What to watch for as Canada's premiers meet in Victoria

It's been three years since what used to be a staple of the political calendar theannual summer premiers' gathering was held in person.

As the Council of the Federation reconvenes, Canada's premiers are packing a lot of familiar baggage, particularly when it comes to their demands of the federal government.

After meeting frequently sometimes weekly or biweekly earlier in the pandemic, the premiersnow feel"ghosted" by Ottawa, B.C. PremierJohn Horgan, the chair and host of this year's gathering, told CBC Radio's The House on the weekend.

It's unclear what might be delivered between now and Tuesday night, since only one side of the federal-provincial table is gathering in Victoria. Nevertheless, here's what's on premiers' minds.

Health care

It was already the biggest expenditure in premiers' budgets and an oft-cited top priority for voters. ThenCOVID-19put unprecedented stress on health infrastructure that advocates warned wasn't up to code even before the pandemic.

"When you look at our health-care system compared to other, comparable countries, it's been deteriorating in terms of the quality of care and the timeliness of care over a long period of time," Canadian Medical Association president Katharine Smarttold CBC's The Currentlast week. "That's not only about dollars. That's about failing to modernize the system."

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In many ways, Canada's health-care system has not been modernized since the 1960s, says Canadian Medical Association president Dr. Katharine Smart. She's urging Canada's premiers to address these 'structural issues' at their annual meeting in Victoria this week.

Still, it's the dollars premiers were talking about before travelling to Victoria. They remindedCanadians, yet again, that the federal share of health-care spending (22 per cent, they calculate) is nowhere near where it used to be (35 per cent) or needs tobe (as much as the 50 per cent it once was, as Alberta's Jason Kenneyand Manitoba's Heather Stefanson have toldus).

So they'reasking Ottawa, yet again, to sit down and negotiate larger Canada Health Transfer payments.

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Canada's premiers are set to meet this week for the first time in person since 2019. Health care is expected to be one of the top items on the agenda, with hospitals in parts of the country struggling with major staffing shortages.

It's not that Justin Trudeau's Liberal government doesn't agree that more health-care funding is necessary, although officials take issue with the 22 per cent calculation, arguing the premiers' math ignores their revenue from federal tax points transferred to theprovinces since 1997.

While both sides call for a more"adult conversation" on health-care funding in place of a"sterile" debate on percentages that now resembles a stalemate, the premiers' request last fall for an urgent first ministers' meeting on health carewas rebuffed.

Why? Provincial elections in Ontario (this spring)and soon,Quebec (this fall), apparently made for difficult political timing in Ottawa's eyes, even though last winter's supply and confidence agreement with thefederal NDPhas presumably given Trudeau's Liberals more spaceto work something out without fear of a writ period of their own.

As chair, Horgan(a New Democrat)along with Newfoundland and Labrador Premier Andrew Furey (a Liberal) and Saskatchewan Premier Scott Moe (representing more conservative premiers), have been tryingto engage Trudeau in what they say is a non-partisan way. But it hasn't worked.

"As the kids say, we've been ghosted by the federal government," Horgan said. "I know the prime minister is committed to this, but it's a matter of timing and tick-tock goes the clock, as far as I'm concerned."

Federal Health Minister Jean-Yves Duclosannounced $2 billion to help with surgical backlogs last March. But last spring's federal budget didn't havea large, permanentandnon-specificboost to health transfers on itsshort-term horizon.

In Ottawa's defence, some provinces have sparkedskepticismthat additional federal health transfers wouldbeused for their intended purposes. Last month, Alberta's auditor general found it couldn't properly account for how billions in COVID funding was spent.Ontario's Financial Accountability Office reportedlast fallthat Doug Ford's government didn't immediately spend billions transferred for urgent COVIDneeds.New Brunswick used federal COVID transfers to pad its provincial surplus.

Horganseems to understand that repeating another requestfor unconditional transfers would bea non-starter.

"This is not about blank cheques,this is not about no-strings-attached," he told The House."We need to work on what those accountability mechanisms will be."

Beyond funding, it'sunclear whether any other kinds of health-care innovations are on the agenda in Victoria.

Smart, for example, has argued for national, not provincial, licensing for health-care professionals, to improve interprovincial mobility for a workforce desperately in demandand making it easier to scale upvirtual health-care delivery across jurisdictions. Premiers like Horgan aren't keen, arguing that their provincial budgets funded thetraining of these professionals and they can't risk losing them if licensing barriers are removed.

Pharmacare

Prescription drug expenditures are a major component of health-care costs, but they've been broken off into a separate political conversation.

At past summer premiers' meetings, agreementswere hammered out to collaborate on bulk purchasing of medicines to wrestle these costs down. That work continues.

