Moved second 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 to begin the debate on Bill C-31, An Act respecting cost of living relief measures related to dental care and rental housing.

Canadians across our country are feeling the effects of the rising cost of living caused by the global inflation. The government has responded with legislation that will quickly provide relief to those who are struggling most. This proposed legislation aims to bridge the gap for Canadian families. If passed, this bill will give an estimated 1.8 million Canadians an extra $500 to cover their rent through a one-time top-up to the Canada Housing Benefit. In addition, the bill creates the “Canada Dental Benefit,” which will provide needed dental care for children under 12 from low- to middle-income families, helping an estimated 500,000 children.

If passed, this legislation will not only help with the immediate effects of rising inflation but be a very good first step to a long‑term Canadian dental-care program.

I will begin my speech by talking about the Canada dental benefit and will finish by talking about the one-time top-up to the Canada Housing Benefit.

Dental care is essential to maintaining good oral health, especially for our youngest children, whose teeth are still developing. Yet, the reality is that professional dental care is out of reach for many Canadian families across this country. Seeing a dental professional can be expensive, and approximately one third of Canadians do not have insurance to cover the costs. This means that many parents have to postpone or forgo important dental care for their children at a time when 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 the type of health inequality that the bill being introduced here today is trying to mitigate.

In 2018, more than one in five Canadians reported avoiding dental care because of the cost. That is roughly 6.8 million people. 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. That, in turn, increases public-health spending in cost-intensive health-care systems such as cardiac, cancer and emergency services.

We heard testimony at the National Finance Committee from Dr. Walter Siqueira, Dean and Professor at the University of Saskatchewan, who warned us about the dangerous health effects of not having proper oral health. It is clear that poor oral health places a significant burden on society as a whole. These direct and indirect costs affect all of us, and we all stand to benefit when we improve access to dental care professionals.

When it comes to children, the stakes are even higher. The consequences of poor oral health in childhood can last a lifetime. Many oral diseases can begin in the preschool years. It may surprise you to learn that tooth decay is actually the most common childhood chronic disease in Canada and around the world. In Canada, the treatment of dental problems is the leading cause of day surgery under general anaesthesia for children under the age of five.

Childhood is also a critical time for establishing good dental hygiene behaviours. Seeing a dental professional during these formative years can be instrumental in developing healthy habits that last throughout one’s life.

There is no doubt that inadequate access to dental care during the critical years has a significant effect on children, and that effect is more pronounced in certain groups. Research data shows that dental diseases are more commonly found among children from low-income families, Indigenous children and children with disabilities or special health-care needs.

It is clear that some Canadian children are falling between the cracks. If we do not act now, those children may have to live with the consequences of poor oral health for the rest of their lives.

It does not have to be that way. With the right care, we can prevent minor dental issues from growing into major ones. For children whose whole lives are ahead of them, the benefits of accessing dental care early are immeasurable.

With that in mind, the proposed Canada dental benefit is designed to help the youngest Canadians first, specifically children under 12 from low-income families who do not have access to private dental insurance coverage. The benefit would provide eligible families with payments of up to $650 per year per child under 12 years of age. The benefit would also be tax-free.

I first want to address the issue of adequacy because I know several senators had questions and concerns about whether $650 per year is enough. I will make two points. First, this program is not to be a replacement or substitute for existing private or public plan coverage. The intent of this interim program is to help ensure that basic oral health care is available to children of low- and middle-income families when they cannot access it through private or public coverage.

How was the $650 amount determined? Health Canada officials, in collaboration with the Chief Dental Officer of Canada, examined average costs of dental care for a range of basic care needs for children, including exams, X-rays, fillings and preventative care like fluoride and sealants. Based on the cost of those basic treatments and measures, they came up with the benefit amount to help fill the gap to ensure basic oral health‑care needs are met for children.

My second point is that the dental benefit program is an interim program, not a long-term solution to children’s oral health-care needs. More in-depth discussions will take place over the next two years between the federal, provincial and territorial governments, along with main stakeholders including dental health-care professionals, to help inform a better and longer-term solution.

If the proposed legislation is passed, eligible families could apply for the Canada dental benefit as soon as later this year.

Health Canada and the Canada Revenue Agency have committed to working together to ensure that Canadians receive their benefit payment as quickly as possible. Parents and legal guardians of eligible children will apply through the Canada Revenue Agency’s My Account or through their contact centres, after which they will receive an upfront payment that will allow them to take their children to the dentist. Money provided through the benefit will be used to cover oral health care services delivered by any regulated, independently practising oral health care provider in Canada.

To qualify for the benefit, applicants will need to meet certain criteria. They must have a child under 12 years of age in their care who does not have access to private dental care. They may be asked to provide information about the employer to help verify whether or not they have access to private dental insurance for their children. They must have an adjusted family net income under $90,000 per year. They must have filed their most recent income tax return. They must be a parent or legal guardian who receives the Canada Child Benefit for eligible children. They must have spent or have a plan to spend money on dental expenses for the child that wouldn’t be fully reimbursed under another public program. They must provide information about the dental care visit and the dental care provider for which the benefit will be used.

Children who are receiving oral health care services through other public programs, such as those provided by provinces and territories or the federal Non-Insured Health Benefits program for First Nations and Inuit, may also be eligible for the Canada dental benefit. However, they would still have to meet the other criteria. Most importantly, they would have to have out-of-pocket expenses that would not be fully reimbursed under these programs.

There have been some questions and concerns raised about whether you must pay up front and then wait for reimbursement. I want to be clear that the money disbursed through the Canada dental benefit would be provided to eligible applicants up front before they access dental care. By providing an upfront payment, the proposed benefit recognizes that many eligible recipients do not have the financial flexibility to wait for reimbursement.

In the case of someone who has paid for care before applying for the benefit, that person could still apply to receive the benefit after the fact, as long as the care was received during the eligible period and was not reimbursed by another program and they are eligible at the time they apply.

The Canada Revenue Agency is well equipped to deliver this program with its extensive secure infrastructure and long-standing experience delivering benefits to Canadians. The agency 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 to help ensure benefit payments are deliverable only to individuals who are entitled to receive them in the first place. In some cases, the CRA could request additional information or contact an applicant’s employer or dentist’s office to validate eligibility.

The CRA continues to enhance the security of its digital services to protect Canadians from fraudulent activity. Security features include multi-factor authentication and making email addresses mandatory for those who use CRA’s My Account. The CRA will lean heavily on a range of existing tools for administering other government programs as set out in the draft legislation to conduct compliance, verification and collections activities.

I want to stress that the Canada dental benefit is just a start. This benefit is an interim solution to provide urgent support to those most in need. The benefit would provide immediate financial support to families, allowing them to begin addressing their eligible children’s dental care needs as soon as possible.

While the Canada dental benefit is in place, the Government of Canada will be taking the necessary steps to build a comprehensive, longer-term dental care program. That includes engaging with key stakeholders, such as industry and experts in oral health care delivery.

This past summer, for example, the Minister of Health and the Minister of Public Services and Procurement Canada launched a Request for Information with industry representatives. As you know, health care is a shared responsibility between the Government of Canada and the provinces and territories. As always, the Government of Canada recognizes and respects the mandates and jurisdictions of our provincial and territorial partners.

