Medicare has always been universal, and this dental care plan should abide by the Canada Health Act and cover everyone

David MacdonaldThe federal government is in the midst of the second phase of its national dental care plan, the most significant expansion of Canadian healthcare in decades. And with 12.9 million Canadians, including children, living without any dental care coverage, federal dental care insurance is sorely needed.

Unfortunately, the plan will still leave out plenty of people without dental insurance, even once it’s fully implemented.

To qualify for the new dental care plan, Canadians must meet two criteria: individuals may not already have dental insurance, and families may not have a combined income higher than $90,000.

An income of $45,000 is pretty modest in Canada these days, but if you had a family where both parents were making that, they’d be hitting the income cap. If neither of them received dental coverage through their jobs, neither they nor their children would be eligible for the new federal plan. Even at this modest income level, they’d be too rich for the plan. In fact, 59 percent of families with children make more than $90,000.

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We have to remember that this isn’t how we do medicare. There isn’t an income check when you go to your doctor, and the hospital doesn’t check your tax return to see if you’ll be paying out of pocket to repair your kid’s broken bone. You’re just covered. Setting up major medicare expansions like this that aren’t universal sets a dangerous precedent for future expansions, like in the pharmacare plan expected to be announced in March.

In the end, this means that 4.4 million people who presently don’t have dental coverage would remain without it, even once the federal plan is fully implemented. They’d hit the income threshold and be ineligible.

Here’s how the three phases of the new dental care program are rolling out:

The first phase, underway through June 2024 and called the Canada Dental Benefit (CDB), is a cash transfer of $1,300 per child under 12 if that child sees a dentist. For this age group, 65 percent of children without dental insurance will be eligible, but 35 percent will be excluded because their parent’s combined income is over $90,000.

Phase two, the Canada Dental Care Plan (CDCP), is being rolled out right now. Older seniors can apply now, and by June all seniors, all children under 18, and those with disabilities will be eligible too.

In phase three, which will start in 2025, the only eligibility restriction will be the $90,000 family income cap and the lack of other dental insurance. This phase will cover an additional 8.5 million people but exclude 4.4 million Canadians due to the income restriction. An additional 1.4 million people should see their provincial government dental insurance supplemented.

All told, there should be almost 10 million Canadians who will benefit from this plan, and for them, dental care will become much more accessible. However, another 4.4 million Canadians will remain uninsured.

In fact, the federal government could – and should – close this gap by adding an estimated $1.45 billion to the dental care plan and eliminating the $90,000 income cap. The feds have already levied a corporate surcharge on the big banks for their pandemic and inflation profits; this could be expanded to other sectors, like the oil and gas or grocery sectors, raking in inflation profits.

Ultimately, the federal government faces two choices in how it approaches public dental care: The first is continuing with the current plan, which has a fill-in-the-gap model and an income cap. The second is delivering on the promise of the Canada Health Act, which is based on healthcare for all and imposes no income threshold for care.

Medicare has always been universal, and this dental care expansion should abide by the Canada Health Act and cover everyone.

David Macdonald is a senior economist at the Canadian Centre for Policy Alternatives.

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