Alberta’s health ministry says an audit has determined that more than 40 medical clinics in the province are advertising membership fees for services, nearly a year after one such plan landed a Calgary clinic in hot water.

The audit was launched last December. In July, CBC News reported that a medical clinic in Calgary’s Marda Loop district was moving to a membership system and planned to charge $4,800 a year for a two-parent family membership, covering two adults and their dependent children.

The next day, Health Canada said the arrangement at the Marda Loop Medical Clinic equated to patients purchasing “preferential access” and warned Alberta that it could face cuts to federal health transfers if the situation wasn’t handled. 

Alberta Premier Danielle Smith and Alberta Health Minister Adriana LaGrange directed Alberta Health to investigate, and the clinic halted its plan for membership fees shortly after. 

In December, LaGrange told CBC News that “appropriate action” would be taken if audits determined that violations were found, adding the province would do whatever it took to ensure clinics were in compliance.

The province promised the audits early in the new year. Now, the health ministry says it has conducted interviews to gather information on operations and business models of the clinics, adding this work is ongoing.

“Over 40 clinics in the province [advertise] a membership meant to pay for a defined set of uninsured services, while also providing insured services covered under the Alberta Health Care Insurance Plan at no cost to Albertans,” wrote spokesperson Andrea Smith in a statement.

“Once this review is completed, its findings will be used to inform next steps. Alberta’s government will also determine if additional audits of more membership clinics is required.”

In July, Health Canada said executive and primary health clinics charging patients enrolment and annual membership fees exist in a number of provinces. Generally, investigations have indicated that clinics provide members with an variety of uninsured services, such as life coaching and nutritional services.

“However, in some cases … these fees are also a prerequisite to accessing insured services at the clinic (i.e., medically necessary physician services). Mandatory fees to access or receive preferential access to insured services are contrary to the Canada Health Act,” the government department wrote in a statement.

A spokesperson for LaGrange told CBC News in July the ministry wasn’t aware of any other clinics offering services for membership fees that didn’t align with legislation.

What comes next for those 40 clinics is a murky grey area, said Fiona Clement, a professor at the University of Calgary in the department of community health sciences. Much of it has to do with the exact language being used when services are outlined as parts of packages.

“We’re on the razor’s edge of exact wording there that runs them afoul. Really, I think it will come down to what the government is willing to fight with these clinics about,” she said.

CBC News asked the provincial government for a list of the clinics identified, but did not receive it by publication time. A spokesperson with the province said if any clinics are found to be non-compliant with legislation, appropriate action would be taken.

Report had identified 14 clinics

Clement said the big issue that got the Marda Loop Medical Clinic in hot water was the concept of guaranteed access.

“That’s the problem that Marda Loop got into, because there you are charging access to medical care, which is the part that contravenes the Canada Health Act,” Clement said.

At the time the Marda Loop clinic fell under scrutiny, it was clear there were other such clinics providing membership programs, in Calgary and Canada. 

In 2022, researchers from Dalhousie University and Simon Fraser University released a paper tracking the number of clinics taking private payment across the country. Between November 2019 and June 2020, the period of the analysis, there were 14 private clinics in Alberta with a range of membership fees and private payment.

“So, 40 is a larger number than I was expecting. And I think it speaks to growth in this area, the number of clinics that are charging fees for different parts of care,” Clement said.

“I think it underscores the lack of stability, and the need to really think about how we’re funding primary care, because more and more clinics are turning to this private charge as a revenue source to keep the doors open.”

Provinces that allow private health-care providers to charge patients for medically necessary services have dollars clawed back by the federal government under the Canada Health Act.

According to Health Canada, Alberta was subject to a $20,450,175 deduction to its Canada Health Transfer payment in March 2024 under the diagnostic services policy. That’s up from $13,781,152 last year.

But the province received $20,538,796 in partial reimbursements tied to its March 2023 and 2024 deductions, which represents actions that Alberta Health has taken to limit patient pay for publicly funded goods or services, according to Clement.

“I guess we’re making some progress. But it’s still a big number, which says there’s still a lot of patient billing going on,” she said.

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The federal government is looking at making Islamic home financing increasingly accessible to help more Canadians break into the housing market.

