Open letter: 20+ organizations urge Ottawa to act on Alberta’s two-tier law
The Canadian Health Coalition is among 23 national and provincial health and labour organizations that have endorsed an open letter sent by Canadian Doctors for Medicare to Prime Minister Carney and Health Minister Marjorie Michel, calling on the federal government to act on Alberta’s Health Statutes Amendment Act (No. 2), formerly known as Bill 11.
Read the full letter below, or download the letter here.
March 3, 2026
Sent to:
Prime Minister Mark Carney
Office of the Prime Minister
mark.carney@parl.gc.ca
Minister of Health Marjorie Michel
marjorie.michel@parl.gc.ca
Dear Prime Minister Carney,
We write to you out of deep concern regarding passage of Alberta’s Health Statutes Amendment Act, 2025 (No. 2), and the threat it poses not only to Alberta’s public health care system, but to the integrity of Medicare across Canada.
Canadians understand that provincial health systems are under genuine strain. We all share the goals of reducing wait times to improve access to timely care and of recruiting and retaining health care workers. We know that protecting and improving Medicare to enable healthy populations is a vital nation building project. However, Alberta’s Health Statutes Amendment Act, 2025 (No. 2) risks undermining these goals.
Instead, it proposes a system where patients face financial uncertainty and where timely access to care will inevitably depend on ability to pay. Alberta’s law abandons the foundational principles on which Canada’s health care system has been built, as enshrined in the Canada Health Act. By formally enabling physicians to accept both public and private payment (dual practice) and allowing patients to be billed for medically-necessary services, this legislation enables a multipayer, two-tier system of care that is confusing, inefficient, unfair, and expensive.
This shift is unprecedented in Canada. Since 1984, when the Canada Health Act was passed, Alberta, like all provinces and territories, has upheld a single-payer model grounded in equitable access to medically necessary care based on need, not ability to pay. The Health Statutes Amendment Act, 2025 (No. 2) represents a clear departure from that shared national commitment and raises grave concerns about Alberta’s compliance with the Canada Health Act.
International evidence (including that adduced at trial during Cambie Surgeries Corporation v. British Columbia) and Canadian experience consistently show that systems permitting dual practice incentivize health professionals to shift time and services toward higher-paying privately funded care. This shift would drain capacity from the publicly-funded services upon which the vast majority of patients rely, worsen access, undermine quality, and increase total system cost. Although the Government of Alberta has proposed minimum public-system hours for physicians and continued public funding for some core services, these measures do not address the deeper structural risks introduced by the legislation. The evidence is abundantly clear that parallel private payment systems have never reduced health care wait times for all patients. In fact, when other countries have moved towards a parallel private-pay system, overall wait times have increased.
We are deeply concerned that Alberta’s Health Statutes Amendment Act, 2025 (No. 2) will:
- Undermine equity by normalizing private payment for medically necessary care,
privileging those with financial means; - Risk contravening the Canada Health Act which exists to protect universality and
accessibility; - Exacerbate workforce shortages in the publicly-funded system by permitting physicians to split their practice between public pay and private pay sectors;
- Set a dangerous national precedent inviting similar legislation in other provinces thereby weakening Medicare across the country.
Beyond its domestic impacts, Alberta’s Health Statutes Amendment Act, 2025 (No. 2) raises uncertainty related to national treatment and market access obligations under the current CUSMA. If Alberta’s legislation opens a pathway to private duplicative insurance (covering the same medically necessary services as the publicly funded system) and for-profit investor-ownership of hospitals (delivering medically necessary care), we are concerned this could lead to US health insurance companies and hospital corporations expecting to enter Canada’s market. Notwithstanding the protections afforded by Canada’s sectoral reservations listed in CUSMA related to health care, if the US were denied entry to Canada’s market, we are concerned this could expose Canada to CUSMA’s investment and services disciplines.
As Prime Minister, you have a responsibility to uphold the Canada Health Act and protect equitable access to care for all Canadians, regardless of jurisdiction. We therefore call on your government to:
- Conduct a formal Canada Health Act compliance review of Alberta’s Health Statutes Amendment Act, 2025 (No. 2);
- Urge the Government of Alberta to pause implementation of Health Statutes
Amendment Act, 2025 (No. 2) while its impacts are assessed by Health Canada’s legal team and independent national experts; - Use the full range of federal tools available, including discretionary penalties permitted under the CHA.
Turning Medicare into a marketplace experiment risks destabilizing an essential service that is core to Canadian identity and to the health and well-being of everyone living in Canada. Health care is a public good and a moral commitment that defines Canada’s social contract. Canadians deserve reforms that strengthen Medicare, not policies that quietly erode it through profitization, privatization, and inequitable access.
The choices made now will shape the future of health care in Alberta and across Canada for generations. We urge your government to act quickly and decisively to protect one of our country’s most important collective achievements.
Yours sincerely,
Dr. Melanie Bechard
Chair, Canadian Doctors for Medicare
Signed and endorsed by:
Alberta Federation of Labour – Gil McGowan, President
Alberta Union of Provincial Employees – Sandra Azocar, President
BC Health Coalition – Ayendri Riddell, Director of Policy and Campaigns
Canadian Centre for Policy Alternatives – Peggy Nash, Executive Director
Canadian Federation of Medical Students – Bryce Bogie, President
Canadian Federation of Nurses Unions – Linda Silas, President
Canadian Health Coalition – Jason MacLean, Chair
Canadian Labour Congress – Bea Bruske, President
Canadian Union of Public Employees – Mark Hancock, President
Coalition Solidarité Santé – Geneviève Lamarche, coordonnatrice
Congress of Union Retirees of Canada – Micheal MacIsaac, President
Friends of Medicare – Chris Gallaway, Executive Director
Independent Voices for Safe & Effective Drugs – Colleen Fuller, Director
Manitoba Health Coalition – Noah Schulz, Provincial Director
Médecins québécois pour le régime public – Dr. Xavier Gauvreau, Président
National Union of Public and General Employees – Bert Blundon, President
New Brunswick Health Coalition – Jean-Claude Basque, Co-Chair
Nova Scotia Health Coalition – Jennifer Benoit, Provincial Coordinator
Ontario Health Coalition – Natalie Mehra, Executive Director
PEI Health Coalition – Mary Boyd, Chair
Registered Nurses Association of Ontario – Dr. Doris Grinspun, Chief Executive Officer
United Nurses of Alberta – Heather Smith, President
United Steelworkers – Marty Warren, National Director
