In December, the Alberta government passed the Health Statutes Amendment Act, 2025 (no. 2). The innocuously named legislation is a direct attack on the Canada Health Act.

Bill 11, as it’s commonly referred to, allows doctors to work in the public system and charge patients privately at the same time—a first in Canada.

This is a stark change from what has existed in Canada until now: Doctors can work entirely in the private-pay market, charging patients for services, or in the public system. But they must choose whether they’re in the public system or not. They can’t do both at the same time.

Alberta has changed that and, by allowing doctors to work in both the public and private systems simultaneously, it has opened the door wide to American-style, two-tier health care.

Two-tier health care is against the Canada Health Act. It means the departure from a health system based on medical need and not the ability to pay.

It will encourage doctors and for-profit facilities to charge patients for faster access to care, regardless of whether it means pushing aside others who have more urgent needs.

Alberta’s Bill 11 also opens the door to private health insurance for medically necessary care, which is already covered under the Canada Health Act.

That will allow a for-profit health care industry to flourish. This for-profit industry is the largest cause of personal bankruptcy in the United States, and this would be terrible for all Canadians. Imagine losing your house because you can’t afford private health insurance premiums. Nurses in the United States are actively fighting for the Medicare we already have in Canada, to protect their patients and themselves from this dire reality.

As nurses, we know this inequality isn’t good for patients—and it doesn’t reflect Canadian values.

The Canada Health Act requires that services performed by nurse practitioners, doctors, and hospitals are to be provided without financial barriers.

The Act also requires that provincial public insurance plans adhere to five principles: public administration, comprehensiveness, universality, portability, and accessibility.

Alberta’s Bill 11 clearly contravenes multiple provisions of the Canada Health Act, including accessibility.

This principle forbids the Alberta government—and any provincial government—from introducing changes to the public insurance plan that may “impede or preclude, either directly or indirectly, reasonable access” to public health care services.

Previous efforts to establish two-tier health care in Canada have been evaluated and rejected. In the decade-long Cambie Surgeries Corporation constitutional challenge over private health care payment, the trial court and court of appeal rejected a similar effort to introduce two-tier health care in B.C.

The courts reviewed a large body of Canadian and international research evidence and practical experience with two-tier health care, but the trial and appeal court did not agree with the proponents of privatized health care.

In fact, the judge ruled that there is an abundance of evidence to suggest that allowing doctors and for-profit facilities to charge patients would unreasonably harm access to patients on the public waiting list.

The trial judge suggested that the best course of action would be for the provincial government to reduce wait times by improving the public system. The public interest would not be served by a two-tier system.

The Government of Canada was even an intervenor in this legal challenge, led by a surgeon and CEO of a for-profit surgery centre, because of the risk that this litigation would kill the Canada Health Act.

Now Alberta seeks to accomplish the same ends, but this time the federal government is failing to intervene.

Indeed, the federal health minister has not taken a firm stand against Alberta’s two-tier legislation by calling for its repeal. Nor has the prime minister signalled the importance of upholding the Canada Health Act.

As nurses, we call on the federal government to unequivocally stand up for the Canada Health Act and our shared Canadian values premised on the idea that health care should be based on need and not your ability to pay.

Alberta needs to be put on notice that the federal government is willing to withhold nearly one-third of Alberta’s health care budget through the Canada Health Transfer. The federal government has tremendous power to uphold the values that make us Canadian—and distinct from the greed and profit-taking we see in the United States.

It’s up to the federal government to protect everyone in Canada from the Alberta government’s outright attack on public health care.

Silence and inaction from the federal government only bolsters the corporate interests that seek to end public health care as we know it.

The federal government must stand up before it’s too late.

Linda Silas is the president of the Canadian Federation of Nurses Unions.

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