All provinces and territories currently provide some form of supplemental coverage for dental services. These programs vary in scope and may only be available to specific groups, such as seniors, children or those receiving social assistance. But provincial and territorial programs do not cover dental care for children under 12 equally and, in some cases, the programs focus only on emergency needs.

Some children under 12 who are also covered by provincial and territorial programs may still be eligible for the Canada dental benefit if the family meets all the criteria to qualify for the benefit. If a family still has out-of-pocket expenses over and above those covered by the provincial and territorial programs, they can apply for the Canada dental benefit to cover these extra expenses.

For example, in Quebec, their program only covers up to the age of 9 — not 10 years old and not 11 years old — unless the parents are on a social assistance program to access any types of benefits. Additionally, the Quebec program provides no prevention measures such as cleaning for children up to the age of nine.

Our recent experience with the COVID-19 pandemic has illustrated clearly that we can work together on health care priorities. As a result, we know we have the momentum we need to think big and to tackle larger system challenges. By building on the investments made to date and through collaboration across governments, it is my hope that governments will continue to look to find ways to work with their provincial and territorial colleagues to develop a shared vision for the future, one that includes expanded access to dental care.

Canadians deserve a health care system that delivers results, and they expect their governments to work together to deliver value for their tax dollars.

Honourable senators, if passed, this bill will help bridge the gap for hundreds of thousands of Canadian children who cannot afford dental care. It will ensure that all children under the age of 12, no matter where they live, will have access to some dental benefits. The dental benefit act also proposes an interim benefit because we recognize that children whose teeth are still developing must be a top priority.

With this in mind, I would like to speak about timelines. Through Budget 2022, the Government of Canada committed to help the youngest Canadians access dental care before the end of the year. In order for this to happen, the proposed legislation must receive Royal Assent as soon as possible, so I’m urging all honourable senators to support Bill C-31.

As I previously mentioned, Bill C-31 also includes a one-time top-up to the Canada Housing Benefit. It will give Canadians an extra $500 to cover their rent. The Canada Revenue Agency will process the applications and payments on behalf of the Canada Mortgage and Housing Corporation and the Minister of Housing and Diversity and Inclusion. In other words, it will operate separately from the existing Canada Housing Benefit, which is delivered by the provinces and the territories across the country.

Honourable senators, this one-time payment will have a far-reaching impact. The government estimates some 1.8 million people across the country will receive it, including an estimated 700,000 low-income renters in my province of Ontario.

Is this benefit meant to be a long-term solution for the affordable housing challenges we face in our country? Absolutely not. This short-term benefit is meant to deal directly with the short-term problem of rising inflation that is disproportionately hurting low-income renters.

According to the October report from Rentals.ca, the average rent is now about $100 more than the pre-pandemic peak level in the fall of 2019. The $500 rental benefit will help cover some of this increase over the short term, but I think we can all agree that more needs to be done in the long term to help Canadians deal with housing affordability.

We have already heard the broad strokes of the one-time top-up to the Canada Housing Benefit. Now, I’d like to spend some time answering some of the questions that my colleagues on all sides of the Senate may have.

First, let me explain who is eligible for the benefit. Individuals will be eligible if they have completed their 2021 tax return and if, based on the return, they have an adjusted net income below $20,000, or below $35,000 for families.

To be eligible, people must be residents in Canada for tax purposes in 2022. Their principal residence must be situated in Canada on the latter of December 1, 2022, or on the day the act is in force. They must have paid rent for their own shelter in Canada in 2022, and paid at least 30% of their adjusted net income on rent.

People must apply for the benefit via the Canada Revenue Agency’s, or CRA, secure My Account portal, or by calling the CRA contact centre.

The government expects that people can apply for the one-time top-up to the Canada Housing Benefit by the end of 2022, and their application period will be open for 120 days. To ensure Canadians get the benefit as soon as possible, the government will encourage applicants to sign up for direct deposit, which can be done through the CRA My Account secure portal, or through many Canadian financial institutions.

Those applicants who are eligible, and who have signed up for direct deposit, will receive their payment quickly — in five business days. Those who haven’t signed up for direct deposit can expect to receive their payment by cheque within 10 to 15 business days.

Your Honour, some people might be worried that this benefit will impact other benefits they rely upon. I can assure them that the nature of the one-time payment of $500 would mean that this is non-reportable from an income tax perspective. It will not reduce their other income-tested benefits, such as the Canada workers benefit, the Canada Child Benefit, the Goods and Services Tax credit and the Guaranteed Income Supplement. Our government will work with the provinces and territories to ensure the benefits they administer will not be negatively impacted by this benefit.

Your Honour, the government designed this benefit so that it will make a difference for the families who need it the most — without creating more inflationary pressures on housing costs. That is because this relatively modest, one-time payment is paid directly to low-income renters.

We know that many homeowners are also struggling to make ends meet, but in this legislation I believe the government is taking a targeted approach by focusing, specifically, on the renters’ households where this investment can have the most impact. That is because research shows that renters are four times more likely to experience core housing needs than homeowners.

Your Honour, I conclude with this last important point: The one-time top-up to the Canada Housing Benefit is only one of the measures in the tool kit of solutions addressing housing affordability. We know that reaching housing affordability calls for a significant investment over the long term. It calls for a comprehensive plan that benefits all Canadians, no matter where they live along the housing continuum in this country. This plan exists; it includes measures to put Canada on the path to doubling housing construction over the next decade. It will help Canadians save for and buy their first home. And it will ban foreign ownership and curb speculation, both of which make housing more expensive for Canadians.

Central to the plan is Canada’s National Housing Strategy. This 10-year strategy, backed by more than $72 billion in investments, is making a real difference in the lives of Canadians, and the strategy keeps expanding to address housing affordability from every angle.

Your Honour, I trust I have been able to clear up some of the most pertinent questions about the one-time top-up to the Canada Housing Benefit. In conclusion, I know that Canadians are counting on all of us to deliver what they are asking for and what they deserve, including safe, adequate and affordable housing — an affordable place to call home.

No child should have to suffer poor oral health simply because their family does not have the means to pay for dental care. Painful dental problems do not have to be part of childhood — not when professional dental care is widely available in this country.

I hope we can all agree that every Canadian who needs medical care should get it, regardless of their ability to pay. A Canadian seeing their dentist should be no different. Canadian families in need have waited too long to access essential care for their children. This legislation has the potential to make a powerful difference in the lives of children — and the adults they will eventually become. By acting now, to ensure better access to dental care for our youngest Canadian citizens, we are investing in the health of the whole cohort of Canadians. There can be no doubt that such an investment will pay dividends for many years to come.

I hope we can count on colleagues from all sides of the Senate to support this bill and the much-needed financial relief this bill will provide for those who need it the most. Thank you kindly.

Would Senator Yussuff take a question?

Yes.

First of all, Senator Yussuff, thank you for agreeing to sponsor this bill.

My question relates to the part about housing. In his review of Bill C-31, the Parliamentary Budget Officer noted that 86,700 tenants in Quebec will not be eligible for the $500 allowance because they spend less than 30% of their income on rent. Yet these are Quebecers who are generally disadvantaged, because they live in subsidized low-rent housing known as HLMs, which stands for “habitations à loyer modique.” Quebec is the most affected province, because there are more low-income housing units there than elsewhere in the country.

Across Canada, 118,000 people will be excluded from the program for the same reason.

Senator Yussuff, should the 30% income criterion be removed or modified to include more tenants in need?

