The Alberta government appears to be swayed by the private insurance industry—and this powerful lobby has a large financial stake in a two-tier health care system. While, so far, the Canadian private insurance industry appears only to be involved in the development of Alberta’s new two-tier legislation, Bill 11 opens the door for foreign private health insurers, including from the U.S.
Back in December, the Alberta government passed most sections of Bill 11 (the Health Statutes Amendment Act), which allows physicians and for-profit facilities to charge patients for medically necessary health care already covered under the Canada Health Act. (The sections related to “dual physician practice” which allow two-tier medicine have not yet been proclaimed.) Legislating two-tier health care is a first in Canada.
The CCPA report The end of medicare? explained that Bill 11 expands the private health insurance market for medically necessary care, which until now, has never existed in the country because it is not permitted under the Canada Health Act. And it is still not: Alberta has passed legislation that contravenes this federal legislation.
There are many risks associated with private health insurance for medically necessary health care, especially from foreign providers, including the U.S. private health insurance industry. Here are five things to know.
The insurance industry has direct involvement in developing Alberta’s two-tier health care legislation
In its January 2026 pre-budget submission to the Alberta government, the Canadian life and health insurance lobby association revealed its involvement in the implementation of Bill 11:
“Our industry appreciates that the Alberta government considers life and health insurers as a key partner in the healthcare system, as demonstrated through the introduction of Bill 11 “supporting a world-class health care system”. We appreciate the opportunity to help facilitate a smooth transition for Albertans through our inclusion in the technical implementation of certain aspects of the changes.”
The Alberta government has offered no public information about a technical implementation committee and the composition of any committee within government. This key section from the insurance lobby’s submission suggests that the Alberta government has only invited the industry into the very process that will determine its profits.
In industry publications, the insurance industry has expressed excitement about increased profit-making opportunities. In a November 2025 article, the industry publication stated that “[b]y enabling patients to pay privately for procedures or use supplemental insurance to bypass public wait times, the plan could open the door to new coverage options, higher demand for private benefits, and a fundamental shift in how insurers price and design health plans across the province.”
Provincial governments are responsible for regulating the insurance industry and the products they sell. This apparent regulatory capture by industry should concern not only Albertans, but all Canadians who care about transparency and distance between government and industries that they are supposed to be regulating.
What is the extent of the involvement of private insurers in Alberta’s health care reforms? Did the industry draft the legislation? Has the U.S. private health insurance industry been involved?
These are all important questions for which Canadians deserve answers.
The Canadian and U.S. health insurance industry is overwhelmingly for-profit
The cozy relationship between the Alberta government and the insurance industry is of significant concern because this industry is overwhelmingly dominated by large for-profit corporations that appear closely involved in the creation of a new private health insurance market for medically necessary care that is already publicly covered.
For the industry, Bill 11 is—as an industry publication states—an opportunity to “significantly reshape the province’s health insurance market” by selling insurance products for medically necessary care.
Industry statistics show that the existing Canadian private health insurance market is worth $53 billion. All but eight of the 85 insurers are for-profit. As The Breach has reported, 63 per cent of the total life and health insurance market in Canada is controlled by three corporations: Manulife, Canada Life, and Sun Life.
But the creation of a two-tier health care system in Alberta is fundamentally about the expansion into a previously non-commodified part of the health care system—the public insurance plan. In industry terms, the $34 billion in provincial health care spending is a market opportunity—dollars that could flow through private health insurers, rather than through the public plan.
In Alberta—like every province—the industry understands publicly insured health care as the largest untapped market. That’s why the interest in Alberta’s two-tier health care reforms are unlikely to remain limited to Canadian insurance companies.
In a recent CCPA webinar, David Himmelstein and Steffie Woolhandler, leading scholars on the U.S. health care industry, commented that U.S. private health insurers are looking for new markets and many are already active in South America. They noted that Americans are “tapped out” and increasingly unable to pay rising premiums (more on this below).
There is no doubt that Canada is an untapped market and the U.S. health insurance industry is hungry for new profit-taking opportunities. As global consulting giant McKinsey & Company notes in a recent analysis, profit levels are at “historic lows across [payer] markets”. In other words, insurers are looking for new opportunities to grow profits and are likely to “reallocate resources to growing market segments.”
UnitedHealth Group (16 per cent), Elevance Health (12 per cent), and CVS (Aetna) were the top three U.S. private health insurers by market share. UnitedHealth was found to have used “aggressive tactics to collect payment-boosting diagnoses for its [U.S.] Medicare [members],” a U.S. Senate committee investigating the corporation’s practices said. In his report, Senator Chuck Grassley said that “my investigation has shown UnitedHealth Group appears to be gaming the system and abusing the risk adjustment process to turn a steep profit.”
