental professionals. My sister is qualified as a dental nurse and dental hygienist. She studied with Senator McCallum many years ago in Regina. For years, my sister was president of the Saskatchewan Dental Hygienists’ Association. My brother-in-law is a dentist. My nieces are a dental hygienist and dental therapist, respectively. My daughter-in-law is a dentist in Germany, and my father was a dentist and professor of dentistry. They are everywhere.

Some of you have watched the “Ted Lasso” series. There is a little chant about somebody named Roy Kent in it. I’m going to leave out a word that I think we are not allowed to say here, but the phrase is: “Roy Kent! He’s here, he’s there, he’s [everywhere].” Well, the dentists in my life are everywhere.

My father was the finest person I have known in my life, with this one exception: When I was a kid, every now and then on a Saturday morning — when I wanted to be almost anywhere else — he would drag me off to his dental office for some painful treatment.

Working on your own children is probably not allowed anymore, but this was a long time ago — I believe shortly after dentistry had been invented. He used interesting — and now antiquated — pain-management techniques. One I recall is that he used to tug sharply on my cheek, so painfully that I didn’t notice the freezing needle going in. It was an interesting technique — to cause pain to distract from pain. I feel that I come by my aversion to dentistry and the dental profession honestly.

To moderate these somewhat uncharitable perspectives, I will add this comment and one story. Every dentistry professional I know has been deeply committed to their work and loved their work, knowing they were making things better for their patients. This is true for many occupations and professions — not just dentistry but carpenters, counsellors, painters, plumbers — the greatness of doing something honourable to help your customer, client or patient.

I want to share with you one example of this — a dentistry story. It is a bit gruesome, but also beautiful.

Late in his career, my father acquired a specialty in prosthodontics and maxillofacial surgery. They are big words, but the first one basically means false teeth, and the other is jaw and facial reconstruction. At the time, he was perhaps the only specialist in that area in Saskatchewan.

He was asked on one occasion to help a patient who had experienced a severe facial cancer and had to have part of his jaw and all of his nose removed to defeat the cancer. My dad was asked to do the jaw and nose reconstruction, which he did. What remained was both to rebuild the jaw and then to build the patient a new nose. It sounds gruesome, I admit.

He created that nose out of material, shaped it, firmed it up by whatever techniques, and got it in the right shape and skin tone for the patient, corresponding with the patient’s original nose. He noted in the picture he had of the patient that it wasn’t quite right.

I started laughing when I wrote this out. I apologize.

The man, it seemed, had a close relationship with alcohol and had had a very veiny nose. My father went to the art store and bought paint and a paintbrush with only one bristle and brought them home. At the kitchen table, with this man’s new nose on the table, he carefully painted veins onto the new nose. Then, to get it just right — I’m sorry to be sharing this — he pulled nose hairs from his own nose and glued them, one by one, to the man’s new nose.

That surgery saved the man’s life, but this reconstruction — nose and all — gave him back his life. It is pretty gruesome, but also pretty great.

Returning to my main point: Whether I wanted to go to the dentist or not, I got dental care — as did Senator Simons eventually, as do all of us here and our families, and as do millions of Canadians across the country, as Senator Loffreda pointed out. However, many do not.

As Senator Yussuff noted in his second-reading speech, perhaps 25% of our population does not have access to dental care. There are consequences to that lack of care. We all know what it is like to have a toothache and how pain of this sort, in such a small part of our bodies, can overwhelm us and be debilitating. But there is more to it than that. Longer term health care for all of us is closely tied to dental care.

Let me give you an example. I was visiting my dentist recently — not enthusiastically — and he started to tell me about the importance of the health of my gums and that, if you don’t take good care of them, it can lead to heart disease and death. This sounded a bit extreme, kind of like a car salesman telling you that you have to buy the most expensive car on the lot or you will die in a car accident. So I looked it up and, sure enough, my dentist was right. Good dental care is fundamentally important to overall health.