Thank you for the question. My understanding is that amendments were made to the bill at the final moment in the other place. But, to be certain, with regard to the specific nature of your question, three ministers will be before the committee tomorrow. I will raise this question on your behalf in order to receive the proper answer to ensure I do not mislead you in my response. Thank you kindly.

Senator Yussuff, thanks for your speech. In my province of Saskatchewan, my understanding is that very low-income families receive dental coverage for their children, and many Canadian families, of course, with health plans through their employment, receive dental coverage for their kids. What does the Government of Canada estimate is the percentage of Canadians, not otherwise covered by dental coverage, who will receive this particular benefit?

First, senator, thank you for the question. Clearly, as you know, there are different programs at the provincial and territorial levels, across the country, that help families access certain aspects of dental care.

In the province of Saskatchewan, it is estimated that some 49,500 families will be able to access this program that the government is putting forward. Across the country, there is an expectation that close to 700,000 families might be able to utilize this program, or have it supplement the provincial or territorial benefits, to give their children the proper care they need and deserve.

Senator Yussuff, it appears that the government leader will, unfortunately, not be giving a second reading speech, so we will not get the chance to ask him questions about this bill. Therefore, I have to ask you this, as you are the sponsor of this important government bill. We have a mental health crisis in Canada right now. I personally haven’t heard the same about a dental health crisis. No doubt it’s important, but I don’t think it rises to that same level.

The Trudeau government, in the last election, made a very significant promise on mental health care, promising to establish a Canada mental health transfer to the tune of $4.5 billion, with the amount of $875 million that should have already been allocated and transferred. None of that money has flowed yet. Why did the government choose to spend this money on this particular aspect and not on mental health?

Once again, senator, thank you very much for the question. As you know, mental health is an issue we all have to be concerned about as parliamentarians. The government has already made significant commitments to the provinces during the COVID period. They transferred money to the provinces to help deal with mental health issues. I’m sure that as provinces, territories and the federal government continue to talk, there will be additional support for the provinces in regard to the mental health needs of Canadians right across the country.

But equally so for many working families, while you did not hear about their need for dental health support, working families have been struggling with these issues for quite some time. Based on the estimate the government provided, I know for a fact that, at the end of the day, many families will be assisted. I don’t think we should prioritize dental care and dental support for working families over that of mental health. They are both equal. If you ask a family struggling with these issues, at the time you approach them, they will tell you what their priorities are.

While I recognize mental health is an important issue, we need to find ways to continue to support our provinces to ensure that Canadians can get the services they need. We should not somehow distinguish in terms of priority. When a family is struggling with an issue, that will be their priority. I know that for many working families in this country, dental care is a significant priority because they can’t afford to access dental care in this country.

Senator Yussuff, I want to congratulate you as a sponsor for your involvement. I think many of us — not to mention the majority of us — agree that we have to do something. Back in the 60s, the Royal Commission on Health Services, 1961 to 1964, did, in fact, mention that those services should be part of the national system.

Having said that, many provinces offer a different program. Interestingly enough, the Parliamentary Budget Officer has mentioned that at the cost of $700 million, Quebec residents will receive only 13% since Quebec has been pretty generous with the system they have in place.

In precise dollars, over the next five years, Quebec will receive $92 million, which is equivalent to Alberta but with a much bigger population. So my question is this: Since you probably have contact with the cabinet minister, do you think it will be a good idea to offer an opt-out clause for provinces under certain conditions in that the provinces will receive the money but have to respect some conditions? I think that would be much more efficient since dentists are provincially regulated and the provinces have contact with the dentists.

Thank you for the question. As you know, the Quebec program only allows those under ten years of age to access dental care under certain conditions and is income tested.

In the next two years, the federal government and the provinces will be in some serious deliberations about what a national program should look like. I’m certain that at that time, as they have done throughout history, Quebec will negotiate a way to be compensated for a program that has some national standards.

Given this is an interim measure, I think it’s fair for families who have children under the age of 12 to know they will get this benefit, and it will help them get the care their children need. But in the long-term, as the federal government, provinces and territories negotiate, I hope we can have some national standards. Of course, if Quebec meets those standards, by all means they should be compensated.

Colleagues, we have five senators and 13 minutes left. We will proceed with one question per senator, and if there is time, we’ll go back for a second question.

I’m happy to take Senator Wallin’s question and more importantly, of course, respond. Fraud is always an issue we should all be concerned about regardless of what program the government rolls out.

Individuals have to give attestation that the money they are going to receive will go for their children’s dental needs. They will have to identify the dentist that is providing the service. They will also have to tell the government directly in their application whether or not they have insurance coverage. In addition to that, they will have to keep the receipt. At any time, the Canada Revenue Agency, or CRA, could conduct an audit. It is true that the individual is not required to submit receipts prior to accessing the benefit.

Over time, I think that we will learn how Canadian families access this benefit and whether or not there has been fraud because the CRA will have an opportunity to do some audits and give some data that will help deal with that to a large extent.

I am not worried. I say this because I come from humble beginnings. Working people struggle with the same challenges we all struggle with, like how to access things some of us have had the privilege of accessing. I’m a senator now, so I have dental benefits. At the age of 18 when I worked in the workplace for the first time in my life, I had access to dental benefits. But I know that privilege is not a right. Working families should be able to access the same thing that I have had for a good part of my life. There might be some who want to defraud the program. I am hoping enough deterrent is built into the legislation that it will deter those who may choose to commit fraud. However, as Canadians, I think we should have faith that poor, working families will do what is right to ensure their kids get the care they need.

Thank you, Senator Yussuff, for your speech and sponsorship of this work. You don’t need to convince me for a second about the importance of dental care. I worked in the field for a number of years. When I got this job four and a half years ago, it was the first time in my life that I had dental benefits. It’s a privilege too many Canadians can’t get.

I am worried about the accusations of fraud more than anything, so I would like to just ask: Has there been a consideration? For two years, I’ve been working with CRA to help them correct a problem they made. Their administrative capacity is very limited. Is there the ability for Canadians to upload their receipt? That would limit the pool of those where an audit would be required. I just think having that capacity — has that been considered? If not, would you please make sure it’s considered during the study of the bill? I think having that in the program would limit the risk of fraud, but it would also help reduce the pool of those where an audit would have to occur in the future.

Thank you, Senator Deacon, for the question. As you know, the minister has broad powers under the legislation. The minister will be before the committee. I will be honoured to raise this in terms of the capacity of CRA to upload receipts at the end of the day. It’s not currently required, but yes, it is true the minister could make a ministerial decision to alter or change the direction in regard to requiring receipts for individuals. The acknowledgment is very clearly in the legislation that audits could be conducted, and the CRA will have the authority to do so.

Hopefully I have enough time, Senator Deacon, before the minister appears before the committee. I will specifically ask the minister your point and get back to you.

My questions were asked by Senators Wallin and Deacon. I withdraw.

The $70,000 to $30,000 group is a huge span, and the children will have different needs. At the lower scale of $30,000 to $40,000, this group may not have basic needs met and a lack of resources like lack of internet, phones, babysitting and transportation, which were the problems I had to deal with when I was delivering dental care. It limits their access to care. To add Canada Revenue Agency to this will be another obstacle for them.

How will the government ensure this group will be able to access dental benefits equally? What happens if they use the money to meet their basic needs?

