Provincial Autonomy and the 2023 Federal-Provincial Healthcare Deal: A Federalism Deficit at Work?

The fallout of the COVID-19 pandemic put enormous strain on healthcare services across the country, leading Canadian premiers to call on the federal government to negotiate a new healthcare deal. The dynamics of these negotiations received extensive media coverage and highlighted some of the most fundamental issues in Canadian federalism. The objective of this article is to explore whether the 2023 healthcare negotiations were conducted in accordance with core federalism principles (e.g. autonomy, constitutionalism, partnership), or if they rather reflect some form of federalism deficit. More specifically, it asks whether, and to what extent, provincial autonomy was challenged through conditional federal funding to health care. The authors conclude that the formal division of constitutional powers is blurred through the federal government’s use of its “spending power,” and that the state of intergovernmental relations in Canada has undermined the principle of equal partnership between Ottawa and the provinces within the federal system.