Disability and poverty: funding and structure of new federal benefit unacceptable

While doctors were up in arms over the federal budget’s changes to the capital gains tax, many overlooked an announcement with far more consequence for their low-income and socially marginalized patients—one that will place an immediate burden on our already stretched work lives.The budget included $6.1 billion in funding over six years for the long-in-development Canada Disability Benefit (CDB), and the curtain was lifted on some specifics of how the program will work. For many in the disability rights community and their supporters, the reveal fell far short of the government’s promise of an inclusive “Nothing Without Us” approach to program design. It ignored almost every recommendation people with disabilities and experts had offered during years of consultation.The amount being offered to some people with disabilities, $200 per month, is a drop in the bucket in a time of high inflation, rising rents and significant added costs to living with a disability. This meagre funding reveals a government uninterested in supporting people with disabilities to live with dignity and escape poverty.Of even greater concern, however, is the choice of the Disability Tax Credit (DTC) as the gateway to the new benefit. Using the DTC will severely limit access to the program, especially for those who are low income and socially marginalized, and it will place an unnecessary and time-pressured burden on physicians. Doctors should join people with disabilities in protest.Read: How physicians can show they’re welcoming to patients from marginalized communitiesThe disability benefit will be available only to people with a valid DTC certificate, making it one of the most difficult government disability support programs to access. Disability Without Poverty, an advocacy group, estimates there are 1.6 million Canadians with disabilities living below the poverty line yet the budget itself says only 600,000 will qualify for the new benefit.The program rests on a definition of disability that is predominantly medical and sets an unnecessarily high threshold. While contemporary understandings of disability increasingly focus on the social barriers to participating in society and their impact on day-to-day function (think a lack of ramps to enter buildings or inflexible or nonexistent workplace sick day policies), the DTC looks mainly to medical diagnoses and single organ system dysfunction. Furthermore, it demands a severe level of impairment at least 90 per cent of the time, which does not account for the many disabilities that fluctuate in severity or whose moderate impairments raise high barriers to social and workplace inclusion.This definition will exclude many people from necessary income supports. The structure of the DTC, however, poses even more barriers to access. To date, it provides only a non-refundable tax credit, meaning it only benefits higher income people who pay taxes. It also requires a lengthy and complex form to be filled out by a physician or other health provider, without government payment for its completion. Many physicians charge for this service, once again making it unlikely that lower income people, let alone the millions of Canadians without a primary care provider, have applied. A huge catch-up in applications will be required—possibly on the order of several million—ideally to be completed in the next year, before CDB payments begin in July 2025. Given the complexity of this form, that could mean several hundreds of thousands of hours of physician time to support entry to this program. It is hard to understand why the government would choose to place this burden on an overstretched health system.The irony is many of those who are most in need of this supplement have already been assessed by health providers and have been determined to have a disability by expert government assessors. Anyone who receives provincial disability social assistance or a federal disability support such as the Canada Pension Plan-Disability already has undergone an extensive process of assessment and approval for disability income supports. A federal government whose priority is to urgently provide support to people living with disabilities in highest need could easily offer this benefit to those already approved for these programs. That may not capture everyone who needs these funds, but it would go a long way toward immediately offering support to people with disabilities living in the deepest poverty.Doctors and our national and provincial organizations should rise up in unison to push for a change to the structure and funding of the CDB. After years of consultation, the government is offering a program that is inadequate, inaccessible and inequitable while asking health providers to serve as its gatekeepers. This is unacceptable, unconscionable and will exacerbate health inequities.While this advocacy takes place, however, we need to make sure we are doing everything we can to support our patients living with disabilities. This means assisting every one of them to apply for the DTC, lowering barriers by not charging for this form completion, and proactively reaching out to patients to encourage them to apply. Even an inadequate $200 per month is essential to people living in deep poverty; we must provide urgent, direct support to these individuals with one hand while advocating for better with the other.Dr. Gary Bloch is a family physician with Unity Health Toronto, physician lead, equity and social interventions with the St. Michael’s Academic Family Health Team and an associate professor at the University of Toronto.This item is also appearing on the Healthy Debate website.

Disability and poverty: funding and structure of new federal benefit unacceptable

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