Thank you, Senator McCallum, for the question. As you know, there are many challenges that working families face throughout this country. You stated some of them clearly and eloquently.

This program is not for other needs. It’s specifically for dental care needs for children. A family can’t access this benefit and use it for something else. It is meant as a bridge toward a larger program that, hopefully, the federal government, the provinces and the territories, will provide in the next two years.

There are some challenges, like in every community, for families, such as transportation and what have you. Families will have to lean on access to other programs to help with those particular needs. Specifically, you cannot apply for this program and then use it for something else. That is clearly understood. Of course, families will have to make an attestation that they are using the money for dental needs and not for something else.

Senator, thank you for your speech and thank you for being the sponsor of this bill. It’s obviously a bill with a specific objective. At the end of the day, the current needs of our society — especially as the economy continues to face challenges with both the inflation rate and an economic standstill that is on the verge of a recession very soon, I would venture to say — continue to grow exponentially.

There are a lot of challenges and a lot of great causes out there that currently governments don’t fund. I’ll give one example, autism, which is facing and crippling families right across the country. Hundreds of thousands, if not millions, of Canadians are touched by this. There’s no support on the provincial level by health care systems; there’s no national strategy at this particular point.

This is a great program. We’re adding a few billion dollars into the pot, but where does it end? How many other causes is the government willing to champion and write out cheques for, like autism, for example, and many others I could list if we want to get into the debate?

Thank you, Senator Housakos, for your question. A long time ago, creating a hierarchy of rights and privileges meant the ones with the loudest voices would succeed. I don’t for one minute disagree with you that families that are struggling with autism need help. They should get that help because these are children who should have an equal opportunity to thrive and participate in the schooling system and get a leg up on life. Those are needs that we need to think about and how we address them, with both the federal and the provincial governments working together to make sure that happens.

On the issue of dental care, I think we take for granted the impact this has on working families. It truly is profound. I know stories — I will get into them at second reading — of individuals who lost their teeth because they were poor and didn’t have access to dental care. Getting a decent job without having proper teeth is a problem.

I’ve been fortunate. I didn’t have to go down that road. But I know far too many kids don’t have the same opportunity in life. I think giving them a good oral dental care experience at an early age can prevent a lot of health issues that they struggle with later in life.

Of course, the government has set this as a priority, as they have with many priorities. However, as Canadians, we still need to build a country that’s more equal. This is one step on that path. On the issue you raised about autism, I hope we can do a better job to ensure Canadian families have better support from their national, provincial and territorial governments to deal with the needs of families who require it.

First, I want to compliment you on both your speech and your remarks. Obviously, this bill is very important for working Canadians. Too many children are growing up without dental care. You outlined the concerns about getting a job, social inclusion and so on. It becomes a class issue if you don’t have your teeth fixed, and everybody else in your classroom does.

Second, I want to add this is a benefit of the coalition between the NDP and the Liberals because it has been a long-time commitment of the NDP to initiate this program. The Liberal government wanted to do it for many years and now has done it. This is great cooperation between the two parties in the House of Commons.

Would you share my view that we should strive for a standard of care for all Canadians that is equal to the assistance senators currently receive for dental, health care, drug coverage and pension coverage in this country?

Thank you, Senator Downe, for your wonderful question. In this chamber, we have a lot of privileges. If Canadians could only enjoy them, we would certainly have a far more equal country. One day, maybe.

Senator Downe, I remember vividly in your province when a good friend of mine named Wes Sheridan was crafting the dental program to support working families in P.E.I. He was writing his budget and he told me what he was doing. I was so proud of his leadership because it allowed many poor kids in the province of P.E.I. — one of the smallest provinces in our country — to say they deserve the same thing that other provinces could afford despite the fact they didn’t have the same level of revenue. They saw it as a priority.

I do believe we have a long way to go. If Canadians can have the same benefits as senators have in this chamber, I hope that’s where we will get to one day. Until then, we will have to continue to build it incrementally until we get there. Thank you very much.

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

The objective of this legislation is twofold.

Part 1 of the bill enacts the dental benefit act and authorizes the Minister of Health to make payments out of the Consolidated Revenue Fund in relation to dental care services for children under 12 years of age.

Part 2 enacts the rental housing benefit act and authorizes the Minister of Housing and Diversity and Inclusion to make payments out of the Consolidated Revenue Fund in relation to a one-time $500 payment to eligible individuals.

I will speak first to the new dental benefit act.

Oral disease is one of the most common chronic diseases of childhood, according to the Centers for Disease Control and Prevention in the U.S. The science that has developed over the last 20 years shows a growing body of evidence that links oral health with overall health and well-being. In fact, if you look at the scientific peer-reviewed journals, you will see studies that show a causal relationship between oral diseases in children and increased risk of diabetes and cardiovascular and respiratory diseases in adulthood.

A paper entitled “The effects of oral health on systemic health,” published in the journal General Dentistry in 2017 by Dr. Shawn Kane of the Department of Family Medicine at the University of North Carolina, best sums up the many studies on this subject:

A shared trait of periodontal disease and these medical conditions is that they are chronic conditions that take a long time to develop and become clinically significant. Primary prevention—treating the patient prior to the onset of symptoms, myocardial infarction, stroke, diabetic complications, or significant periodontal disease—is the challenge.

Complications associated with these conditions cause significant morbidity and mortality and are incredibly costly to the healthcare system. Unfortunately, a lack of access to primary medical or dental care prevents some patients from engaging the system until a negative event has occurred.

Dental care is a critical element in caring for one’s overall health, and we understand that preventative care is important. A 27-year follow-up study of 8-year-olds found that poor oral health in childhood was associated with poor heart health in adulthood. The Finnish study’s lead author was clear:

This emphasizes how important good oral hygiene and frequent check-ups with a dentist starting early in life are for general health . . . .

Furthermore, studies show that the use of dental care in childhood influences use of dental care in adulthood. In fact, childhood developmental literature indicates that early childhood experiences have a profound influence on later life. Pediatric dental textbooks emphasize that children learn from their experiences and are socialized toward oral health behaviours by their parents. There is support in the literature that having a childhood dental visit was associated with positive attitudes and beliefs about dental care in adulthood and with preventative and restorative dental visits later in life.

Honourable colleagues, I fully agree with the principles that govern this legislation, but I do not agree with the design of this benefit, as I shall explain. Part 1 of Bill C-31 provides for the establishment of the new dental benefit, which will provide up to $650 a year for dental care per child under 12 for parents with adjusted family incomes under $90,000. This application-based, interim benefit will be administered by the Canada Revenue Agency.

I have three main concerns with Part 1 of this bill. The first is the jurisdiction and the exacerbation of existing inequities among provinces and territories. The second is the administration and design of the program. The third is the potential impact on services currently in place.

On jurisdiction, dental care is not within the federal one: It falls squarely within provincial jurisdiction. This is why the government should have had agreements in place with the provinces before it proceeded with a dental plan. Honourable senators, most provinces and territories already provide dental care coverage programs for children, primarily those from low‑income households, but there is a wide variation in existing dental coverage for children across the provinces. I did review existing dental coverage for children in Canada. To the best of my knowledge, the following information is up to date, but if there has been a change in the province or territory that you represent, please do share that information with me.

