The Canada Health Act of 1984 ensures that all Canadian residents (with the exception of members of the Canadian Forces, the RCMP and prisoners, who are covered by federal health insurance coverage) have free access to necessary medical services insured by provincial/territorial medical care plans. The Act defines Canadian residents as people who are (1) lawfully entitled to be or to remain in Canada, (2) ordinarily present in Canada, and (3) making their homes in Canada. The Newfoundland Medical Care Insurance Act of 1969 and the Medical Care Insurance Beneficiaries and Enquiries Regulations of 1996 adopted the identical criteria to define the term « resident » in order to determine health coverage eligibility in Newfoundland and Labrador (NL).
Until June 2007, international students and their dependants (many of them Canadian-born) were excluded from coverage in NL, since they were not considered residents of the province. However, a closer examination of the three residency criteria, as stipulated in the Canada Health Act, demonstrates that the basis for the students’ exclusion was not valid. The first criterion states that a resident is someone who is lawfully entitled to be or to remain in Canada. According to Canada’s Immigration and Refugee Protection Act, while international students hold a valid student permit, they and their dependants are lawfully entitled, as temporary Canadian residents, to be and to remain in Canada. Canadian-born dependants of international students are also accorded the same right to legal residence, both as dependants and because Canada’s Citizenship Act states that every Canadian citizen has the right to enter and remain in Canada.
The second criterion indicates that a resident is a person who is ordinarily present in Canada. The legislation does not provide any definition of the term « ordinarily present »; however, Canadian family law defines the term « ordinary residence. » It states that the place where a person ordinarily resides is « the place in which a person’s lifestyle is centred and to which the person regularly returns if his or her presence is not continuous. » The life of international students pursuing studies in NL is centred in this province and they do return to the province from their short trips and vacations abroad.
It is essential to note here that the length of the absence is an important issue in determining health insurance eligibility. In NL a resident must ordinarily be present in the province for at least 4 consecutive months in each 12-month period to qualify as a beneficiary. It is very unlikely that international students and their dependants would stay outside the province for more than 8 consecutive months in a 12-month period and thereby jeopardize the validity of their student visas.
Third, in order to be a resident as defined in the Canada Health Act, a person has to make his or her home in Canada. While there is no definition of « making a home » under Canadian legislation, Canadian family law states that « residence in contrast to presence involves a settled and enduring connection between a person and a place… At its simplest level, residence implies that a person is living in a jurisdiction: eating, sleeping, and working in that place. » International students and their dependants are not simply present; they live, eat, sleep, work, study, make friends and become a part of their Canadian communities. These activities entitle them to resident status as well.
One could object that international students do not arrive in Canada with the intention of making it their permanent home. But the intention to remain permanently in Canada is not a necessary condition of resident status. Canadian family law states that « the arrival of a person in a new locale with the intention of making a home in that place for an indefinite period of time makes the person ordinarily resident in the place, even if the person harboured an intention to return to the first place in the future. » In addition, the Canada Health Act does not indicate any difference in eligibility between temporary and permanent residents — all residents are insured for the period of time of their residency in Canada. If the same logic (based on the term « temporary residence ») were to be applied to Canadian citizens who intend to leave Canada for another country sometime in the future (thus making Canada a temporary home), these persons would be excluded from health insurance coverage too.
If health insurance policy-makers and administrators maintained that resident status was not conferred on international students and their dependents in NL, in spite of the above mentioned facts, then they could have been asked to explain discrepancies in the treatment of international students under Canadian law. According to the Income Tax Act, international students are required to pay income taxes for each year they stay in Canada because they are legally considered Canadian residents. Those employed must also contribute (as other employed Canadian residents do) to the Canada Pension Plan and to employment insurance. So international students in NL were considered residents by immigration and tax authorities but not by health authorities. Taxes collected from NL international students were used for the operation of provincial health care services, yet these students were not permitted to access and utilize these services.
As of June 2007, NL no longer excludes international students from health insurance coverage. However, a cross-national comparison of health insurance eligibility reveals that international students and their dependants are covered by publicly funded health insurance plans in only five other Canadian provinces (British Columbia, Alberta, Saskatchewan, Manitoba, Nova Scotia) and in the Northwest Territories (see table 1). In other parts of Canada, international students and their dependants (sometimes even those born in Canada) do not qualify for provincial/territorial health insurance coverage. According to the latest available statistics collected by Citizenship and Immigration Canada, the number of international students in these provinces and territories reaches approximately 85,000.
There are several reasons why Canadians should be concerned about the exclusion of international students from health insurance coverage. The Romanow report on the future of health care in Canada clearly states that equal and timely access to necessary health care services in Canada is perceived by the public as a right, not a privilege of status or wealth. However, at present, in six Canadian provinces/territories, this right is not applied to thousands of residents who are international students or their dependants. These students’ timely access to medical services depends on their ability to pay for these services, which many students do not have.
