Health Care: To ease future cuts, the government established a budgeting system this year which would see much of the COVID-related funding budgeted under special funds distinct from the normal ministries. So much of the increased funding for the Ministry of Health or Ministry of Long-Term Care is not reflected in their line items but instead through special funds that are then later allocated to a ministry.
So first the good news: The health and LTC special COVID funds are “budgeted” to continue for a couple of years. An additional $4 billion in 2021–22 and $2 billion in 2022–23 is currently planned to help the health sector address COVID-19.
The bad news, however, is that even with that continuation of special COVID funds, overall health care and LTC funding is budgeted to go down -- by $1.9 billion in 2021/22 and another $500 million in 2022/23. That's a lot of cutting.
Of course that is “down” after a major increase this year. Including the special funds, $72.8 billion is budgeted for health and LTC this year. That is up from $63.7 billion in 2019/20, a $9.1 billion increase (or 14.3%).
We are truly living in a health care bubble right now. Unfortunately, the plan is to end that extra funding fast.
Notably, outside of the special COVID funds health care and LTC got a pathetic increase of 1.4% this year – up from $63.7 billion last fiscal year to $64.6 billion. Next year, the non-COVID related increase is planned at 3.7%, still significantly less than cost pressures and so likely to further deepen the health care service squeeze. The non-COVID increase planned for 2022/23 is even less (2.2%).
Since the release of the 2020–21 First Quarter
Finances, the Budget reports that they have made a number of COVID-related funding improvements, many related to hospitals:
- $1.4 billion
to expand laboratory capacity, reduce testing backlogs, support existing
assessment centres and more testing locations. Funding will also support
additional contact tracers and case managers to trace and isolate new
COVID‑19 cases;
- $351 million
to build additional hospital capacity to handle a surge in COVID‑19 and
influenza patients;
- $284 million
to address surgical and diagnostic backlogs by supporting extended hours
for additional priority surgeries and diagnostic imaging;
- $572 million
to support hospitals facing additional costs related to responding to
COVID‑19;
- $367 million
for wage enhancements for personal support workers (PSWs) and direct
support workers in home and community care, long-term care, public
hospitals and the social services sector. Investments will help attract
and retain professionals to care for patients, clients and residents in
response to COVID‑19; and
- $200 million
for the procurement of personal protective equipment (PPE) and critical
supplies to protect health care workers, patients, and frontline staff in
other sectors.
The government reports that
hospital funding will be up $2.5 billion this year (well over 10%). That is
likely the biggest dollar increase ever (although not the biggest percentage
increase – Harris increased it 12% in one year when he overcame his
anti-hospital bias). Of course, most of the increase is for COVID,
so it won’t stay around.
Following the Budget, the Ontario Hospital Association identified the need for more funding this year due to COVID-related revenue shortfalls and extra expenses: “The hospital sector is facing a potential forecast deficit of at least $2 billion in 20/21, primarily a result of their role in fighting the pandemic. Yesterday's Budget directly acknowledges the significant financial pressure facing hospitals and reaffirms the government's commitment to supporting them and stabilizing their financial position through the remainder of this fiscal year”.
More funding is needed this year to offset COVID-related issues -- $2 billion would be a big deficit for hospitals, requiring major cuts in the future.
Privatization of hospital services: The Budget further confirms government plans to place hospital beds in “alternate health facilities”:
The Ontario government is proceeding with its $2.8 billion COVID‑19 Fall Preparedness Plan by investing
$116.5 million to add up to 766 additional beds in hospitals and alternate health facilities
across the province. Making more beds available will help reduce surgical
backlogs and improve access to care during COVID‑19. This is in addition to the 139
critical care beds and 1,349 hospital beds already announced as part of the
Fall Preparedness Plan, bringing the total new beds to more than 2,250 in
hospitals and alternate
health facilities across the province. Beds are being added across the
province to help address the surgical backlog and ensure hospitals have enough
beds to treat severe COVID‑19 patients, particularly in COVID‑19 hot spots. Beds are also being added to transition alternate
level of care patients from the hospital to transitional health care settings,
which will help alleviate the capacity pressure in hospitals. That is why the
government is investing $351 million to add more than 2,250 beds across the
province in response to the COVID‑19 outbreak.
This deepens longstanding attempts by government to narrow hospital work to acute care and remove other work to lower paying and less unionized settings. The recently passed Bill 175 allows home and community care employers to take over hospital work in various ways, including by establishing residential congregate care settings.
No doubt the intention is for many of these alternate health facilities to be for-profit. The Ottawa Citizen has just reported a story of a new "alternate health facility" at a retirement home managed by a for-profit home care corporation that is taking over hospital work through a $14 million deal. The government intends to “solve” the hospital capacity crisis by removing services from hospitals and putting them in settings with less care and lower wages. This ain’t good.