In Newfoundland and Labrador, all children under the age of 13 are eligible for the Children’s Dental Health Program, which covers examinations at 6-month intervals, cleaning treatments at 12-month intervals, routine fillings and extractions and sealants.

In Prince Edward Island, the School Oral Health Preventative Program provides preventative services to children from a dental hygienist, including an annual oral health risk assessment, oral health instructions, topical fluoride application, placement of sealants, cleaning or polishing of teeth and referral to a dentist if necessary. Further, the provincial dental care program offers sliding-scale coverage for families who are receiving social assistance or who meet certain financial thresholds. Children are eligible for an annual exam, annual cleaning, sealants, fillings and extractions.

In Nova Scotia, children under the age of 15 are covered once per year for a routine dental exam, two routine X-rays, a preventative service such as brushing and flossing instruction or cleaning appointments, fillings, necessary extractions and nutritional counselling.

In New Brunswick, the Healthy Smiles, Clear Vision program provides regular exams, X-rays, extractions, and some preventative treatments such as sealants and fluoride treatments for children under the age of 19 of low-income families that do not have private insurance.

In Quebec, all children under the age of 10 are eligible for annual examinations, emergency examinations, X-rays, local or general anaesthesia, fillings, extractions, endodontics, prefabricated crowns and oral surgery.

In Ontario, children under the age of 18 from low-income households are eligible for the Healthy Smiles program. The program covers check-ups, cleaning, fillings, X-rays, scaling, tooth extraction and urgent or emergency care.

In Manitoba, the Employment and Income Assistance Program provides families with income support, including support to cover the costs of basic dental services. Eligibility is based on the cost of a family’s monthly basic needs compared to their financial resources. More services are available for children in the Winnipeg health region specifically.

In Saskatchewan, children in low-income working families who meet the standard of an income test or are receiving the Saskatchewan Employment Supplement are covered for most dental services. Children from families receiving Saskatchewan income support are eligible for supplementary health coverage, including a range of basic dental services.

In Alberta, children under the age of 18 from low-income households, and 18- or 19-year-olds who are living at home and attending high school, are eligible for the Alberta Child Health Benefit. The benefit covers basic and preventative services like fillings, X-rays, examinations and teeth cleaning.

In British Columbia, children from families with annual adjusted net incomes of $42,000 or less are eligible for the Healthy Kids Program. The program covers $2,000 of basic dental services every two years, including exams, X-rays, fillings, cleaning appointments and extractions.

In the Yukon, the government provides diagnostic, preventative and restorative dental services to all children, from newborn to Grade 12. Children receive dental exams, X-rays, oral hygiene instruction, cleaning and scaling, fluoride application and sealants. Many of these services are provided in schools. If necessary, fillings, crowns, extractions or other emergency dental services are also covered.

In the Northwest Territories, infants and children aged 0 to 4 years are eligible for primary oral health services in Fort Smith, Fort Simpson, Inuvik, Fort McPherson and Norman Wells at no cost. These services include oral health assessment, oral health screening, oral health education, fluoride varnish application and referral to an oral health professional. Children in junior kindergarten to Grade 12 in these communities are eligible for the school-based Oral Health Program at no cost. Dental hygienists or dental therapists complete oral examinations, offer preventative and therapeutic treatments, provide oral health education and make referrals to dentists.

In Nunavut, children enrolled in the children’s Oral Health Project are eligible for free dental screenings. Following the initial screening, sealants, temporary fillings, extractions, fluoride varnish and referral for additional treatments are made available. Services are provided in a variety of settings, including health centres, schools, daycares and community centres.

Honourable colleagues, I include all this information to demonstrate that existing dental benefits throughout the country are detailed, specified and diverse. While I understand that the new Canada dental benefit is said to act as a top-up to existing benefits, my concern is that it ignores the provinces’ existing programs.

Unlike the provincial and territorial plans, there are no specifications around the dental procedures that the federal benefit is to be used for. The federal benefit can be used for preventative care, diagnostic care or restorative care — essentially anything that the parent and the practitioner determine is needed for the child’s oral health. An additional benefit of $650 will go a lot further to top up care in Quebec — where basic dental services are already covered for children under 10 years old — than in provinces without such coverage, highlighting potential inequities among provinces.

In regard to the administration of the program, the government has told us that the Canada Revenue Agency, or CRA, will administer the program through CRA’s My Account online portal. Parents of eligible children will be required to log in to their CRA account to attest to their child’s eligibility and to claim the benefit. Once the application is complete, the benefit will be paid within three to five days, and the attested details will be verified later. Random income tax audits will likely be part of compliance checks.

Honourable senators, parents will be subjected to uncertainty and costly errors if this benefit’s application process is confusing or faulty. These are the challenges of a benefit that is application-based and attestation-based. There are built-in risks. Parents will be out-of-pocket after paying the dental expenses upfront in a crisis, or parents will anticipate the dental needs of their children, along with the cost, and apply for the benefit before going to the dentist. Undoubtedly, there will be those who thought they were eligible for the benefit, but discover later that they were not.

Also, the amount of the dental benefit varies significantly, depending on the family net income. The briefing note provided by the government states:

The benefit provides $650 per child per year for parents with adjusted family net incomes under $90,000 for dental services received by their children under 12 years of age.

In practice, however, the benefit declines quickly from $650 per child — if the family net income is less than $70,000 — to $390 if the net income is greater than $70,000 but less than $80,000. And then the benefit goes down to only $260 per child if the net income is greater than $80,000 but less than $90,000.

This pay-now-and-verify-later program design lends itself to problems and misunderstandings. Just last week, at the Finance Committee’s pre-study of Bill C-31, the Parliamentary Budget Officer, or PBO, Mr. Yves Giroux, cautioned that because the benefit is attestation-based:

. . . administration will need to be tight. Otherwise, it could lead to abuse. That’s one of the concerns that I personally have as a taxpayer.

Furthermore, proactive reimbursement of anticipated costs may lead to situations in which parents, who are already stretched financially, take a risk and use the benefit cheque for rent, groceries, heating or other essential expenses. It may also lead to confusion about which expenses are eligible.

At the Finance Committee’s pre-study, Senator Anderson raised a very important point, and I think our colleague Senator McCallum raised the very same point today: Indigenous Canadians who have coverage under the Non-Insured Health Benefits program have to travel sometimes to access dental care, though the care itself is covered. Will transportation or food expenses incurred while travelling to access dental care be considered eligible? It is not clear.

The administration of this program could have been greatly simplified had the federal government collaborated with provincial and territorial governments, many of whom already have direct billing agreements with dental care providers in place.

At the Finance Committee’s pre-study, Senator Omidvar asked the PBO, Mr. Giroux, whether it would have been more efficient to transfer money to the provincial governments. He replied:

It certainly would have been better tailored to provincial realities and needs to transfer this money to provinces and territories. However, it would have required what would probably be lengthy discussions and negotiations with provinces.

Furthermore, according to the Canadian Dental Association, regardless of whether they have dental benefits or not:

Canadians with lower household income were less likely to go to a dentist than those in higher income households.

Although the government is providing this benefit, the need to make a cash payment at the time of treatment may remain a barrier. In creating this benefit, did the federal government consider the social determinants of health, or the causes of health outcomes? Did they consider whether a benefit thus designed will actually improve the health outcomes of Canadian children?

