Letter to Ontario's Advisory Committee on Portable Benefits

Sent by email to [email protected] on December 15, 2022.

Dear Committee members,

The Decent Work and Health Network is an organisation of health providers, public health professionals, and health policy experts. Our province-wide network advocates for improved working conditions as a means to achieve better health outcomes, and has been doing so since 2014. We are writing today to bring attention to the existing gaps in health equity for workers in Ontario, which includes access to benefits.

Our network shares the panel’s concerns that the rise of precarious work has put the health of workers at risk. Our patients in part-time, temporary, casual, and app-based work are often denied access to benefits while facing a higher risk of exposure to injury and illnesses.

As health workers who see the daily impacts of precarious work on our patients’ health, we have repeatedly presented evidence-based recommendations both to the public and to policy makers to effectively address the upstream factors of poor health. We believe that a portable benefits program will further entrench precarity by creating a substandard classification of workers without access to basic employment standards.

That is why the most effective policy to address precarious work is not a portable benefits program but to:

1. End Misclassification

With the growth of the gig economy, many employers misclassify employees as independent contractors and deny basic employment standards like minimum wage, regular hours, or paid sick days - all of which undermines health and equity.

Misclassification of employees as independent contractors, are associated with higher rates of physical and mental illness, higher rates of workplace injuries and infections, and higher mortality rates. Workers in the gig economy have increased vulnerability to lack of occupational health protections. A portable benefits program does not address these underlying health equity issues. Instead, ending misclassification, as has been done for workers in many jurisdictions like California, France, the Netherlands, the UK, and Spain, is a far better approach. Unfortunately, in the case of California, no sooner had the ground breaking legislation passed, then app-based employers like Uber spent hundreds of millions of dollars to carve delivery drivers and ride-share workers out of the legislation that would have protected them.

In Ontario, the Gig Workers' Bill of Rights provides the best pathway to protect workers and end the employer practice of misclassifying platform-based workers. 

Ending misclassification would ensure that workers in precarious employment have access to full labour rights. This can be done by presuming workers are employees unless the employer can prove otherwise through the ABC test.

2. Equal Pay for Equal Work

Temporary, part-time, and contract work are associated with increased psychological stress from chronic job insecurity, increased risk of occupational injury, and increased risk for working while sick due to a fear of job loss. Data shows that those who work part-time are less likely to have access to prescription medication and that this disproportionately impacts newcomers, younger workers and racialized individuals. To achieve good health, all Ontarians need access to prescription medications without financial barriers. This means ensuring equal pay and benefits for all workers, regardless of hours of work or type of contract.

3. Implement Universal Public Healthcare Programs

As the complexity of acute and chronic diseases has grown, current universal health coverage is no longer adequate to keep Ontarians healthy. More than one in five Canadian households still have trouble filling prescriptions because of cost, and nearly a million are cutting back on food or home heating costs just to pay for the prescription drugs. Workers across all industries are less likely to have access to benefits, due to an increase in temporary and contract work, changing jobs more frequently than in the past, and having multiple jobs at once.

However, a portable benefits scheme is no more than a ‘fill-the-gaps’ approach to health coverage, and would not adequately support workers nor employers. For example, a hybrid ‘fill-the-gaps’ approach to prescription drug coverage was attempted in Quebec in 1997. It required residents to have drug coverage either through a private plan sponsored by their employer or professional association, or through a public plan. This ‘patch-work’ approach did little to address underlying structural problems with drug costs and as a result, costs for medications are now 75% more per person compared to countries with universal public pharmacare. Costs in Quebec have disproportionately risen for households and employers.

Countless reports, including a special advisory council to the federal government, have since recommended a universal public pharmacare program as a more cost-effective and equitable alternative. All Ontarians, in particular those in precarious employment, would benefit with such a program for drug coverage. There also exists countless age-tested or means-tested programs in Ontario for physiotherapy, dental care, optometry and other areas outside of medicare. Rather than creating a portable benefits program, an expansion of such programs towards an eventual goal of universality would avoid the administrative complexity of introducing yet another barrier of eligibility. The Ontario government can leverage recent federal interest in the expansion of dental and prescription drug coverage to accelerate this process. A universal health program would provide more efficient, equitable and effective solutions.

Ultimately, legislated protections for workers would go a long way to address upstream factors of poor health.

As the leading voice in the media and with policy makers on critical health equity policy and workplace protections, we look forward to discussing this with you further.

Sincerely, 

Sarah Shahid
Coordinator, Decent Work and Health Network

Dr. Danyaal Raza
Family Physician, Unity Health Toronto
Assistant Professor, Department of Family & Community Medicine, University of Toronto

On behalf of the Decent Work and Health Network