"They would never do it to parents who were not racialized and were not immigrants": Denial of newborn health coverage registration as a bordering practice


Monica Gagnon, University of Toronto

Recent Canadian immigration policy has led to an increase in the number of people living in Canada with precarious immigration status, who are disproportionately racialized as non-White, often lack health insurance, and experience discrimination in health care settings. In Ontario, health policy requires that coverage be provided to newborns even if the parents are not covered under the Ontario Health Insurance Plan (OHIP). A parent does not need to have an authorized immigration status in Canada for the baby to be eligible for OHIP as long as their primary place of residence is Ontario. Problematically, despite the fact that newborn citizen residents of the province are immediately eligible for health coverage, this policy is not consistently upheld in Ontario birthing hospitals. I used the concept of bordering to examine how people deemed outsiders to Canada are socially excluded within this health care context. Bordering practices filter people according to who is perceived to belong or not to belong, determining who is included or excluded, who is entitled or unentitled, and who is deserving or undeserving. I analyzed health policy documents and conducted interviews with health care providers, administrators, and researchers about processes of, and negotiations around, denial of OHIP registration. I found that newborns who meet OHIP eligibility requirements may be denied registration in Ontario hospitals due to gaps in provincial policy, restrictive institutional policies, or assessments of deservingness by frontline staff that are based on the parents’ immigration or insurance status. When a parent is without OHIP coverage, questions are raised about their child’s entitlement to OHIP. Hospital OHIP denials make it harder for a newborn to get health care, and some may end up going without coverage indefinitely. I theorize denial of OHIP registration to babies born in Ontario hospitals, and policies that allow for inconsistent application within and across hospitals, as bordering practices that allow gatekeepers to control access to membership and citizenship, differentiating between “us” and “them.” I show how bordering in Ontario health care happens at both the policy and administrative levels and I identify four mechanisms for how it is practiced at each level: omission, devolution, obfuscation, and intimidation. These mechanisms are sometimes practiced independently and sometimes overlap. In omission, the issue is not addressed, or no directive is provided. In devolution, power over decision-making is pushed to lower levels. In obfuscation, the policy is not clearly communicated or the source of the discrimination is obscured. In intimidation, a culture of fear is created, discouraging questioning or resistance. The negative effects of bordering practices in health care are evident in lack of health coverage for eligible newborns, arbitrary barriers to care, undue strain on uninsured parents and their advocates, discrimination and racial profiling in the health care system, stymied advocacy efforts, and the creation of tiers of citizenship. Ultimately, my research argues that unjust denial of access to health coverage threatens the realization of the right to health, marginalizing people deemed to be outsiders. In the context of increasing immigration to Canada, ensuring that the right to health of immigrants with precarious status is not undermined is of utmost importance.

This paper will be presented at the following session: