When Albertans vote in the province’s referendum this fall, they will be asked whether people legally living and working in Alberta without permanent resident status should pay extra to use two of the province’s most important public services. Question 4 reads: “Assuming that all Canadian citizens and permanent residents continue to qualify for public health care and education as they do now, do you support the Government of Alberta charging a reasonable fee or premium to individuals with a non-permanent immigration status living in Alberta for their and their family’s use of the health care and education systems?” The premier has publicly said her government wants a ‘yes’ vote. A ‘yes’ vote would not itself establish a fee, set its amount or determine precisely who would have to pay it. Instead, it would give Premier Danielle Smith’s UCP government political approval to develop legislation to charge some temporary residents for publicly funded health care, public education or both. That could include foreign workers, international students, refugee claimants and some of their family members. What would it cost? Smith has now provided the clearest indication yet of what her government could consider charging for health care, floating a figure of $1,900 per person during a Sept. 23 speech to the Calgary Chamber of Commerce. “So I gave you the idea of what we’re looking at: $1,900 per person,” Smith said. Smith raised the figure while responding to concerns about the effect additional costs could have on businesses employing temporary foreign workers. “So I guess that’s the question: Is $1,900 for the business to take on that fee? Is that going to make or break your business? If it is, you’re probably hiring into a low-skilled profession,” Smith said. “We want those low-skilled jobs to go to youth employment. We want we have a 15 to 16 percent youth unemployment rate, and we want those kids to get the first chance.” Smith’s comments dealt with the health-care portion of the proposal. The eventual amount, structure and application of any fee would still have to be determined. The $1,900 figure is not government policy and would not automatically take effect if Albertans vote ‘yes.’ The government would first have to develop and enact legislation. Smith also did not say whether the figure would ultimately be the amount charged. Calgary Chamber of Commerce President and CEO Deborah Yedlin said the effect would depend partly on the worker and the job. “That’s an extra cost on the worker or the business, and to be honest, that adds to the cost structure that businesses are already dealing with, as they have been rising supply chains, energy prices, etc. This is this is not necessarily going to make businesses more competitive in Alberta,” Yedlin said. Yedlin said businesses employing multiple temporary workers could face a significantly larger expense. “Because it’s one, you know, it’s one worker, $1,900. If you need 10, it’s a bigger number.” Despite Smith’s musings about a cost to employers, the province’s referendum website says employers would not be responsible for paying a future premium or fee. Yedlin says the impact of fees would also be greater for lower-paid workers. “A low-skilled worker obviously is not going to be making the same wage as a software engineer, and so that’ll be harder for them to support that extra cost,” Yedlin said. “If you’re a software engineer, it’s a different conversation. You do have some ability to support that extra cost if you want to access services that you would like in the province.” Extra fee would be a struggle Kayode Southwood of the Canadian Federation of Independent Business said additional costs could make Alberta less competitive for workers at a time when businesses are already struggling with labour shortages. “Anything we see from the government in the future that negatively impacts employers’ ability to bring on TFWs is going to make that shortage worse at the end of the day,” Southwood said. Southwood also challenged Smith’s suggestion that jobs currently filled by temporary foreign workers would simply go to young Albertans saying that goes against the agency’s recent research. “We found that nine out of 10, jobs, filled by TFWs youth aren’t interested in taking,” Southwood said. “And what it really boils down to is, we found that over half of Canadian youth aren’t interested in doing jobs that require them to work late night shifts, or have physical labor. And a third don’t want jobs that pay minimum wage. So there’s definitely a disconnect there between employers and, I think what some of the youth are looking for,” The CFIB also found only eight per cent of youth would consider moving to a small town or rural location to work on a farm. Southwood said imposing new costs on temporary workers could make Alberta less competitive with other provinces. “If you’re a farm owner in Alberta and you have a TFW that now, you’re suddenly having to look at potentially paying health-care costs or education costs,” Southwood said. “Even though the government says that employers won’t be responsible for those costs, if that farmer is competing with a farmer in Saskatchewan or in another part of Canada for that same TFW, obviously, they’re going to have to sweeten the deal,” He said