Another barrier is the need to file a tax return. As Jennifer Robson and Saul Schwartz at Carleton University have shown — and our colleague has repeatedly helped us recognize — about 10% to 12% of Canadians do not file a tax return and, therefore, do not receive the benefits for which they are eligible. In their article, “Who Doesn’t File a Tax Return? A Portrait of Non‑Filers,” Robson and Schwartz note:

Low income is clearly related to the likelihood of not filing. Persons in families with a disposable income below the official Market Basket Measure of poverty were much less likely to file than those whose family income was above the threshold.

As our PBO, Mr. Giroux, remarked at the Finance Committee’s pre-study, more and more benefits rely on the tax system, but in his words:

. . . the government is not as proactive as you would think it could be in 2022, for example, in reaching out to these individuals who fail to file taxes.

I find these vulnerabilities concerning, and they demonstrate the downfalls of cobbling a benefit together in a hurry rather than taking the necessary time to put a proper plan together.

It is also a concern that the government and the Parliamentary Budget Officer have different estimates for the cost of this program. A briefing note shared by Senator Gold notes that Budget 2022 provides $300 million in funding for dental care in 2022-23, and $600 million in 2023-24. The Office of the Parliamentary Budget Officer, however, puts the projected costs for this program at $247 million in 2022-23 and $372 million in 2023-24. That is a difference of $281 million.

At the Finance Committee’s pre-study, Senator Boehm asked the Parliamentary Budget Officer, Mr. Giroux, whether — as we project into the future and with consideration of inflation — the sum that the government has planned to spend on this program is realistic. Mr. Giroux said:

. . . there are too many unknowns as to the format and program designs to say whether or not it’s enough money.

Honourable senators, many of you have more expertise in finance than I do, but I ask: Is this quality of program design acceptable? This is an interim benefit. I sincerely hope that if the government introduces a permanent national program, its design is more robust so that we can provide a proper review.

The need for a robust program design is especially relevant given the state of the Canadian economy. On October 20, 2022, the Toronto Star reported that Finance Minister Chrystia Freeland told her cabinet colleagues that submissions for new programs must demonstrate how existing departmental resources can be used to fund at least 25% of new operating costs. As this bill demonstrates, the government must improve their program design to ensure that new programs and benefits can be budgeted for appropriately.

Finally, in regard to the potential impact on services currently in place, Canada’s premiers are calling on the federal government to rebalance the health care funding partnership.

Earlier this year, Premier John Horgan of British Columbia called for increased health transfers for existing health programs:

Do I think it would be grand to have a national dental care plan? Absolutely. But we need to start with first principles, and that is stable funding so that we can do the hip replacements, so we can have a human resource strategy for our primary care sector.

In August, when asked about a potential new federal dental benefit, Premier Blaine Higgs of New Brunswick said:

. . . we’ve been spending a lot of energy over the last number of months and years talking about a crisis in our current health care system. . . . Because right now, we have a health care service that is not providing what was intended. So my focus would be on our current situation and let’s get it fixed first.

The Canadian Dental Association has also flagged concerns about how this benefit may impact existing dental coverage. In a brief, they note that two thirds of Canadians have dental coverage, and half of Canadians have employer-sponsored coverage. They say:

It is vital that this dental care ecosystem not be disrupted; the focus needs to be on gaps in coverage, particularly for underserved populations.

Will employers stop providing dental insurance to employees? Will the system that now works well for many Canadians and dental care providers be compromised?

Honourable senators, it is a considerable concern that provinces and territories with real dental programs in place will discontinue them so that the funds allocated to their existing programs can be reallocated to their strained provincial health care systems.

Employers may see this as an opportunity to cut costs on private dental insurance as well. The dental benefit act is a poor substitute indeed for many of the existing programs and insurance plans in this country.

Hopefully, the Finance Committee will hear from the provinces and territories regarding potential impacts to their existing dental programs.

Now, for Part 2 of Bill C-31, the rental housing benefit act, which provides a one-time, tax-free benefit of $500 for rent paid on a principal residence in 2022. This benefit will only be available to renters with adjusted net incomes below $35,000 for families or $20,000 for individuals. But it, too, is an attestation-based application process.

Those who apply must have filed an income tax return in 2021 and then attest that they are paying at least 30% of their adjusted net income on shelter; are paying rent for their own primary residence in Canada, which would include the address of a rental property; the amount of rent paid in 2022; and the landlord’s contact information. Lastly, they must consent to the CRA verifying their information to confirm eligibility.

One might legitimately ask how many Canadians even know what “adjusted net income” means — I’m looking to Senator Marshall, because I’m sure she knows — never mind what their own adjusted net income is.

Subsection 2(3) of the bill states:

In section 4, adjusted income has the same meaning as in section 122.6 of the Income Tax Act, except that the reference to “at the end of the year” is to be read as a reference to “on the reference day.”

There you have it — or do you?

If we next look to section 122.6 of the Income Tax Act:

adjusted income, of an individual for a taxation year, means the total of all amounts each of which would be the income for the year of the individual or of the person who was the individual’s cohabiting spouse or common-law partner at the end of the year if in computing that income no amount were

(a) included

(i) under paragraph 56(1)(q.1) or subsection 56(6),

(ii) in respect of any gain from a disposition of property to which section 79 applies, or

(iii) in respect of a gain described in subsection 40(3.21), or

(b) deductible under paragraph 20(1)(ww) or 60(y) or (z) . . .

Honourable senators, does this sound straightforward?

You cannot simply look up your earnings for the last year to see if you qualify. You will be better served by going back to your 2021 income tax return to look up Line 23600 — Net income.

But if you have a spouse, you must add your partner’s net income to your own. But then, you will still have to subtract the Universal Child Care Benefit or Registered Disability Savings Plan benefit in order to obtain, finally, your adjusted net income. The risk here is not that Canadians will apply for the benefit when they don’t qualify, but that they will not apply even though they do qualify.

When one hears on the news that, with the income of $35,000 or less, you may qualify for the rental housing benefit, most would immediately think of gross income, not net income, and definitely not adjusted net income.

It is entirely possible, and even likely, that people with a gross family income of just over $35,000 will not even bother to apply for the benefit because they will assume they do not qualify. This would be regrettable.

Indeed, it appears that the government itself is not very clear on how many Canadians will be eligible for this benefit. The government initially committed $475 million for this benefit in Budget 2022. It has since updated the proposed funding to $1.2 billion for 1.8 million recipients.

The Office of the Parliamentary Budget Officer, meanwhile, has estimated that the program would cost $940 million for 1.7 million recipients.

Honourable senators, in closing, we must consider how well these programs will serve Canadians.

Important questions about the new dental benefit act include:

Were premiers consulted; and will this new benefit change the administration of current programs in provincial jurisdictions?

Will those who are eligible apply?

Will this program cost what the government suggests in their briefing note, or what the Office of the Parliamentary Budget Officer estimates in their legislative costing note?

Will the dispersed funds be used as intended?

How will compliance checks work?

And, most importantly, will more Canadian children ultimately go to the dentist because of this benefit, or will existing disparities in care persist?

Important questions regarding the new rental housing benefit act include:

Will those who are eligible apply?

Will the application process be straightforward?

Does the government have a more comprehensive housing strategy than this one-time payment?

Honourable senators, I look forward to clarifying witness testimony at committee hearings, along with debate on these issues in the chamber.

Thank you.

Senator Deacon, you have a question?