As part of the 2024 federal budget that was released last week, Ottawa said it is “exploring new measures to expand access to alternative financing products, like halal mortgages.”

Last month, the federal government started consulting financial services providers and communities to understand how policies can better support the needs of all Canadians seeking home ownership, according to the budget.

“Canada is home to a vibrant and growing market of alternative financing products, including halal mortgages, that enable Muslim Canadians, and other diverse communities, to further participate in the housing market,” the budget states.

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Currently, none of Canada’s big six banks offer halal mortgages, which are an interest-free payment structure that follows Islamic principles.

However, some lenders in Canada have been offering halal mortgages for several years now.

“Halal mortgages are already offered to all Canadians by financial institutions,” Caroline Thériault, a spokesperson for the Department of Finance, said in an emailed statement to Global News Tuesday.

Thériault said halal mortgages are not government of Canada products.

“The government is simply looking at ways to help more Canadians become homeowners, while ensuring adequate consumer protections are in place.”

A halal mortgage is a real estate financing method that complies with Islamic principles and teachings.

Under Sharia law, it is forbidden for Muslims to receive and pay interest, so a halal mortgage essentially takes interest out of the equation.

Instead, the mortgage is based on the principle of profit, said Mohamad Sawwaf, founder and CEO of Manzil, a Canadian financial institution that offers Sharia-compliant services.

Manzil has been offering halal mortgages that are both partnership- and profit-based since 2020.

“We look at this product as an innovation within the Canadian mortgage marketplace to allow for a segment of the population and the broader ethical community that may want to participate,” Sawwaf said in an interview with Global News Monday.

The end result of homeownership is the same, but the process and documentation are different compared with a regular mortgage, he said.

“Within the Islamic finance principles, you’re acquiring a real asset, it’s commodity-based, and then you are reselling it or partnering in that asset long-term, so that is the key difference here.”

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Victor Tran, a mortgage and real estate expert at Ratesdot.ca and broker with True North Mortgage, said a halal mortgage is almost like a traditional mortgage where the lender and the homeowner have shared ownership of the property, but there are extra steps involved.

He said the difference is that “instead of charging interest to the homeowner, the contract is structured in a way where there’s a fee charged.”

Even though halal mortgages are interest-free, it doesn’t mean the lending happens at a zero per cent charge, Sawwaf said.

“It just means that you’re not part of a transaction where money is being lent and you have to pay more money back,” Sawwaf said.

“That is the principle of usury within Islam and other Abrahamic faiths that we’re trying to avoid.”

Usury, which is the lending of money at exorbitant interest rates, is also prohibited in Judaism and Christianity.

Halal mortgages in Canada fall under three different types of agreements, called Ijara, Murabaha and Musharaka, according to Rates.ca.

Ijara is like a rent-to-own agreement in which the inhabitant of the home starts as a renter and becomes the owner upon final loan payment, Tran said.

Under this type of financing, the home is purchased by a trust, which then leases it to the customer.

The Murabaha is a cost-plus financing structure in which an Islamic financial company becomes the owner of a home and sells it to their client for a price that includes a profit rate, which is benchmarked against the Bank of Canada’s overnight lending rate, Tran explained.

The client enters into a purchase agreement that specifies fixed monthly payments for the duration of the contract, which is usually up to 15 years.

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Under the Musharaka arrangement, an Islamic financial company and its client become co-owners of a home, Tran said.

Throughout the mortgage term, which will follow the traditional mortgage term of up to 25 to 30 years, the financial company’s equity position decreases and the customer’s equity position increases proportionately as they pay out the owned balance.

At the end of the contract, the client will have 100 per cent home ownership and the company will have zero per cent, Sawwaf said.

From the financial standpoint, one of the main benefits of halal mortgages is that it introduces a long-term fixed mortgage rate, Sawwaf said.

For instance, under the Murabaha agreement, which follows the buy-and-sell structure, the mortgage can run up to 10 to 25 years.

Sawwaf said because the lender is sharing in the long-term risk, halal mortgages are “much more ethical and valuable at the end of the day” as opposed to having a debt-based system that is “not really good for society and its long-term social impact.”

However, the downside is that the costs of halal mortgages are higher because the lenders are not able to access low-cost capital, Sawwaf said.

