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Last year, the Alberta government introduced Bill 11 (the Health Statutes Amendment Act), which established U.S.-style, two-tier health care in Canada for the first time. Over the past year, the Alberta government, led by Danielle Smith, has brought many sections of this legislation into force.
This legislation encourages physicians and surgeons to work in the public system and the private-pay market at the same time, charging patients for medically necessary health care, including surgeries already performed in for-profit facilities.
Nearly one year has passed since Alberta opened up Canada to a private-pay health care system where income will determine access to necessary surgeries like hip and knee replacements.
Bill 11 directly and unequivocally breaks the Canada Health Act—the key piece of federal legislation that governs health care—and that ensures that cleaners on Bay Street have the same access to health care as bankers working in the same building.
But so far the federal government is missing in action.
The conventional wisdom was that the federal government should wait until the Alberta separation referendum was in the rearview mirror before taking Alberta to task on an issue that would likely inflame the Alberta government and the small, but vocal separatist movement.
But the October 19 Alberta referendum has come and gone, without any indication that the federal government is planning to enforce its own legislation.
What’s at stake? Bill 11 violates no fewer than five sections of the Canada Health Act as a legal opinion shows.
Alberta’s legislation contravenes the requirements that all medically required services are publicly insured (Section 9), there is “reasonable access” to insured services without financial barriers (Section 12), and that people are entitled to them on “uniform terms and conditions” (Section 10).
The legislation also violates prohibitions against user fees and extra billing (sections 18 and 19). These sections prevent patients from being charged out-of-pocket or through private insurance for services that are already covered under the provincial health plan.
In September, federal health minister Marjorie Michel told the Toronto Star that she had written Alberta health minister Adriana LaGrange to say that she is “very concerned” and conveyed that she doesn’t believe that it can work within the Canada Health Act.
Where has the federal government been for the past year?
A legal opinion clearly shows Bill 11 violates federal law.
A chorus of medical associations, nurses, unions, researchers, and civil society organizations have all raised alarm about how this legislation abrogates federal law—and opens the door for a U.S.-style private health insurance market that would end public health care as we know it.
This legislation was introduced nearly a year ago. But the federal government, via the health minister, is still musing that Bill 11 “may” break the law.
It does break the law. Time is of the essence if we want to prevent a U.S.-style system from taking hold in Canada.
The Alberta government is moving quickly to implement its private health care model, with close to 400 specialists and surgeons expressing interest in working in both the public system and private-pay market in August.
Many of the procedures that wealthy patients can obtain through private payment require nurses and anesthesiologists who are already in short supply in public hospitals—the main reason why public wait times are likely to become longer.
The federal government must initiate the formal review process
On most issues, this federal government appears keen to serve the interests of corporations, ranging from pharmaceutical policy to data centres to fossil fuel expansion.
But should the federal government abandon public medicare, it risks abandoning the most popular Canadian social program and one of the most important issues for voters.
If the federal government truly believes that health care is a right, not a business, as the Liberal Party campaigned on in spring 2025, then the federal government needs to immediately initiate the formal review of Bill 11 under the Canada Health Act.
Under section 14, the health minister must send a letter to Alberta, initiating the 90-day consultation process with the province over Bill 11’s failure to comply with federal law. If Alberta does not repeal Bill 11 in order to comply with the Canada Health Act, the health minister must refer this matter to cabinet for discretionary penalties against Alberta.
The federal government has the authority to withhold all of Alberta’s share of the Canada Health Transfer—$9.2 billion in 2026-27—until Alberta comes into compliance with the Act.
There is no question that Alberta premier Danielle Smith will relish the opportunity for a new fight with Ottawa, but the evidence shows that public opinion is clearly on the side of the federal government.
A recent public opinion survey shows that Albertans overwhelmingly oppose Bill 11 and the shift to private-pay health care. Albertans also believe in the principle of universal health care access based on need, not wealth.
More to the point, Albertans rejected the Alberta government’s proposal of opting out of federal programs like health care and amending the federal constitution so that provincial laws could take priority over federal laws, such as the Canada Health Act.
If the federal government fails to enforce the Canada Health Act and stop a U.S.-style system from taking hold, then we should be under no illusion that this federal government has abandoned Canadian medicare—and is prepared to sell us out to investors and insurance companies just like other vital public assets.
About the author
Andrew Longhurst
Andrew Longhurst is a senior researcher and political economist, with a focus on health policy, at the Canadian Centre for Policy Alternatives. He holds an MA from Simon Fraser University where he is a PhD candidate. He is the author of over 45 publications on public finance, health services, and the care economy.
