The End of Canadian Medicare? Alberta Legislation Opens the Door to U.S. Health Care

In December 2025, Alberta became the first province to legislate two-tier health care and private health insurance for medically necessary services. Bill 11 establishes  two-tier health care, which is defined as a system that provides faster access to those with the ability to pay privately, and longer public wait times for those who are unable to pay for queue jumping.

This is the latest intervention in the health care system by Danielle Smith’s United Conservative government, following a dramatic restructuring of the provincial health authority, transfer of health care facilities’ ownership, expansion of for-profit surgical outsourcing, and complex changes to the hospital funding model that create perverse incentives.

Two-tier health care has clearly arrived in Canada. Bill 11 and dual practice fundamentally reshape the Alberta health care system. Will the federal government remain silent on the potential multiple violations of the Canada Health Act? Will civil society be compelled to seek a court order to force the federal government to enforce the Canada Health Act? We will be seeking answers in coming months to these important questions on the future of Canadian medicare.

This report discusses 11 things you should know about Alberta’s new two-tier health care system — and why it matters for the rest of Canada.

Note: The End of Canadian Medicare? was created in collaboration with the Canadian Centre for Policy Alternatives (CCPA) and is also available at policyalternatives.ca

Rebecca Graff-McRae

Rebecca Graff-McRae is research manager for Parkland Institute, where her areas of research include public health care, seniors’ care, and public services. She holds a PhD in Irish Politics from Queen’s University Belfast, and has previously held fellowships with the Institute of Irish Studies at Queen’s, Memorial University Newfoundland, and University College Cork. In addition to many reports for Parkland Institute, she has contributed to the Canadian Centre for Policy Alternatives’ Alternative Federal Budget since 2022 and her work has been featured in local, provincial, national, and international news outlets.

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Andrew Longhurst

Andrew Longhurst, B.A. (Hons), M.A., is a senior researcher and political economist at the Canadian Centre for Policy Alternatives (CCPA). He is also a PhD candidate at Simon Fraser University. His research has been published in academic journals and by research institutes, including the Canadian Journal on Aging, Political Geography, the CCPA, and the Parkland Institute. His recent publications include Hollowed Out (CCPA, 2025), Operation Profit (Parkland Institute, 2025), and At What Cost? (CCPA, 2023). As an expert on health policy and finance, his commentaries appear regularly in news media across the country. Follow him on Bluesky at @alonghurst.bsky.social.

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