Then the question is posed: Why are dental services not available to more Canadians? Access is an issue in rural and remote parts of the country, as Senator Loffreda and others have pointed out. However, the largest reason is because dental services are expensive. They are expensive to provide. For dentists, at least, the education is long, arduous and expensive. At the University of Saskatchewan, the tuition for the dentistry college is among the highest of any university program in Canada. Dentistry professionals, to be fair, earn a good living. Indeed, my father, when he was teaching dentistry, probably inadvertently contributed to this. When he was helping students in the clinic make false teeth — upper and lower sets of dentures — he used to think he was giving advice to them in terms of how to be a dentist in practice. What he used to say to them was, “After you have made the dentures, the patient is sure to ask, ‘So doc, how much?’” And he would continue, “What you say then is ‘$700,’ and then you pause, and if there is no reaction, you would say, ‘for the uppers.’”

The reality is that even now the demand for dental professionals is overwhelming. Most dentistry services operate at full capacity, and dentists can hardly find dental hygienists to support full-service dental practices. So market forces alone will not solve the problem of access. Into this context comes this bill. It’s the beginning of a regime of dental coverage that will make meaningful differences in dental care for some millions of lower- and modest-income Canadians who, mostly due to cost, are simply unable to access basic dental services. Too many families, whether in these somewhat more inflationary times or otherwise, have to choose to use their limited resources on food, rent, clothing or other needs for their families, and children’s needed dental care goes wanting. The dental insurance program, of which this bill is a start, will address the beginnings of that gap in services.

This bill is focused on dental care for children only — more coverage will follow, as we’ve heard — but for kids’ dental health and to address the cost burdens for lower- and modest-‑income Canadians, it’s a good start. All of this is great, and I support the initiative. However, as Senator Loffreda noted, there’s more to be done, and I want to highlight one aspect of it.

I would call this a knock-on consequence of the program that is unfolding, beginning with this bill. As leaders of the profession and particularly dental educators have told the finance committee, the program will require a significant increase in the supply of dental professionals in order to ensure that caregivers are available at affordable prices to meet a significant increase in demand for dental services. Indeed, that’s what we hope. At committee, Dr. Siqueira, the Dean of the College of Dentistry at the University of Saskatchewan, noted this and the way in which, for example, the University of Saskatchewan is well positioned to take on this challenge, having brought a full range of dental professionals’ education — dentists, dentistry specialists, dental hygienists and dental therapists — under one umbrella within his faculty. But it should be noted — and this is, I think, an important future point — that nearly all the educational programs that will be looked to in order to meet the needed and significant increase of dental professionals fall within provincial jurisdiction over education. It will be critical for the Government of Canada in the coming years to have a plan to work with the provinces and territories in partnered, respectful and potentially financially supportive ways to get us to that goal of affordable, good-quality dental health for all Canadians.

In the spirit of cooperative federalism that has been the way forward for most of the life of our country, I’m hopeful that such partnerships will develop and prosper and Canadians will benefit. Thank you.

Hon. Pat Duncan [ + ]

Honourable senators, I rise to speak to third reading of Bill C-31, An Act respecting cost of living relief measures related to dental care and rental housing.

You may have heard the phrase, “Sometimes, the hurrier I go, the behinder I get.” Anyone who has tried to make a hand-crafted gift with a deadline — Christmas is coming — or tried to assemble a bed intending to sleep in it that night will in all likelihood agree with that statement. In other words, sometimes we need to take things a little slower or at least obey the speed limit to get to our destination.

Honourable senators, we’ve heard several times in this chamber, and will likely hear several more times, that the goal should be the good rather than the perfect. I’ve also heard legislation compared to sausage making: You really don’t want to be aware of all the ingredients and effort it takes to make a tasty end product.

Legislators are also likely familiar with Miscellaneous Statute Law Amendment bills. These are bills that need to be introduced when renumbering is required, the French translation is not quite correct, the English translation is not right or there’s a minor name change, and are sometimes referred to as housekeeping bills. These are not popular with either the opposition or the government.

