Better for Workers, Better for All? Assessing a Portable Health Benefits Plan in Ontario

Millions of workers in Ontario have no access to supplemental health and dental benefits that reimburse most costs for prescription drugs, dental, vision and mental health services. These services are indisputably essential to good health, productivity and financial security for workers and their families. One solution is a portable health benefits (PHB) plan that allows a worker to maintain coverage while moving from job to job. The Ontario government announced a Portable Benefits Advisory Panel in February 2022 with up to 18 months to advise on the viability, design and implementation of a PHB plan aimed at workers without benefits. This includes those who are self-employed, such as independent contractors, or in part-time, temporary or gig-type jobs. This Commentary explores the purpose, structure and feasibility of a portable health and dental benefits plan in Ontario. The author finds a PHB plan to be feasible, affordable and sustainable. A portable plan is likely administratively feasible because private health insurers, pharmacy benefit managers and third-party administrators already use similar systems. A PHB plan can be integrated with new federal plans, existing employer-sponsored health plans and Ontario’s Trillium drug plan. Participatory governance that includes workplace stakeholders should encourage public support and ensure ongoing innovation and sustainability. Provincial regulation will protect the public interest, similar to what Quebec requires for its universal drug plan. Feasibility on many dimensions is critical. A key question is to what degree businesses must provide benefits. The government should anticipate resistance among small employers that do not currently provide a health benefit plan. Financial and fiscal feasibility depends on many variables, such as political will, eligibility, individual and employer mandates to take out insurance, and plan design including cost sharing. The best estimates are that 3.5 million to five million Ontario workers and their families would be eligible. Assuming an average annual per-capita claim cost of $907 (author’s estimate), the cost of this plan could be high: $3.2 billion to $4.5 billion, not including administration costs, tax considerations or subsidies for low-income workers, and assuming current provider service profiles and costs do not change. However, this cost is likely to be shared by three parties – employers, workers and the provincial government. Cost would be reduced by Ontario’s share of previously announced federal spending on dental and mental health services, and by new federal funding for rare disease drugs. Assuming the province pays one-third of the new PHB plan claim costs, the annual provincial fiscal bill would be $1.1 billion to $1.5 billion. That would mean a PHB plan would consume between 1.5 to 2 percent of health program spending. A PHB plan appears to be an appropriate way to improve access to essential health and dental benefits for millions of Ontarians.