employers could respond with higher compensation, with those costs passed on to consumers. “If a lot of these businesses are going to be paying more to keep on TFWs … then there’s going to be some huge costs, I think, for the consumer,” Southwood said. Juan Carlos, a refugee from Mexico who is trying to establish himself in Calgary, said willingness to contribute is not the same as being able to afford a new charge. “Me as a refugee, I don’t have the money to do it. Not that I don’t want to,” he said. “I’m willing to cooperate and to pay anything, but my situation or our situation is really hard at the beginning, very very hard.” Carlos said if a new health-care fee were imposed, the small used car he and his son bought might be the first thing to go. “The only kind of luxury that we have, that my son and myself have, is this little small used car that we bought a few months ago. I may need to sell it right away to have a some money just to for an emergency or to cover those fees,” he said. The government’s argument The Alberta government presents the proposal as a response to rapid population growth – more than 600,000 people in five years – and pressure on health care, schools and other public services. Its referendum website says federal immigration policies “almost doubled, and then more than tripled,” the number of newcomers over the past decade and blames that growth for pressure on public services. It describes Question 4 as asking whether temporary residents should pay tuition or health-care premiums “so long as their status remains temporary.” It says permanent residents would not be affected and emergency health care would continue to be provided. The province says the Canada Health Act does not require provincial plans to insure temporary residents. But temporary residents do not all have the same circumstances or existing coverage. The category includes temporary foreign workers, international students, refugee claimants and family members. Some currently qualify for Alberta health coverage, while others receive federal or private coverage. Foreign workers can qualify for Alberta coverage if they meet residency requirements and hold an eligible work permit. International students can also qualify under certain conditions. Refugee claimants generally receive coverage through the federal Interim Federal Health Program while awaiting a decision. The referendum question does not explain how those existing categories would be treated under a future Alberta law. In a written response to CTV News, Premier Danielle Smith’s Press Secretary Sam Blackett said the referendum questions would have a broad reach. “Questions 2 through 4 would apply to all those who are not Canadian citizens and those who do not have permanent resident status,” Blackett wrote. “The details of new legislation to implement the will of Albertans as expressed in the referendum, including the amount of any premium or fee, will be decided by the legislature thereafter,” he said. The province estimates there are 47,389 students with temporary resident status, at an average education cost of about $12,000 each. It also estimates temporary workers and international students account for 1.27 per cent of Alberta’s annual health spending, or just over $400 million. One major question remains unanswered: whether people already living in Alberta with temporary status would have to pay a future fee or would be grandfathered under the existing system. “We have to talk about that as a as a cabinet. I want to see if we even have a mandate to do it,” Smith said. Finance Minister Jeremy Nixon said significant consultation would be needed before that could be determined. “I don’t think it’s possible to answer at the moment. We would need clear instructions from Albertans, which we’re asking for during this referendum, and from there we will begin the process to implement it,” Nixon said. Nixon said legislation would be required and he did not expect the policy to be fully implemented until after the 2027 election, although details could be announced before then. Smith suggested the implementation period could reduce the number of current temporary residents affected because some workers and students would leave as their permits expire. “And so if it’s going to take about a year for implementation, I would imagine that’s going to limit the number of people who will be directly impacted, and those who are coming will know what the new rules are,” Smith said. Might people delay medical care? Critics also question what happens if people cannot afford a health-care fee. Noha El Tanahi, settlement and financial literacy manager with the Immigrant Education Society, said charging for basic services would not address shortages in the system. “But at the same time, charging fees or to let newcomers wait for 12 months until they receive the basic service. I don’t think this will add more doctors to the healthcare or build new schools.” “Germs and sickness don’t ask for the immigration paper, nor for immigration categories,” she said. Deborah Akinrinde, a client of the Calgary Immigrant Women’s Association, believes some families could avoid seeking care. “Most people would probably just self medicate, which is quite dangerous. I doubt if they would even consider taking their