Bill C-31 has clearly been prepared fairly quickly as there are a number of details yet to be ironed out. We’ve been advised that it’s an interim measure. Although Bill C-31 is not as finely tuned as we in this chamber might like, if approved in the chamber, it will provide relief to Canadians paying a substantial portion of their limited income on rent and provide money for dental care for young Canadians without a family dental plan. The intent of this bill is absolutely necessary, and in these challenging times, it is absolutely essential that this money be provided as soon as possible. I support this bill and its immediate passage. My remarks will be brief and focused on the dental provisions of this legislation only.

Honourable senators, I cannot in all good conscience vote in favour of Bill C-31 without ensuring that a serious concern is placed on the record — to use the words of another political adage, to “hang a lantern on the problem.”

Repeatedly, through the media and at the Senate’s National Finance Committee, we’ve been made aware that the details of the dental health program will be modelled after the Non-Insured Health Benefits program — or NIHB, as it is called. Allow me a few moments to provide some background.

In the words of Manitoba’s then-premier Gary Doer back in 2000, when the Western premiers were discussing — oh, surprise — more money for health care, Canada is the fourteenth province or territory at the federal-provincial-territorial health care table. Canada has a fiduciary responsibility for the health of First Nations, Métis and Inuit Canadians. There are other federal responsibilities, like that of the Canadian Armed Forces. I’m focusing my remarks today on the Indigenous recipients of health care services that are provided through the NIHB program. At the very practical level, let me explain the Yukon situation.

If you’re over 65, your Yukon health care card entitles you to several services that are beyond the usual publicly funded services — for example, prescription glasses, dentures and certain pharmaceuticals. These are all approved and paid for at the territorial level through the Government of Yukon’s health care services — unless you’re a status member of a First Nation. For these Yukoners, the drugs are approved and paid for through NIHB, as are glasses and dental services. This presents the first very serious concern with this bill. Dental services are already provided to Yukon First Nations children. The bill does not apply to Indigenous children in Canada except that, in the administration of this temporary program, any services over and above those provided by NIHB and paid for by parents might be reimbursed up to $650 or according to any other program adjustments that are made by the government. I’m compelled to raise serious red flags with the government’s intent to model the NIHB system or to use something similar, even temporarily, to provide these necessary dental services.

Honourable senators, allow me to share another example that I shared with my colleagues at the National Finance Committee. In British Columbia, the provincial fee schedule sets out a dental primary complete exam at $87.30; the Non-Insured Health Benefits program covers $65.94. In Alberta, the fee is $77.18, and the NIHB program covers $74. The fees in the Yukon are $118, and NIHB covers $95.97. This means that under the Non‑Insured Health Benefits program, there’s 76% coverage in B.C., 96% in Alberta and 81% in Yukon. That’s two provinces and one in three territories. There are different coverages by NIHB throughout the country.

Rather than simply accepting my entry of this issue into the record of this debate, I invite senators to review the Canadian Dental Hygienists Association’s submission to the National Finance Committee. Their letter, dated November 1, stated that the NIHB platform does come with challenges that governments should — and I would say must — address to ensure a seamless and less cumbersome process for the authorized oral health professionals working with the program.

Senator Colin Deacon, in his question a few moments ago, made a very reasonable suggestion that I do hope the officials working on this program will take into account.

Honourable senators, I’m not the first senator to raise concerns regarding NIHB in this chamber. As recently as May 17, 2022, speaking to Bill S-242, our colleague Senator Yonah Martin, at page 1427 of the Debates of the Senate, said:

According to the Indigenous Services Canada website, mental health providers “. . . must be enrolled with Express Scripts Canada . . .” an online health management tool “. . . in order to bill the [Non-Insured Insurance Health Benefits] program for services provided to eligible First Nations and Inuit clients. Please note that providers who are not enrolled with Express Scripts Canada will no longer be able to submit claims for the NIHB program.”

Colleagues, I appreciate this is delving deeply into the administrative details of the legislation. It is where the rubber hits the road. We want to ensure that these benefits are paid to those who need them and that the government’s intentions with this legislation are realized.

