Feds ‘very concerned’ about Alberta’s dual practice law, weighs unprecedented penalties

The federal health minister has told the Alberta government that she is “very concerned” about the province’s dual-practice law and warned that it may violate the Canada Health Act, according to reporting from the Toronto Star.Alberta’s Bill 11, which received royal assent last December, will allow physicians to work both in the public health system and in private clinics where patients may pay out of pocket. The province says this move will alleviate pressure on the public system and reduce wait times while expanding choice for patients.On Sunday, the Star reported that federal Health Minister Marjorie Michel sent a letter on July 24, to Adriana LaGrange, Alberta’s minister of hospital and surgical health services, expressing that Bill 11 may violate two components of the Canada Health Act’s five core criteria: comprehensiveness and accessibility.“Why did I send the letter? Because for sure, dual practice, I don’t know how it can work within [the Canada Health Act],’” Michel told the Star.Under the Canada Health Act, the “comprehensiveness” criterion requires provincial and territorial insurance plans to cover all medically necessary services provided by hospitals, and the “accessibility” criterion prohibits user fees for insured services.The Star did not obtain the letter itself but spoke with a source within the federal government who summarized the contents of the letter.“The communication states that we’ve done some review on the regulations published, and that [Michel] has acknowledged that there were some . . . measures put in place by Alberta to mitigate any adverse impacts to the public system, but that she felt that more work was needed to protect public access for medically necessary care,” said the Star’s source.“The minister further went on to state that there is a great deal of evidence that we’ve seen where other countries have implemented dual-practice approaches and that implementing systems such as that can potentially reduce access for more vulnerable populations.”“I am trying to convene conversations with them. At the same time . . . the tool I have is really the penalties when [provinces] are outside the Canada Health Act, Michel said to the Star.The federal government has two ways to enforce the Canada Health Act: Canada Health Transfer deductions and discretionary penalties. The feds have routinely issued mandatory dollar-for-dollar deductions from their Canada Health Transfer payments against provinces and territories that charge patients out-of-pocket for medically necessary services (although these deductions can be reimbursed back to the provinces and territories if they correct their policies). In March 2026, the feds issued $65 million in deductions against eight provinces, although $42 million was ultimately reimbursed back.However, discretionary penalties can apply if a province fails to comply with one of the five core criteria of the act—a step that has never been taken against any province or territory thus far. Such an unprecedented move could also further heighten tensions between Alberta and the federal government, with a referendum on separation just two months away. “Just the fact that it would be initiated and not just threatened would be an unprecedented move in the history of Canada. So it’s not something to be taken lightly,” the Star’s source said.The new model is officially set to roll out on Sept. 1, 2026. Throughout this summer, applications have been rolling in from physicians seeking approval to join the dual practice framework. Until then, Michel says the feds are in a wait-and-see mode to see what their next steps are.“Until they put it in place, and until I see that their new model is preventing people to get access to what is medically necessary, until that point, I have no real hook,” she said.

Feds ‘very concerned’ about Alberta’s dual practice law, weighs unprecedented penalties

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