Will you take a question, senator?

Absolutely.

Thank you. You raised some really interesting questions as you finished off your speech.

As you were speaking and covering a number of things, I was wondering, as we are preparing for it going to committee, if you had to pick one key miss or one key concern — because you do have a number there that you thought through — is there one particular item that you would say, “This is where we need to get it right at committee?”

Thank you, senator. It’s hard to narrow down to one miss. As I said, the most important question is: Will this design reach the kids it needs to reach, and will it really improve dental care for these children?

That’s the bottom-line question. That’s the question that senators in committee and in the chamber have to ask when they look at the design of this program. It’s not a program, really.

With that in mind — and I’m trying to think of some of the other work we have been doing where we’re saying, “Does it do what it means to do? Is it set up to be successful?” — in regard to the review process, what would you see, then, as meaningful, purposeful and knowing that it’s making a difference? What would that look like to you?

Thank you, senator. There we have really hit the wall because, as you know, data collection in this country is a huge issue. We discovered that during COVID. Certainly, every province collects their own data. There is not a lot of sharing. The data that is collected isn’t consistently gathered in the same way in every province, so it’s very hard from the point of view of being comparable.

Data is what you use to analyze whether the program is successful or not. In this case, we have an interim, two-year situation. I think it’s a serious problem to ever find out whether the outcome has been achieved. For any long-term program, one would have to build in some kind of data collection system in order to be able to analyze whether you’re really meeting your objectives.

Thank you.

My question is the same as Senator Deacon’s. What are the outcomes of these programs that you have looked into? I looked at those same programs as well, and I’m looking at data such as: How many accessed the program? How many completed care? How many were on maintenance? How many needed continued care? If they did, what was the reason why their teeth required treatment?

Thank you, senator. What you’re asking is a really critical question. There is no doubt about that. But the fact is that we don’t have a lot of data to provide those answers. The provinces in Canada are where dental services are currently provided for children, and there are varying degrees of recording this. Dentists don’t keep this information. They can’t. If you ask them, they will say they don’t record this information. Therefore, it falls upon some agency to do this. There isn’t a national agency that records that information because it’s a provincial responsibility.

How to evaluate the success of its outcome is the big question here. There is no doubt about that.

Honourable senators, I rise today to speak on Bill C-31, an act respecting cost of living relief measures related to dental care and rental housing. I support this bill in principle, and today I will focus my remarks on the dental benefit portion of the bill.

I wish to congratulate my colleagues, Senator Yussuff and Senator Seidman, for their excellent speeches. For my part, all this talk about dentists and kids takes me back to my own childhood of being dragged to a dentist. I was very traumatized. I have a vague memory of a lot of persuasion being at play. I think hard candy was involved, but I have my own teeth today, all of them. I’m very grateful that my parents had the means to insist on this essential care. It’s not the same for all Canadians. I speak from a bit of first-hand experience.

In 2016, just eight years ago, a Syrian refugee family with eight children under the age of 15 landed in Toronto. As their sponsor, the first three months were completely hectic for them and for us. We soon discovered a challenge we had not prepared for: the oral health of the eight children. Their teeth were in terrible shape. They were rotten, frankly, because apparently there were rivers of hard candy running through the camps, as opposed to healthy food.

Even to our untrained eyes, we could see there was a problem. However, although the federal government picks up the costs of health care for refugees in the first year of arrival, this coverage does not extend to routine dental care, only to emergency dental care. In other words, the family would have needed to wait for a dental emergency to get the care they needed or until they qualified for the Healthy Smiles program, which was a year.

Left up to our own resources, the sponsoring team had to dig into our pockets, and we relied on the good will of many volunteer dentists.

Oral health for all children, as we have heard today, is very important. Let me quote some further facts for you.

According to the 2010 Canadian Health Measures Survey, well over 50% of 6 to 19 year olds have or had at least one cavity and have, on average, 2.5 teeth affected by tooth decay. Bad oral health is the most common chronic disease in children, five times more prevalent than asthma.

Poor oral health also increases gum disease, and has been linked to cancer — as Senator Yussuff has pointed out — Alzheimer’s, diabetes and heart disease. A study has shown that:

Across OECD countries . . . 5% of total health expenditures originate from treatment of oral diseases. Direct treatment costs due to dental diseases worldwide have been estimated at US$298 billion yearly, corresponding to an average of 4.6% of global health expenditure. . . .

Having good oral health is good for the kids. It’s good for our health care system. It’s certainly good for the economy.

Colleagues, I know that during questions and debate today, we have talked about concerns that this bill moves into provincial jurisdiction. We know that provinces and territories in Canada have pre-existing dental care programs for children. However, according to the Canadian Dental Association:

While several of these programs have a solid infrastructure in place, others are currently underfunded and, as a result, do not always respond to the individual oral health needs of pediatric patients.

They noted that P.E.I. does oral health fairly well, whereas the outcomes don’t seem to be so good in my province of Ontario.

In an ideal world — I do not dispute, Senator Seidman — it would have been preferable to use the plumbing of existing provincial agreements and sign agreements with the provinces to bolster their own programs to get the money faster, through existing machinery, to the people. I do not dispute that. However, as we well know, such agreements are hard to negotiate. They take a very long time. Every agreement with every province and every territory is different, and, inevitably, we would see a patchwork of services.

As we have heard from Senator Seidman, Quebec does this, Ontario does this, Newfoundland does this, et cetera.

With this initial two-year program, the government accomplishes a number of objectives. First, it covers the whole nation regardless of where you live. If you have a child aged 1 to 12 years old, they will benefit from the program. It is contingent only on income levels.

Second, it takes effect almost immediately, bringing much-needed relief to poor people in a timely manner.

Third, I believe it allows the government to assess the efficacy of a two-year initial pilot program, let me call it that, as they consider rolling out the permanent program.

Whilst we are on federal-provincial agreements, let me clutch a bit on the province I live in. Even when agreements are signed, there is no assurance of accountability. In Ontario, parents are still waiting for $10-a-day daycare program, although the agreement was signed, I don’t know, maybe even a year ago. Again in Ontario, we have seen a government accrue a budget surplus of $2.1 billion when our health care system is in shambles. It is the same government that is using the “notwithstanding” clause to deal with the labour issues. It makes sense to me that the federal government will trust families to make the right decisions for their children. That given a chance, given a little extra money, the extra boost in financial confidence, they will call their dentist and make appointments for their children and use the money to bridge whatever gaps there may be in provincial programs.

To those who say that $650 is not enough, honestly, you may well be right. But the government has not dreamt up this figure out of thin year. At pre-study at the National Finance Committee, we heard from the Parliamentary Budget Officer that the average cost of dental care for children under 12 — remember under 12 they still have milk teeth — is under $650. The same was confirmed by the Canadian Dental Association.

In comparison to other jurisdictions — you may be interested in this — we are playing catch-up. We are always playing catch‑up, I feel. Australia rolled out a very similar program in 2014. Its program functions very much the way this program is designed to function, except it extends to children up to 19 years old. Of course, the gold standard would be the National Health Service in the U.K., which covers all dental costs and encourages parents to start with dental appointments as soon as milk teeth appear.