Ministers’ mandate letters contain the phrase “a whole-of-government” approach. This benefit program needs to take a whole-of-government lens to examine what works in some areas and what does not, to ensure that the benefits intended in Bill C-31 will use the information that is available and develop the very best program. I, for one — and I believe I can count on my colleagues at the National Finance Committee, as well as all of you, in our efforts of transparency and accountability — will be watching. We will be observing the results.

Honourable senators, I commend the government’s intention with the dental program and the rental program in Bill C-31 and I look forward to the performance results. I hope that with these comments, drawing your attention to the challenges of the NIHB program, and with the current attention to health care in Canada, perhaps with some semblance of federal, provincial and territorial cooperation, we will see a closer look being taken at services like Non-Insured Health Benefits and that First Nations, Métis and Inuit Canadians — all Canadians — can look forward to improved services that all Canadians deserve.

I’d like to express my sincere thanks to Senator Yussuff for his sponsorship of the bill and all my colleagues for their speeches. I certainly commend it to the House, to this chamber. Thank you very much for listening to my remarks today. Mahsi’cho. Gùnáłchîsh.

Hon. Clément Gignac [ + ]

Honourable senators, I rise today at third reading to speak to Bill C-31, An Act respecting cost of living relief measures related to dental care and rental housing, which was passed by the House of Commons on October 27, 2022. I would like to acknowledge all of my colleagues who have spoken so far and thank them for their thoughts. In particular, I would like to recognize the work of Senator Hassan Yussuff who so ably sponsored this bill in the Senate.

As a member of the National Finance Committee, I feel privileged to have had the opportunity to study this bill. While some have pointed out to me that this bill, with over 35 pages, had been approved in clause-by-clause consideration at the National Finance Committee in just 15 minutes, without any amendments or observations, I would like to point out that this does not reflect all of the upstream work they had done on this bill under the leadership of our chair, Senator Mockler.

Indeed, we had five special meetings dedicated to this bill and heard from nearly 25 witnesses, including 3 federal ministers who were present at the same time before the Senate committee, probably a first in our recent history.

As stated previously, the purpose of Bill C-31 is to relieve the pressure that low-income individuals and families in Canada are experiencing. Unfortunately, they are the ones hit hardest by rising inflation. To be precise, where household income is below a set limit, this bill will provide up to $650 per year for two years to help pay for dental care for children under the age of 12 and up to $500 in a single lump-sum housing benefit for Canadians in need. Although the housing and dental benefits in Bill C-31 are temporary, they will still help those in greatest need.

I will now get into detail about each of the two measures in the bill.

Regarding the temporary dental benefit, the Parliamentary Budget Officer estimates that the program will cost approximately $700 million until a permanent Canadian dental plan is established in 2025. During meetings of the Senate Committee on National Finance, I raised three concerns, which I would like to share with you.

As our colleague Senator Seidman demonstrated during the second reading of the bill, all the provinces have already implemented dental care programs, even if the coverage of these programs is very different from one province to another.

In Quebec, there is already a universal dental care program for young children under 10 years of age. This is partly why the Parliamentary Budget Officer, or PBO, estimates that Quebec would represent only 13% of the total cost of this new temporary federal program, despite representing a quarter of the Canadian population.

Given the federal government’s intention to extend this plan on an ongoing basis over the coming years to young people 18 and under, seniors and persons with disabilities, in a provincial jurisdiction no less, it is incumbent on the government to be flexible and consider that the provinces may use provisions to opt out with financial compensation, which is obviously conditional on meeting certain conditions.

At the same time, this pragmatic approach would be more respectful of a decentralized federalism, especially since the dental and dental hygiene professions are regulated by the provinces. What is more, the recommended fee structure for dental care delivery varies from one province to the next. In short, while supporting the federal objective to ensure universal dental care coverage from coast to coast to coast, in particular for young people, I hope the federal government — a bit like Senator Mockler was saying — is receptive to the demands of the provinces — including Quebec — that may want to administer their own dental care system with full compensation, if the conditions are met, obviously.