Indeed, the U.S. private health care industry is one of the most profitable industries in the country. UnitedHealth Group and CVS (Aetna) are in the top five of highest revenue companies. One estimate puts the profits of the top seven publicly traded insurance companies at $71 billion in 2024. This is one of the reasons that the United States far outspends other high-income countries on health care as a share of GDP.
For these corporations, Canada could be that next goldrush if Alberta’s two-tier reforms proceed, and if the federal government fails to intervene and uphold the Canada Health Act.
The entrance of U.S. private health insurers would upend single-payer health care
Although we often refer to Canada’s public health care system—or “medicare”—it is actually a collection of nine provincial and three territorial health insurance plans. Across the country, when you access public health care services, you are relying on your public provincial health insurance plan.
The entrance of Canadian private health insurers—and especially U.S. insurers—would upend public health care as we know it. If the Alberta government is successful in the privatization of health care financing, rather than relying on our single-payer insurance system that has existed for decades—the reason for our much more cost-efficient system compared to the U.S.—we would see the development of a multi-payer system with private health insurers. The involvement of private health insurers means much higher administrative costs and, of course, profit-taking—a requirement that does not currently exist in our public, single-payer model.
The movement of the U.S. private health insurance industry into Canada via Alberta would be devastating for patients—and it would make it very difficult to force these companies out of Canada, once entrenched, due to our international trade agreements.
Most of us have had little direct experience dealing with private health insurers other than extended health plans, and it’s important to understand what’s at stake.
The U.S. private health insurance industry is the leading cause of America’s cost of living crisis
Recent polling shows that Canadian residents rank the rising cost of living as their top concern. What if we added private health insurance premiums, co-payments, and other out-of-pocket expenses to the mix? The costs to Canadians would be significant and near impossible to contain, if we allow an unrestricted private health insurance market based on Alberta’s reforms.
The U.S. health care statistics are sobering:
- In 2026, just under half of adults say it is difficult to afford health care costs and 30 per cent say a family member had problems affording health care in the past year.
- In 2026, more than one-third of adults skipped or postponed getting necessary care because of the cost. Three in four uninsured adults under age 65 went without needed care due to cost.
- The average American pays more than $17,000 for health care annually, which does not include insurance premiums that they and their employers pay, as well as co-payments, deductibles, and the taxes that fund Medicare, Medicaid, and other public programs.
- The average annual cost for employer-sponsored family insurance premiums was nearly $27,000 in 2025, with workers paying $6,850 from their paycheques. The family premium increased 26 per cent over the last five years.
- Even among those with health insurance, almost four in 10 insured adults under age 65 worry about affording monthly insurance premiums.
- In 2022, 41 per cent of adults had debt from medical or dental bills, including debts owed to collections agencies, credit cards, family and friends, banks, and other lenders. Black and Hispanic, women, parents, low-income people, and uninsured people were disproportionately affected by medical debt.
- An estimated 100 million Americans owe $220 billion in medical debt.
- As many as two-thirds (66.5 per cent) who file for bankruptcy cite medical bills as the primary cause—a proportion that has remained largely unchanged, despite efforts to overhaul the private health insurance market under the Affordable Care Act.
The federal government needs to intervene before it’s too late
So far, the federal government has not taken a public position on Alberta’s Bill 11 and Bill 29—the latter of which encourages two-tier diagnostic testing. On March 16, the Canadian Health Coalition and provincial health coalitions organized a “Day of Action” to break the silence on Alberta’s two-tier health care and call on the federal government to enforce the Canada Health Act.
Some members of the federal Liberal caucus spoke out against Bill 11 in response to the Day of Action, including Vancouver MP Hedy Fry. She said, “there is no doubt that Alberta’s Bill 11 absolutely contravenes the Canada Health Act.” While it is positive to hear from individual members of the federal Liberal government, so far, the Health Minister Marjorie Michel has not taken a position—nor has the prime minister.
Canadian insurance corporations are already preparing to sell products in this new private health insurance market. How long will it take before U.S. insurers enter the market as well? Once employer plans and individuals begin to purchase products, it will become increasingly difficult to put the brakes on this new insurance market—even if it directly contravenes the Canada Health Act.
Time is of the essence. The federal government needs to decide if it stands for Canadian medicare or if it believes that private insurers should call the shots.
