The Canadian Dental Care Plan has been touted as a long overdue way to ensure Canadians’ access to critical dental care.
But the program is not for everyone.
Eligibility is based on a family’s income. This means someone could be deemed ineligible for dental care because of their spouse or common-law partner’s income, creating a so-called “marriage penalty.”
Experts say this penalty is not necessarily problematic — and would be difficult to change.
“I think you would have your work cut out for you to show that this is discriminatory versus just reflecting the fact that when you’re in a spousal relationship, there’s going to be some pooling of resources,” said Kerri Froc, a law professor at the University of New Brunswick.
Sharing resources
Ottawa launched the Canadian Dental Care Plan to different groups in stages, beginning in May 2024. Starting June 1 of this year, all Canadians without dental insurance and with annual family incomes less than $90,000 became eligible.
As of May, just over four million individuals had been approved for the program.
If a family’s household income is less than $70,000, and they do not have private dental coverage, they are fully covered. If they make between $70,000 and $90,000, they receive partial coverage.
These eligibility rules functionally penalize individuals who are married or in common-law relationships.
For example, two single individuals each earning $50,000 would qualify for dental care. If they were to marry, both would lose their coverage.
The rules can also create a disincentive to increase one’s income, if a pay bump were to push the individual — or household — over the $90,000 threshold.
“The assumption is [if your household earns] more than $90,000 you can afford your dental care — I mean, that’s what [the policy] is kind of saying,” said John Stapleton, a policy analyst in Ontario.
The Canadian Dental Care Plan is a “residual benefit that only covers people based on need,” Jennifer Robson, a political management professor at Carleton University, told Canadian Affairs in an email.
“So, it adopts that frame where members of the family are expected to be sharing resources. That’s how the NDP designed it in collaboration with the government.”
Family income is used to determine eligibility for a number of government programs, including the Canada Child Benefit, the HST/GST rebate and Guaranteed Income Supplement for low-income seniors.
These programs assume both people in a couple share money and make decisions about how to use it, says Robson.
Programs that base eligibility on an individual’s income are “less frequent,” she wrote. Old Age Security, for example, looks only at an individual’s income.
Benefits that use family income for eligibility are “great if both people are poor,” said Stapleton, because it means both partners will qualify.
Stapleton doubts people will avoid marriage or common-law relationships to keep their dental coverage.
“I don’t think you’d decide to be a single or a couple based on what you’re going to get for dental,” he said. “What you may do is decide to get some expensive dental work done first and then become an item.”
Determining discrimination
Legal experts say it would be very difficult to successfully challenge the Canadian Dental Care Plan for discriminating against couples on the basis of their family status.
“Many government benefits look at family income, everything from social assistance to … the child tax benefit,” said Froc, of the University of New Brunswick. “Whole benefits and taxation systems are premised on that. That’s a big thing for a court to take on.”
Froc, who is an expert in constitutional law, says it is “an open question as to whether family status is even protected [under the Charter].”
Many provincial human rights codes prohibit discrimination on the basis of family and marital status. The Supreme Court of Canada has yet to make a similar determination about family status, she says.
An individual would also have to show that treating single individuals and couples differently is based on stereotypes or prejudice, and that it perpetuates a disadvantage, says Froc.
“The government would simply say it’s not prejudice or stereotype to say if you’re in a spousal relationship with someone that you have access to more than your own income,” she said.
It may be more effective to argue that assuming couples pool their resources discriminates against certain types of families, she says. She gave the example of two seniors who remarry but keep their finances separate.
Or, a case could be made that family income eligibility tests discriminate against women, because they do not always have access to the total family income, especially in abusive relationships, Froc says.
The assumption that couples share resources equally is “not reflective of reality for a number of people within those relationships,” she said.
She hopes this question gets studied in the future. “It’s something that is worth looking at in the bigger picture,” she said.
Means testing?
Some critics argue income tests contradict the purpose of public health care.
“Means testing, on the basis of principle, is concerning,” said Steven Staples, national director at the Canadian Health Coalition, an advocacy organization dedicated to improving public health care.
“It shouldn’t matter how much you earn [to receive health care],” he said. “It should be a part of living here in Canada, being part of our society, of our community, and that everybody is accorded the same benefits.”
He also noted that $90,000 is a relatively low income for a couple.
In an interview with Canadian Affairs in June, the federal government defended using family income to determine eligibility for the dental plan.
Limiting who is eligible for the Canadian Dental Care Plan ensures people in the most need get it, says Lindy Vanamburg, director general of the Oral Health Branch at Health Canada.
“I’ve had people say to me in the past, ‘You should look at income differently’,” said Vanamburg.
“For adults with disabilities, they have different costs, or if you have children, or if you have a stay-at-home parent, or any number of variations — but there are none of those exceptions in the plan now, and I’ve not had any direction to explore any of those changes,” she said.
Thank you for this thoughtful and well-researched perspective. I would only add that, if dental care were extended to all income groups, many more private insurance companies would drop dental from their coverage packages. Canadian Affairs covered that trend last year. Private health insurance premiums might go down, but insurance company profits would also go up. The federal deficit would increase.