But more recently, pharmacare has become a federal file, with the Trudeau government first appointing a former Ontario health minister to study how a national drug plan could be implementedand the federal NDP demanding serious progress towardthis goalas a condition for its ongoing support in the House of Commons.

If a federal universal drug insurance plan ever cameto fruition, it could not only allow for more equal coverage for Canadians no matter where they live, but also let provinces that already provide a lot of provincial drug coverage to reallocate that money in their respective health budgets. So why aren't all the premiers leaning in?

Similar to the $10-a-day federal child-care proposal, it could help each jurisdiction, but differently, based on what they already offer. Because of these potential redundancies, implementing what may seemlike a simple idea becomescomplex.

Interprovincial trade barriers

This past Canada Day marked five years since thecountry's interprovincial "free trade" deal took effect. So why do business groups still complain about interprovincial barriers costing Canada billions in lost productivity and economic growth?

In its recent report card, the Canadian Federation of Independent Businesses found a lot of work remains, with many "F" grades awarded for a lack of progress on specific barriers,like mutual recognition of credentials or theharmonization of business regulations and registrations.

Past summer premiers' meetings have featured specific headline-grabbing but incremental announcements about "freeing the beer" or "freeing the grapes" (wine), notwithstandinga 2018Supreme Court decision that allows provinces to continue to restrict interprovincial alcohol trade.

Some premiers have liberalized a lot,andothers might bewilling to liberalizemore, but there's never beenunanimity around the table, particularly among premiers whorepresent remote Northern communities with high rates of alcohol-related health and social challenges.

Sovereignty, Part 1: immigration

In a scrum with reporters last week, Scott Moe openly mused about the need for Saskatchewan to "use up the full scope of autonomy that we have" and follow Quebec's lead in seeking more powers to regulateimmigration. Moe argued that he needs more newcomersto pursue the economic growth agenda he wants for his province in this tight labour market.

By week's end, Ontario Premier Doug Ford was also talking about "historic labour shortages," with his labour minister saying thousands of jobs gounfilled and that it'surgentforthe business community to add more skilled workers in particular. Federal immigration allocations are inadequate, Ontario is arguing, so it needs to be free to do something about it.

CouldQuebec Premier Franois Legaultoffer some tips in Victoria for seeking more independence? Maybe, but the federal government may be reluctant to enable it. Less restrictive immigration policies could exacerbateinequities: it could be hard for less-popular regions to attract skilled workersand investors if wealthier provinces fling opentheir doors.

Sovereignty, Part 2: energy

Moe also told reporters he wants to focus on energy security this week.

The war in Ukraine has disruptedglobal markets and created new demand for not only Canadian oil and gas exports, but uranium and other critical minerals.

Framing thiseconomic opportunity in "energy security" terms also countersthe federal government's climate change objective of gradually weaning Canada off its dependence on fossil fuel exports and keeping its international commitments to cut carbon emissions.

The Alberta government issued a press releaseThursday touting how all nine provinces have signed on as intervenors in the upcoming Supreme Court case on the constitutionality of C-69, which Jason Kenney's government has dubbed the "No More PipelinesAct" for what it says are changes to the federal impact assessment process that threaten the future of Alberta's economy.

Just like the recent provincial challenge to the federal carbon tax, the Alberta Court of Appeal found C-69 unconstitutional, but legal experts aren't sure the Supreme Court will agree. Inthe meantime, this latest legal fight appears to have united the premiers on the need to push back.

New faces, lame ducks and powerfulincumbents

This year's talks will feature new faces, like Nova Scotia's Tim Houston and Manitoba'sStefanson. The former is coming up on his first anniversary in office, and the latter will find out next yearif voters want to keep her party in power.

Doug Ford may return to the table with some swagger after winning another majority in Ontario last month. Legault, who posed with Ford for the cameras on Sunday night, is tracking towarda potentially even moreresounding re-election this fall.

This week will be a swan song for not only chairHorgan, who hasannounced he won't run again, but fellow lame-duck Premier Kenney, whose party showedhimthe door in May.

After a period of suits-only visuals, the premiers' annual photo call will include a couple of women again: not only Stefanson, but Caroline Cochrane from the Northwest Territories.

Talks begin Monday morning asthey havein the past hearing from representatives ofCanada's national Indigenous organizations.

The Assembly of First Nations will be represented by its B.C. regional chief, Terry Teegee, while Elmer St. Pierre, national chief of the Congress of Aboriginal Peoples, will also attend. Inuit Tapiriit Kanatamiwill not be present this year, but Mtis National Council President Cassidy Caron will attend, as well asa regional representative of the Native Women's Association of Canada.