Hon. Tony Loffreda: Honourable senators, I rise to speak to Bill C-31, the government’s proposed cost of living relief act No. 2, which offers targeted support for lower- and moderate-income households in a time of high inflation.

I want to start by congratulating and thanking Senator Yussuff for such an insightful and emotional personal speech. Thank you very much.

Part 1 of Bill C-31 proposes a tax-free dental care benefit for parents with children under the age of 12 whose household income is below $90,000 and who do not have access to dental insurance. In Part 2 of the bill, it authorizes a one-time rental housing benefit for eligible applicants who paid rent on their principal residence in 2022.

[Translation]

It was an honour for me to study this bill at the Standing Senate Committee on National Finance. For our work we held four meetings with witnesses. Twenty-five witnesses appeared, including public officials, the Parliamentary Budget Officer, and representatives from dental associations and the housing sector. We also had the privilege of receiving three ministers.

Today I will take a few moments to address four topics that were explored during our meetings.

[English]

The first issue I want to address is inflation. In my view, the sums being injected into the economy with Bill C-31 should not have a noticeable impact on inflation. I spoke about this during my second reading speech on Bill C-30, the GST tax rebate, and I stand by those comments.

The Parliamentary Budget Officer, or PBO, estimates that the dental benefit will cost $703 million, while the cost of the one‑time top-up to the Canada housing benefit program will increase federal spending by $940 million. In a $2.8 trillion economy, the injection of an addition $1.6 billion is nominal.

As I said a few weeks ago, the doubling of the GST tax rebate in Bill C-30 along with the measures in Bill C-31 amount to 0.1% of Canada’s GDP in additional costs. This amount is not insignificant, but it is a fraction of the country’s GDP.

I appreciate these measures increase government spending at a time when fiscal restraint is needed. However, I think the dental benefit could unclog our emergency rooms, and end up being a cost-saving investment. Our committee was told that 1% of emergency room visits made by patients with non-urgent dental conditions cost the health care system an estimated $1.8 billion in 2017.

Not only will this benefit help our youth access proper dental care, but I hope it will have the added benefit of encouraging better overall oral health and prevention. We know that more than one in five Canadians avoided dental care because of cost. This interim benefit is expected to allow some half a million children to finally have access to basic dental services.

[Translation]

As Senator Mégie put it so well, when it comes to health, an ounce of prevention is worth a pound of cure. Lynne Tomson, Assistant Deputy Minister at Health Canada, also stressed the importance of prevention, which, over time, would result in significant savings. Prevention and early intervention will also be less expensive to the system as a whole. Moreover, Minister Duclos recognizes that putting off or completely avoiding dental care can have serious consequences for people’s health.

This in turn can increase the public’s dependence on costly sectors such as cardiology, cancer and emergency services.

[English]

The second issue I want to address is the displacement risk. In other words, will this publicly funded dental benefit encourage employers to cancel or reduce dental coverage for their employees? It is an important question that cannot be glossed over.

[Translation]

Last week, I met with representatives of the Canadian Life and Health Insurance Association, which shares my concerns about a risk of displacement. Consider the following statistics: In 2021, personal insurers in Canada provided coverage for more than 29 million insured and paid out more than $30 billon in extended health benefits, including $9.5 billion for dental care.

The association is concerned, as am I, that employers will opt to reduce or cancel their coverage, given that the state is prepared to intervene. It would not be prudent to transfer these amounts of money to the public. Naturally, this issue will have to be resolved when the government undertakes to enhance the current dental benefit or create a permanent program.

[English]

Health Canada explained that it does not anticipate a displacement at this time, but acknowledged that it is an element of concern that will be taken into consideration as it designs the longer term program.

I strongly encourage the government to consider ways of incentivizing businesses to keep their current coverage. It is not realistic to penalize corporations for dropping plans. Incentivizing is the way to go.

The third point I want to discuss is the labour shortages in the industry. Naturally, the expectation is that the dental benefit will finally allow some of our kids to receive proper dental care. I’m sure this is a huge relief for many parents who are unable to afford dental fees. I hope these kids will soon book their appointments and get the care they deserve.

But will the industry be able to manage an influx of new patients? The short answer is yes. But it will not necessarily be easy. Human resource challenges also exist in the sector, especially with respect to dental hygienists and dental assistants.

Dr. Lynn Tomkins, President of the Canadian Dental Association, assured our committee that there is not a shortage of dentists. Rather, there is a distribution issue. The association would like to see more young dentists going to remote and rural areas. But as she said, “We will deal with the influx of new patients that come in.”

I’m also reassured that within the definitions in the bill, “dental care services” means the service that a dentist, denturist or dental hygienist is lawfully entitled to provide. Ondina Love, CEO of the Canadian Dental Hygienists Association, reminded our committee that her industry counts over 30,000 hygienists among its ranks, and that they offer care in innovative ways such as stand-alone clinics, community clinics, daycares, schools and mobile settings.

Unfortunately, while dental hygienists are captured in the bill, the 10 dental schools across the country are not. Dr. Walter Siqueira, Dean of the College of Dentistry at the University of Saskatchewan, who also serves as President of the Association of Canadian Faculties of Dentistry, feels they have been left out.

Dental schools see around 350,000 patient visits per year, and they could help with the increase in new patients. He explained, for example, that “In the north of Saskatchewan, basically 80% of dental care is provided by our dental school clinics.”

Dental schools already have a network of clinics and programs tailored to the people Bill C-31 targets. As he told us, with the proper support, dental schools could double the number of patients they see since they are well placed to become a core element of a much larger network of community and institutional clinics for the provision of dental care to those most in need.

It is clear that the government must collaborate with the schools as it expands and elaborates the permanent program. Minister Duclos appears to be open to engaging with them.

[Translation]

Finally, the last issue I want to address is the permanent dental program that the government is looking to establish. As a reminder, the government’s 2022 Budget sets out an investment of $5.3 billion over five years. The government is proposing that the benefit, which we are currently studying, would initially cover those under the age of 12. The intention is to then extend the benefit to those under 18, seniors and persons with disabilities in 2023. Finally, full implementation of a new permanent plan is slated for 2025.

[English]

As the government undertakes the study, development and implementation of a permanent program, a few issues deserve further consideration. Data collection will be key in assessing the success of the temporary benefit.

The government will have to evaluate the uptake rate, identify who benefits from this subsidy, identify any gaps and measure to what extent the amount of the benefit is in line with the cost of dental care. This may be difficult to accomplish, and there are certainly some privacy considerations. However, this is something that should be considered before we implement a more robust and hopefully data-driven, longer-term program.

Minister Duclos assured us in committee that his department will monitor health and other outcomes, and improve the benefits as required. Health Canada also confirmed that it will be receiving statistics from Canada Revenue Agency to see what the uptake is by province.

The Canadian Dental Hygienists Association also calls upon the government to measure access to dental care and the provision of oral health and dental care services to determine the return on investment of this newly implemented dental care program.

Dr. Siqueira strongly believes in the value of data too. Here’s what he wrote to Minister Duclos:

As the government develops and rolls out various elements of this new national dental program, researchers in dental schools can evaluate the outcomes and provide information to make changes where necessary.

With the cost of living increasing at a rapid pace, the government should also monitor any potential increase in dental fees.

Some concerns were raised in committee about the possibility of fee hikes. While legitimate, I personally don’t expect any increases. Like the Parliamentary Budget Officer said, in fact, that the bill is targeted to specific segments of the Canadian population, it lessens the impact of undue profit-taking.

Dr. James Taylor, Chief Dental Officer with the Public Health Agency of Canada, also believes that if fees do go up, it would be due to cost of labour, cost of materials and not simply supply and demand.

In a follow-up written submission, the Canadian Dental Association provided information on the average treatment cost per visit. The association informed us that:

The median claim per visits for a patient under the age of 12 was $150. Half of all claims fell between $92 and $233 [and] overall, 95.6% of all claims submitted were less than $650.

As we know, applicants with an income of less than $70,000 are eligible for a yearly dental benefit of $650. Those who make between $70,000 and $80,000 are eligible for $390, and those who make between $80,000 and $90,000 are eligible for $260.

Some argue that the dental benefit is not generous enough. I, too, was concerned that $650 per year may not be sufficient for basic dental care. However, now that we have received these figures, I’m reassured. Of course, it won’t be enough for everyone, but it’s a great start. Let us not lose sight of what this is: an interim benefit, a starting point.

The Canada Revenue Agency should also try to monitor that the funds it distributes are being used for their intended purposes, since eligible applicants can receive the benefit before their kids receive dental care. As I often say, trust is the currency of every relationship. I trust that parents will use these funds for the health and well-being of their kids.

We were reminded by Senator Yussuff that the CRA:

. . . is also well equipped to guard against fraud and ensure the program is being accessed as intended.

The CRA will take steps to implement additional verification and security measures up front . . . .

But this is certainly something that needs to be monitored.

In conclusion, honourable senators, Bill C-31 is a good bill. I feel it is appropriate at this time for the government to invest in Canadians who are struggling the most to make ends meet, particularly for two basic human needs: shelter and health care.

I will vote in favour of Bill C-31, but I believe the hard work is still to come. Implementing a permanent dental program will be a huge undertaking.

If the government is to pursue this initiative, it will have to consult widely, budget accordingly and legislate a program that has all the accountability and transparency measures needed to ensure its success. When the time comes, I’m confident the Senate will be ready and willing to take the necessary time to review any future dental program.

Thank you, meegwetch.