Originally published on the Breach on April 16th, 2026.
“This could end Canadian medicare as we know it.”
That’s the chilling conclusion of a recent report on Alberta’s push to create a privatized, U.S.-style health care system in the province.
With its controversial Bill 11, Premier Danielle Smith’s hard-right government is effectively taking a wrecking ball to Canada’s public health care system and the principles that underlay it.
But Smith is not working alone. Documents and lobbying records reviewed by The Breach show that behind the scenes, private health insurance giants—Manulife, Canada Life, and Sun Life—and their lobbyists are, in their own words, “key partners” of the Smith government’s efforts to craft a two-tier health-care system.
While doctors and other stakeholders have been shut out of the policymaking process, the Smith government is consulting with private insurers on the “technical implementation” of Bill 11. The UCP government even set up a working group of insurance industry insiders to oversee its changes to regulations.
With at least 25 registered lobbyists in the province, the private insurance companies are working directly with the Smith government to “help facilitate a smooth transition for Albertans” to a new, two-tier health-care system, as one Alberta pre-budget submission by a lobby group put it.
While Smith claims it will be limited to certain non-emergency procedures, industry representatives themselves have admitted it will open a “Pandora’s box” of privatization that will spread to all medical services.
Popular resistance to this unprecedented attack on public health care is already gathering steam in Alberta. But much depends on how the federal government reacts—or doesn’t—to the Smith government’s trampling of the Canada Health Act, the federal legislation that governs health care insurance.
If it is not stopped now, Alberta’s two-tier health-care scheme could spread to other provinces, setting up a wave of privatization across the country.
Unleashing the private insurance market
Smith waited until the eve of the Christmas holidays to sneak through her controversial health care privatization bill.
On December 18, 2025, the United Conservative Party government rushed Bill 11 through the provincial legislature. Debate on the complex, 296-page legislation lasted less than four hours.
The bill was drafted without input from citizens or health-care workers. The Alberta Medical Association, which represents the province’s doctors, told journalists that it was completely in the dark about Bill 11 before its public release.
Premier Danielle Smith and her health ministers sold the legislation as an overdue effort to “modernize” health care and improve health outcomes, downplaying the sweeping changes it contains.
But as a February 2026 report by the Canadian Centre for Policy Alternatives (CCPA) and the Parkland Institute shows, Bill 11’s ambitions are anything but modest. It will “fundamentally reshape the Alberta health care system,” massively opening the scope of private health insurance and for-profit health care in ways no other province has yet tried.
While Bill 11 enacts a huge number of changes, two broad ones stand out.
First, it allows doctors to charge patients user fees for medically necessary services on a case-by-case basis, even if these services are supposed to be publicly insured. By inventing a new category of “flexibly participating physicians,” doctors will now be allowed to operate with one foot in the public health-care system and one foot out.
Second, insurers are now allowed to cover services that are normally covered free-of-charge to patients under the public system, namely physician and hospital services. Allowing this kind of “duplicative” private insurance for surgeries and other forms of medically necessary care is unprecedented in Canada.
The Smith government’s so-called “dual practice” model, where physicians can bill the public system while also charging some patients privately, has received most of the attention in media coverage. But it’s the attack on the single-payer nature of Canadian Medicare—where the government is the sole entity paying for health care—that is perhaps the most significant change.
“The major aim of Bill 11 is to encourage the creation of a much larger private health insurance market, likely encouraging existing employer-sponsored insurance plans to expand into medically necessary health care,” write Longhurst and McGraff. By creating an “unrestricted private health insurance market,” Bill 11 encourages high-income patients to buy private health insurance so they can pay their way to the front of the queue.
The ultimate goal of Bill 11 is the creation of a private, for-profit fast lane for what should be publicly insured care—and a slower, public lane for those who can’t afford to pay.
The likely consequences of Smith’s privatization scheme, Longhurst and McRae argue, are longer wait-times and worsening staffing shortages in public hospitals, as private clinics drain away doctors, nurses and other health-care workers. For workers and businesses, that will mean higher insurance premiums, more complex paperwork, and fewer jobs offering extended health benefits.
“By encouraging private payment for publicly insured health services, the Alberta government has effectively ended universal health care in the province,” the report concludes.
Insurance giants in Smith’s ear
While doctors, health-care workers and the public were shut out of the decision-making process behind Bill 11, private interests that stand to profit from Smith’s privatization scheme got in on the ground floor.
