There are signs of momentum toward finalizing new health-care funding pacts with the provinces, with plans for the first one-on-one negotiation set for Thursday with the Ontario government, and the Prince Edward Island premier indicating he will sign the deal.
"I'm prepared to take that money and put it to good use," P.E.I. Premier Dennis King said Wednesday, following a private meeting with Prime Minister Justin Trudeau.
King remained in Ottawa for the meeting one day after the prime minister laid out Ottawa's long-awaited new health-care funding deal to all 13 premiers during a first ministers meeting.
The offer amounts to $196 billion in total federal funding for health-care transfers to the provinces and territories over the next 10 years, about one-quarter of which is new money the provinces weren't expecting in existing health transfer forecasts.
It includes an immediate $2 billion top-up to this year's Canada Health Transfer and would accelerate the pace that the transfer increases over the next five years.
There is also $25 billion for one-on-one agreements with each province to address specific areas including family medicine, health worker shortages and surgical backlogs, mental health and health data collection.
The offer is well shy of the province's demands for the federal government to increase its share of health spending to 35 per cent from 22 per cent. The provinces say it will increase the federal share to about 24 per cent for now.
The premiers were disappointed and plan to speak virtually again Friday to discuss how they plan to respond. They are trying to maintain a united front in their demands of Ottawa.
Neither Trudeau nor Health Minister Jean-Yves Duclos will specifically say it's their final offer but they are showing no signs of willingness to negotiate on the dollar amounts.
"The offer was announced yesterday and now we need to see what it will do for people over the next few years," Duclos said in French in an interview Wednesday with The Canadian Press.
Negotiations would focus on the priority areas to which each province wants to devote new cash, and how premiers will meet the federal demands of accountability for how the money is spent.
Duclos said Wednesday he will begin those talks Thursday in Toronto with Ontario Premier Doug Ford and Health Minister Sylvia Jones.
Following the meeting Tuesday, Ford said he would push for more cash but would never turn down new money, and he appears ready to work on a deal.
On Wednesday, he seemed eager to get to work to finalize the deal, which for his province could amount to at least $74 billion in transfers from Ottawa for health care between now and 2033, including about $16 billion in previously uncommitted dollars.
"I’m confident we’ll get the t's crossed, the i's dotted," he said. "We’re grateful for the offer. We’re grateful for sitting down with the prime minister but we want sustainability."
King didn't have a date for Duclos to meet with P.E.I.'s health minister but said he wants it to happen soon so the funding can flow. King said as long as health transfers have existed, provinces have always wanted more money.
But at the end of the day, he said, the federal government holds the purse strings and the provinces don't have a lot of power to change that.
"Look, we're ready to go," said King. "We'll have a budget coming out here for the next fiscal year, we want that money to be in our budget. We want to put it to use and to make health care a little bit better for Islanders."
Duclos hopes to conclude talks with Ontario in a few weeks.
"Lots of the preparatory work has been done on this (and) we can build on that to proceed relatively quickly," he said.
To receive much of the money, the provinces must agree to overhaul their health data collection, including harmonizing digital patient records with other provinces and making them more easily shared and accessible between various health professionals.
Ford said last month he was fine with the data upgrade requests from Ottawa. His announcement helped turn the tide on negotiations between Ottawa and the provinces for new health money, which had fallen apart last fall.
The federal government's biggest concern, beyond improving the health-care system, is showing Canadians how the money is spent and how it helps people.
The $25 billion for priority areas will only be transferred to provinces that lay out a detailed plan for how the money will be spent and how progress will be measured.
Duclos said there will be some specific indicators provinces will have to report publicly on in each area for which they receive money. He said those indicators have been developed by experts and the provinces are already well aware of most of them, including how many more Canadians get access to a family doctor, how quickly surgical backlogs are reduced, or how many young people are connected to appropriate mental health services and how promptly.
The Canada Health Transfer, which was $45 billion this fiscal year, has few strings attached beyond abiding by the principles of the Canada Health Act.
The government topped up that transfer by $2 billion last July, and proposes to add an additional $2 billion before the end of March. The money goes to provinces' general revenues and is therefore difficult to track in terms of use.
Duclos said he and Mental Health Minister Carolyn Bennett will send a letter to each province with more details of the offer and their expectations.
The letters will seek feedback from the provinces about whether they intend to accept the offer.
Duclos said it will largely be up to the public to hold provinces accountable for meeting goals of the proposed health-care spending.
This report by The Canadian Press was first published Feb. 8, 2023.
— With files from Allison Jones in Toronto
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