As I previously said in committee, there is already tension in federal-provincial relations in the area of health, as we saw in Vancouver, and there is no need to add another layer of tension by establishing a national dental care plan without consulting the provinces.

My second concern relates to the ability of dental clinics and all associated practitioners to suddenly accept all these new clients without imposing generalized fee hikes or increased wait times for current clients, who often find it difficult to get appointments.

We learned at committee hearings that there is a shortage of dental hygienists in Canada and that people have trouble accessing a qualified dentist across the country, especially in our more remote areas.

Let’s hope that the Canadian Dental Association and the Canadian Dental Hygienists Association will be able to work with educational institutions across Canada to address this challenge and provide these necessary services to all eligible young Canadians.

Let’s also hope that dental clinics will strictly abide by the fee schedule proposed by their professional association and will not take advantage by imposing a small surcharge, given the immediate increase in demand that may occur.

My third concern is the total annual amount that Canadian taxpayers will have to shoulder when the dental care plan is implemented in 2025. For now, the government expects that the annual recurring cost of the future dental insurance plan would reach $1.7 billion effective in 2025.

That does not take into account the fact that some employers might take advantage and decrease the dental coverage in their own dental insurance plan in order to save money. On that point I have the same concern as my colleague, the Honourable Senator Loffreda. What monitoring mechanism will be in place to prevent a considerable increase in the bill to Canadian taxpayers and to ensure that employers do not opt out to leave the government on the hook instead?

So far, no one has really been able to give us any answers. With rising inflation and the uncertainty surrounding the behaviour of employers toward this national dental plan, you will allow me, dear colleagues, to express some concern and a bit of skepticism about the estimated cost of $1.7 billion a year for this future plan, starting in 2025.

As we say in English, “Stay tuned.”

My next comments will focus on the second component of Bill C-31, the creation of a $500 one-time benefit for low-income Canadian renters. If this bill is passed, this benefit would be available to those who spend at least 30% of their income on rent in 2022, and whose income is less than $20,000 for a single person or less than $35,000 for a family. The Parliamentary Budget Officer estimates that the cost of this one-time measure will be close to $1 billion.

Just as we did during the study of Bill C-30, in committee we raised the fact that, on average, 10% of Canadians, especially the poorest, do not file income tax returns for a variety of reasons. That percentage is even higher in Nunavut, as Senator Patterson has already mentioned. Consequently, these people will not receive the $500 one-time benefit unless they finally file their previous year’s return. The Minister of Revenue, in her testimony before the committee, tried to reassure us that she was doing everything in her power to encourage low-income Canadians to file their tax returns so they could access this program.

In conclusion, honourable senators, these targeted programs provided in Bill C-31, and contained in the recent Bill C-30, to help low-income Canadians are great initiatives that deserve our support.

However, as pointed out by Senator Cotter, the federal government needs to, and should, consult the provinces to find out — in good faith — which level of government is best placed to provide those dental services, given the fact that this is regulated by the provinces.

For now, the federal government has been able to launch many new initiatives over the last 12 months while significantly reducing deficits at the same time — thanks to inflation because inflation helps the government in terms of revenue.

One day, and, perhaps, not far away, the source of federal revenue will be less prolific and dry up due to a potential recession or geopolitical risk. We should avoid repeating the experience of the 1990s when it was the provinces that took the hit from the consolidation of federal finances, with massive cuts made to transfer payments to the provinces from Ottawa, due to the spending spree that had been put in place in the previous years.

In closing, I would like to thank all of my colleagues on the Standing Senate Committee on National Finance for their analyses and their commitment. I am already looking forward to examining the next bill with them, Bill C-32, which concerns the November 3 economic statement and promises to be rather substantial, since it is 172 pages long. At that time, I will have a lot of things to say about the various federal government initiatives in the wake of this pandemic and especially about the threat that the potential deterioration of the economy could pose to our public finances.

In the meantime, honourable senators, I will support Bill C-31.

Thank you.

Hon. Elizabeth Marshall [ + ]

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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