Private insurers are actively involved in the policy-making process of the UCP government’s two-tier health care, as one document authored by the insurers’ own lobbyists shows.
“Our industry appreciates that the Alberta government considers life and health insurers as a key partner in the healthcare system, as demonstrated through the introduction of Bill 11,” the Canadian Life and Health Insurance Association (CLHIA) boasted in a January 2026 pre-budget submission to the province.
The CLHIA lobbies on behalf of Canada’s largest insurance giants as well as smaller, regional companies like Green Shield, Blue Cross, and Desjardins.
In the submission, the industry-wide lobby group thanked the Smith government for letting its lobbyists weigh in on “the technical implementation of certain aspects of the changes” contained in Bill 11. As of the start of this year, the CLHIA had no less than 18 lobbyists registered in Alberta, according to the province’s lobbying registry.
The CLHIA’s pre-budget submission revealed that the Smith government has even created a “working group of industry representatives” within government to oversee Bill 11’s reforms to drug insurance regulations. “We are happy to continue to meet over the coming months to ensure a smooth transition.”
The Breach asked the Alberta government for comment, but it did not reply before publication.
Like many industries in Canada, the health insurance industry is basically three companies in a trenchcoat.
Manulife, Canada Life, and Sun Life together control 63 per cent of Canada’s $64 billion life and health insurance market, which is centred on workplace plans that provide drug, dental, and disability coverage.
The province’s lobbying registry shows that Manulife and Sun Life both updated their lobbying registrations this past fall, around the time when Bill 11 was being drafted.
Sun Life’s four lobbyists in Alberta have met with public office holders on “health innovation”—a favourite euphemism of the Smith government for privatization.
Manulife’s three representatives, meanwhile, have been lobbying Alberta Health officials about how to make health care more “interoperable” with the insurance giant’s business.
As Canada’s health care system has struggled under the impact of decades of underinvestment and chronic staffing shortage, private insurers have moved into the cracks opening up in the public system. The pandemic and its aftermath widened these cracks even further.
“In Canada, we’re playing a growing role in addressing the healthcare gap,” said Sun Life CEO Kevin Strain, in the company’s 2024 annual report, describing Canada as “a growth engine” for the company.
“A new path has opened up in this space,” CLHIA president and CEO Stephen Frank said during a February 2023 webinar on industry trends. “The crisis in health care is an opportunity for us to do better for Canadians, to do better for patients.”
And, of course, to do better for themselves.
Industry watchers expect private insurers to come out as Bill 11’s biggest winners. Insurance companies “may see rising demand as patients seek faster access to surgeries or elective procedures currently subject to public wait times,” Insurance Business reported after Smith’s two-tier legislation was unveiled.
Market projections suggest that even if uptake is limited to the wealthiest Albertans, Bill 11 “could translate to tens of thousands of additional claims annually,” the online business journal reported. As such, the UCP’s privatization legislation “stands to significantly reshape the province’s health-insurance market.”
As Premier Smith takes a huge swing at Canada’s single-payer health-care system, Canada’s highly concentrated insurance sector is hoping to clean up in the wreckage.
Opposition in wild rose country
Opposition to Smith’s move toward two-tier health care is growing in Alberta.
Polling shows Albertans are deeply unhappy with the UCP government’s handling of health care. Petitions against Bill 11 have racked up tens of thousands of signatures.
Friends of Medicare, a coalition of union and community groups that fights to protect and expand public health care, has organized nearly two dozen town halls in communities large and small across the province. They’ve struck a chord, with thousands of Albertans turning up.
“They do not like the idea of two-tier American-style health care,” said Friends of Medicare’s executive director Chris Gallaway. “They don’t trust that this legislation will improve care or capacity or wait times. They’re very upset when they think about it through the lens of insurance. They don’t want insurance companies to be in the middle of their care.”
In anticipation of Bill 11’s two-tier model coming into effect, some clinics have already started to offer patients the option of paying their way to the head of the queue. Like Calgary’s Mitchell Eye Centre, which in March emailed the patients in line for publicly-funded cataract surgery, offering them the option “to pay privately for cataract surgery rather than remaining on the public waitlist.”