We all know that this is a time-sensitive program. This interim program of two years will eventually develop into a more permanent program; at least that is the hope of many Canadians. It targets those in highest need. Parents who have private dental insurance are not eligible, and those who are covered by a provincial program are only eligible to have out-of-pocket expenses compensated. Provinces and private plans will always be the first payers, and the federal dental program will come after that. At committee, we were informed by officials that there will be no clawback from provincial governments, as this bill does not touch on or harmonize with any of theirs.

I do have some concerns about the bill. Some of these have been raised by other people, but I think it doesn’t matter if we raise concerns again and again; maybe the committee will take note of them. We know that about 10% of Canadians are non-filers. How will they access this benefit? For those who are already in the system and receive the Canada Child Benefit, it is fairly simple. The individuals have a CRA My Account and they simply have to use it to apply for the new benefit. My concern, though, is for the non-filers, and this is not an insignificant number, 10% to 12%.

I don’t know who these non-filers are. I know they are low-income, as studies have pointed out, but we don’t know if they have children. We don’t know if they are working or not; likely they are, but they are not filing their tax returns. I do believe it is time that the CRA address this very important question in a serious manner. To my question to the officials at the committee, I was told that they have a strategic plan called “Get ready,” but they don’t appear to have set any standards or benchmarks against this plan to assure the people of Canada that they are reaching non-filers, and that non-filers are beginning to file. I would like to see a benchmark, an objective put in place that after the end of their “Get ready” program, on evaluation, at least 3% more are filing. That would be a success.

The second question is about capacity. We know that certain parts of the country, especially rural and Northern communities, do not have good access to dental care. There are shortages in dentists and hygienists. The extra demand from the South — I hesitate to say “South” in the context of Canada, but I think you all know what I mean — creates a concern that supply of dental services and dental professionals may migrate to the South. One unintended outcome could be the loss of dentists and dental hygienists from small and rural communities.

The federal and provincial governments should think long and hard about using an untapped source of workers, and those are internationally trained dental health care professionals. We know that many of these internationally trained professionals come here through the Express Entry program, which favours people whose skills are badly needed. However, when they arrive, they get in what I call “credentialism hell,” which takes a great deal of time and a huge amount of resources to pull yourself out of.

This is a national problem which is complicated by the fact that regulated occupations such as dentistry are under the jurisdiction of provincial governments, who, in turn, maintain, “This is not our business — these are self-regulating, independent occupations. We cannot force them to do anything.” It is a veritable maze.

However, the issue of capacity in the context of dental care in remote and rural communities could be addressed by providing a restricted licence to those dentists who have passed some portion of their exams as long as they work in a restricted location, restricted practice. Clearly, this would have to be done province by province, but it does provide an impetus for provinces to consider this or other proposals. Perhaps the federal government could even play a role in incentivizing such behaviour. This practice is followed by Australia, for example.

In conclusion, colleagues, the absence of dental coverage for poor people, especially children, is a blemish on Canada’s avowed aspiration to be a nation of inclusion and opportunity. This bill takes the first small but very important step in building a healthier future for our children.

Thank you.

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

In specific, I wish to speak to the bill’s provision with regard to dental benefits for Canadian children. I don’t think — especially after what we’ve heard here today — that there need be any doubt that proper dental care for kids is a fundamental question of public health and disease prevention. We claim to have universal health care in this country, but as long as some families are forced to forgo timely dental care for their children, our boasts are a tad hollow.

I was lucky when I was the parent of a young child to work for a company that provided excellent dental benefits to its employees, but I was not always so lucky. As a young adult, I went for years with no dental insurance. I was working full-time as a journalist, first for a small magazine and then for the CBC, but I had no dental benefits. In fact, I worked full-time as a producer with the CBC for six years with no dental plan and a low enough salary to make trips to the dentist seem like a luxury. 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 cleanings or checkups. I know all too well that thousands of working Canadians and Canadian families simply do not have the means to make regular trips to the dentist a part of their budget.

So I applaud the intentions of Bill C-31. Here we are after all, the day after Halloween. Who amongst us would want to deny cleanings and X-rays and fillings to all the princesses, lions, monsters, firemen and pirates eating their Halloween candy today? But I confess, I do have some misgivings about the jurisdictional complexities of this bill and its interconnection — or lack of interconnection — to various provincial and First Nations dental programs. I want to put those concerns on the record because Bill C-31 is obviously meant to be just the first step in the creation of a more ambitious national dental care program.

Health, as we have all said today, is an area of provincial jurisdiction. As we roll forward, we need to be sure that provinces, to the best of our ability, are at the table as partners.

These are times when certain provincial governments are being even more than usually prickly on this subject.

Last week, on October 27, Alberta’s new premier, Danielle Smith, released, via Twitter, a letter to all her ministers asking them to make what she called a “united front” against federal policies that would, in her words, “threaten Alberta’s interests,” even if that meant rejecting federal government grants for various programs, especially targeted transfers. She further instructed her cabinet to insist that Ottawa respect constitutional division of powers, specifically related to health care and other social programs, and to seek, instead, to accept money only by “unconditional block transfers” to be spent entirely at Alberta’s discretion.

She further noted that when unconditional block transfers — money with no strings attached — were not on offer, Alberta would seek to opt out of new federal programs.

And if Ottawa does not, in the premier’s words, “honour co-operative federalism,” then, said Premier Smith, Alberta would refuse to participate in consultations with the federal government.

Now, please do not confuse me with Premier Smith. We are both, indeed, former newspaper columnists turned politicians, but we have rather different perspectives. I wanted to quote from this letter, not because I share all its views but because I want us to be fully alert to the complicated political tenor of the moment and to be alert to the future challenges of attempting to put together some kind of jury-rigged dental plan using the Canada Revenue Agency to do an end run around provincial jurisdiction.

Giving money directly to families, for all the reasons Senator Omidvar mentioned, does seem like an attractive option, but it comes with real political risks.

Of course, the program laid out in Bill C-31 would be of huge benefit to thousands of Alberta families. Alberta does have the Alberta Child Health Benefit which, as Senator Seidman explains, covers basic and preventative services like fillings, X‑rays, examinations and teeth cleaning. But the income cap for a couple with two children is $36,634, whereas this new federal benefit would be extended to families making up to $90,000 so that many more working families would be covered.

But if we don’t properly coordinate future federal and provincial programs, we are going to end up in a jurisdictional and political quagmire. We don’t want to duplicate existing services. We certainly don’t want to leave some families worse off than they were before. We also don’t want tremendous inequality across the country, where this top-up gives some provinces tremendously strong dental programs and leaves families in other provinces struggling.

Then there’s the question of how this program would coordinate with the one offered to First Nations and Inuit families via Indigenous Services Canada’s own NIHB — Non‑Insured Health Benefits — program, which provides comprehensive dental care, including orthodontics, to Inuit Canadians and those with Indian status.

Now, I’ve been told that First Nations and Inuit families can still receive the dental benefit proposed in Bill C-31, but only if they incur out-of-pocket expenses that are not covered by the NIHB — and the NIHB covers almost everything — and only if they file their tax returns. You don’t need much imagination to contemplate the kinds of complications that might ensue if some families claim the new benefit in mistaken good faith and then have it clawed back via audit. Given the percentage of Indigenous families that already live in poverty, it would be ironic indeed if Bill C-31 actually did little or nothing to help them, or ended up in some way undermining the future of the dental benefits they already have.

I trust that, while this bill is at committee, some of these questions can be explored in more depth. Thank you, hiy hiy.