children to the public spaces or to the public health facility,” she said. University of Calgary law professor Lorian Hardcastle, an expert in health policy, said restricting preventative care can work against the objectives of the health system. “From a policy perspective, we’re not necessarily doing ourselves a service if we’re denying newcomers access to healthcare services,” Hardcastle said. “If we keep them healthy, we keep them in the workforce.” The Canada Health Act question Hardcastle said governments have significant authority to determine eligibility for provincial health insurance, but limits on care can still raise legal questions. “This is a messy problem with a long history,” she said. “There was a federal decision that’s quite a few years old now, where the court was actually willing to find that it could constitute cruel and unusual punishment under the Charter to deny, you know, refugees these kinds of basic health services.” Any legal challenge would depend on the eventual legislation, including who is charged, what services are covered and what exemptions are provided. Workers who keep public services running Temporary residents also work in sectors facing labour shortages, including continuing care, child care, food production and hospitality. Hardcastle said many newcomers work as health-care aides, personal support workers and early-childhood educators. “There certainly is an irony to that,” she said, “denying them access to the education and health systems when they’re helping keep it afloat.” Non-permanent residents pay taxes Non-permanent residents working in Alberta also pay income and other taxes. Hardcastle said many are younger than the Canadian population overall and could contribute taxes throughout their working lives. “A lot of the people who are coming from these countries are relatively young compared to the Canadian population as a whole, and potentially have an entire working career to pay taxes and to support the aging population,” she said. Blackett said temporary residents pay an estimated $150 million annually in taxes and that the government considers its cost estimate to be net of those contributions. The province did not explain how it calculated that tax estimate or whether other economic contributions were included. Permanent residence as an alternative Smith said expanding provincial nominee pathways could provide another option for temporary residents whose skills fit Alberta’s economic needs. “And so that’s the other pathway: is that once you become a permanent resident, you’ve made a commitment to being a lifetime taxpayer, and your kids are going to become Canadian citizens, you get treated as a Canadian,” Smith said. Paula Calderon, CEO of the Calgary Immigrant Women’s Association, said the proposal could have longer-term consequences. “The questions are quite vague, and it’s quite difficult to understand the long-term implications of these measures,” Calderon said. She also questioned whether the policy could make Alberta less attractive to immigrants who have choices about where to settle. “The people that we want to attract into the province, the economic class migrants, the people that that as has been said are the ones that are ready to contribute as soon as they land, are the people that can actually choose where they want to go, and do they want to go to a province that is unwelcoming to immigrants? I don’t think so,” she said. Would the policy save money? The proposal could reduce direct provincial spending if temporary residents paid premiums or tuition and continued to live, work and study in Alberta at the same rate. But the net savings are unknown. A new system would have administrative costs, while businesses could face higher labour costs if they have to offer additional compensation to attract temporary workers. Alberta NDP Leader Naheed Nenshi criticized Smith’s $1,900 figure, arguing it would represent a significant additional expense for temporary residents and their families. Nenshi also disputed the government’s economic rationale, arguing temporary residents already pay taxes and questioning whether the potential revenue would materially improve the health-care system. What happens after the vote? A ‘yes’ vote would not create a $1,900 health-care premium. The government would still have to determine the amount, who would pay, whether existing temporary residents would be grandfathered, what exemptions would apply and how the system would operate before bringing forward legislation. Nixon said he did not expect a new system to be fully implemented until after the 2027 provincial election. That leaves Albertans voting on the principle of charging a fee with an indication of what the premier believes a health-care premium could look like, but without knowing the final price or precisely who would ultimately have to pay it. Since the referendum was announced, Calderon said immigrant-serving organizations have also seen a change in public sentiment. “The whole sector has seen an increase in negative feelings against immigration and immigrants,” Calderon said. “We are constantly having to vet messages on our social media,” Calderon said. “There’s been other partners in the sector who have seen vandalism to their offices and negative messages sent to them.”