Gallaway said there is a tremendous amount of anxiety about what will happen once the for-pay surgery “floodgates” are opened by Bill 11. “There’s lots of people I’ve talked to who are waiting for a knee surgery or an MRI or something that say, ‘I’ve already been waiting this long, how much longer will have to wait if we go to a model of those who pay get faster care?’”
That anger and anxiety reaches all the way into rural communities that have historically voted for the UCP.
Ranchers from deep in UCP territory have been attending events, and small-town Albertans who had never before contacted Friends of Medicare are reaching out to the organization to host their own discussions.
Rural communities have already seen hospital closures and shortages of doctors, and residents are “very worried” that they might lose what little services they have left, if Bill 11 goes forward. Albertans rightly fear that “it’s not going to be profitable to have health care in their rural community,” and worry about “what that will mean for the community,” said Gallaway.
The fear that Bill 11 could unravel public health care in the province has been dismissed by Premier Smith as hyperbole. But insurance industry insiders share Friends of Medicare’s conviction that the legislation has put the province’s health-care system on “a slippery slope,” reports the trade publication Benefits Canada.
“It will start with orthopedic surgery and similar [procedures], but eventually it may slide into all forms of physician and hospital services,” one vice-president of an insurance brokerage firm told Benefits Canada. “That’s not the case yet, and changing government could easily put the brakes on or stop it completely, but it does make it a bit like [opening] Pandora’s box.”
Premier Smith has no mandate for the two-tier health care that Bill 11 represents, Gallaway emphasizes. “One thing that comes up often in the conversation is that no matter how you voted in the last election, no one voted for this health-care agenda.”
In the 2023 provincial election, Smith and the UCP ran on a public health-care guarantee, and committed to fix wait times and other issues—promises that haven’t been kept.
‘Alberta is not an island’
Alberta’s Bill 11 goes far beyond what other provinces have attempted in terms of privatizing health care—and if it’s allowed to go forward, its impacts won’t stay in Alberta.
To build up their privatized parallel system, Alberta government officials have explicitly said they intend to poach medical personnel from other provinces.
“Alberta is not an island. Alberta competes for health-care professionals all across Canada,” Alberta’s minister of hospital and surgical health services Matt Jones said at a news conference unveiling the legislation in November 2025.
Two-tier health care in Alberta could prompt other provinces to adopt similar reforms to retain their doctors, setting off a race to the bottom of privatization. Saskatchewan is openly considering following in Smith’s footsteps. In a year-end interview with Rebel News, Premier Scott Moe referred to Alberta while promising “a very open discussion about delivering health care in a very innovative way.”
Defenders of public health care in Alberta and across Canada have appealed to the federal government to intervene. Bill 11 is a clear violation of the Canada Health Act, federal legislation which requires provinces’ health-care systems to respect the principles of universality and accessibility for all.
The Carney government, however, has been more focused on stepping back from health care, rather than stepping up to defend it.
The federal government is spending billions on corporate tax cuts and the weapons industry , while imposing harsh austerity everywhere else—including in health care. Health Canada spending is being cut by $3 billion, the expansion of universal pharmacare to other provinces (beyond B.C., P.E.I., Manitoba, and Yukon) has been halted, and over 2,000 federal workers at Health Canada and other health-related departments are facing layoffs.
Nearly five months have passed since Bill 11 was adopted. Federal Health Minister Marjorie Michel and Health Canada officials still have yet to make any statement on the legality of Alberta’s two-tier health-care bill.
The Carney government has also displayed a disturbing closeness to insurance company CEOs, with Minister Michel and her staff meeting with insurance industry lobbyists 29 times on pharmacare since taking office in May 2025.
This silence makes a mockery of federal Liberal election promises to uphold the Canada Health Act and expand Canada’s public health care, advocates point out.
“It’s completely unacceptable that our federal government is currently sitting silently on the sidelines rather than stepping up to save our public health care system from those who wish to tear it apart,” Friends of Medicare’s Gallaway said in a media statement.
With insurance giants whispering in Smith and Carney’s ears, countering Bill 11 will require rallying a public counterweight that’s more powerful than the insurance industry’s lobbyists.
It’s a fight that has significance beyond Alberta’s borders: the very existence of Canadian public health care.
Nikolas Barry-Shaw
Nikolas is the Trade and Privatization Campaigner for the Council of Canadians and author of the book “Paved with Good Intentions.”
Membership builds our movement
Become a member of the Council of Canadians for as low as 1$/year