LTC: Despite the government's recent promises to increase nursing and personal care to four worked hours per resident per day in long-term care, it appears there is no new money for LTC staffing this year, other than changes related to COVID. Here’s what they say about how they have spent new LTC COVID money:
“The government is working to ensure that loved ones in long-term care are protected as COVID‑19 continues to unfold. In addition to the $243 million in support immediately provided to long-term care homes in March for emergency capacity and virus containment measures, the government is providing close to an additional $540 million in new funding to protect residents, caregivers and staff in long-term care homes from future surges of COVID‑19, for a total of $783 million. This includes:
- $405 million to help homes continue prevention and containment of COVID‑19 including enhanced screening, staffing supports and purchasing additional supplies and PPE
- $61.4 million for minor capital repairs and renovations in homes to improve infection prevention and control;$40 million to help stabilize the homes as they transition to lower occupancy rooms, to stop admissions of third and fourth residents to larger rooms;
- $30 million to allow long-term care homes to hire more infection prevention and control staff and train new and existing staff; and
- $2.8 million to extend the High Wage Transition Fund to ensure that gaps in long-term care staffing can continue to be addressed during COVID‑19.”
Presumably, this is in addition to the standard increase to the MLTC line item. That increase was a very modest $113.8 million or 2.6%.
Notably, they do not break down a forecast for MLTC funding in the years ahead, so we do not know what sort of funding they plan for the staffing increases in 2021/22 and 2022/23, if any. The cost should be in the range of $350 million per year if done over four equal steps (not counting the new beds they keep promising).
Instead of a staffing increase, the government is now pushing to hire “Resident Support Aides” in LTC. These would be workers with less training than PSWs who would assist with activities of daily living. The government says this is for the COVID period. No doubt their intention is to pay them less than PSWs. The government has promised the 4 hours of worked care will not include such new categories of workers, but instead will be restricted to nurses and PSWs. We will see.
They are increasing the funding for construction of LTC beds, especially in large urban areas (where the cost of land has sky-rocketed).
This is a fat increase for the corporations involved in LTC. The government is determined, it seems, to pay a lot of money to for-profit corporations so they can own land and facilities, rather than the public.
Debt, Deficit, and the Reeling Economy
Total funding is up from $164.8 billion last year (actual) to $187 billion budgeted this year. That would be an increase of a whopping $22.2 billion, or 13.5%. Approximately 41% of that is for health care and LTC. None of the increase is due to increased debt charges (which are budgeted to remain at $12.5 billion).
I had thought this Budget would report a significantly lower deficit than their earlier plans reported, as it appeared they were not going to spend their special funds. But no, the deficit is still reported at a whopping $38.5 billion. I still expect this to go down somewhat as they continue to report on this fiscal year (in the spring Budget and the fall Public Accounts). Even so, we are in for some eye-watering increases in deficit and debt levels.
The government continues to
forecast that we will not get back to 2019 GDP levels until 2022, and
will then return in 2023 to the low level of growth that capitalism seems to
deliver these days.
Under their main forecast, tax revenue will not return to 2019/20 levels until 2022/3. (Note the “increase” in health care funding in this chart is deceptive as the special funds -- which are reported in a separate line item -- are being cut, leaving an overall decline in health care funding in 2021/22 and 2022/23, as noted earlier.)
On top of all this, the government is also reducing electricity costs for business, "saving medium-size and larger industrial and commercial employers about 14 and 16 per cent respectively, on average, on their electricity bills (at an additional expense of $1.3 billion over three years)."
This tips the government's hand about how they will deal with the fat structural deficit that will remain after COVID. They will oppose tax and revenue increases on the wealthy and corporations and in fact are more likely to cut their taxes and other costs further.
Money for business, restraint for workers: In sharp contrast to the largesse afforded business, government plans to cap broader public sector wage increase at 1%, likely a real wage cut.
The Budget claims in passing (table 3.7) that each 1% change in employee compensation leads to $995 million in extra expense. In other words, “employee expense” for the provincial government is about $99.5 billion per year. So reducing settlements from (say) 1.75% (which would almost keep workers wages level with inflation) to 1% should save them about $750 million. That will almost pay for the business tax cuts discussed above.
It is also fairly small change in the scope of a $180 billion annual budget – about 0.4%. (Of course, it would grow over three years - -to $2.25 billion or about 1.25% of the annual Budget.)
By way of comparison, over half way through the fiscal year, the government still has a $2.912 billion operating contingency fund for unexpected spending (and another $99.3 million for capital contingency). This is a larger than usual contingency fund - -but even smaller contingency funds (say $1 billion) are often not spent. I wouldn’t be surprised if this year’s contingency funds are not spent (we will know for sure when the Public Accounts are released at the end of September). $2.912 billion is almost four times the size of $750 million.
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