“We’re hoping that the government signalling that they’re in support of halal mortgages with respect to potential legislation or policy changes, this could allow us to tap into institutional capital at the banks or other institutions,” he said.

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Tran said because the costs and fees are a little bit higher for a halal mortgage than a traditional mortgage, it may not be a financially feasible option for many.

Among the measures that Ottawa is exploring are changes in the tax treatment of halal mortgages or a new regulatory sandbox for financial service providers.

Anyone in Canada, Muslim or non-Muslim, can apply for a halal mortgage, which is currently offered by a few financial institutions.

“Everyone is allowed to have a halal mortgage no different than you can go to any restaurant and eat a shawarma with halal chicken in it,” Sawwaf said.

“We don’t care what your background is, your religion, your creed, even if you’re non-religious or an atheist.”

As for the down payment, most lenders in Canada require clients of halal financing to pay a minimum of 20 per cent of the market value, or purchase price, of the house.

Customers should also have a good credit history and sufficient income to meet the monthly payment obligation, the Canadian Halal Financial Corporation says.

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Facing pushback from physicians and businesspeople over the coming increase to the capital gains inclusion rate, Prime Minister Justin Trudeau and his deputy Chrystia Freeland are standing by their plan to target Canada’s highest earners.

In respective press conferences on Tuesday, both Trudeau and his finance minister defended their proposal to rake in $19.3 billion over the next five years by increasing the capital gains inclusion rate — the portion of capital gains on which tax is paid – for individuals with more than $250,000 in capital gains in a year.

This new revenue stream comes as the federal government plans to spend billions of dollars to increase Canada’s housing supply and enhance social programs, with the Liberals framing the new revenue as helping to offset those investments in a way that’s fair and doesn’t offload a larger deficit on younger generations.

“At a time when young people have started to give up on the dream of eventually ever being able to own a home, it was really important to rebalance the situation,” Trudeau said, speaking to reporters in Saskatchewan.

“I understand for some people this may cost more if they sell a cottage or a secondary residence. But, young people can’t buy their primary residences yet.”

What is the capital gains tax change?

As revealed in last week’s federal budget, the capital gains inclusion rate will increase from 50 per cent to 67 per cent, and will also apply to all capital gains realized by corporations and trusts.

That means that as of June 25, people with more than $250,000 in profit made on the sale of assets in a year will have to pay taxes on a larger portion of that money.

This incoming amendment to the Income Tax Act is expected to affect the wealthiest 0.13 per cent, and approximately 12 per cent of Canada’s corporations and Canadians with an average income of $1.42 million.

The inclusion rate for capital gains realized annually up to $250,000 is not changing, the existing capital gains exemption on primary residences will remain, and the lifetime exemption limit for small business shares, as well as farming and fishing properties is increasing.

What is the criticism?

While not the direct wealth tax or excess profit taxes some had anticipated – given Freeland’s dodging of questions about whether those were revenue routes the government was considering – since the budget was tabled, many Canadian business owners and entrepreneurs have raised concerns that the move could stunt innovation.

“At a time when our country is facing critically low productivity and business investment our political leaders are failing our country’s entrepreneurs,” wrote Shopify president Harley Finkelstein in a post on “X” last week.

On Tuesday, the Canadian Medical Association (CMA) also came out against the move, asking the Liberals to reconsider as the change will impact doctors’ retirement savings as most incorporate and operate their practice as a small business. 

“It is completely unfair, late in the game taxation for those physicians who did follow the rules of the day and save for their retirement inside of our professional corporations,” CMA president Dr. Kathleen Ross said Tuesday. 

PBO cautions ‘collateral damage’

It’s this kind of potential for “collateral damage” that Canada’s Parliamentary Budget Officer Yves Giroux voiced caution about in an interview on CTV News Channel’s Power Play on Friday, with host Mike Le Couteur.

Citing the sale of secondary residences such as cottages, or rental properties in the current housing market as examples of how Canadians could feel the impact of this tax change, Giroux said it’s not unusual for capital gains to be realized “well in excess of $250,000.”

“The moment you have a capital gain that’s higher than a quarter million, then you’re captured by that higher capital gains inclusion rate,” he said.

The PBO also cautioned that it’s difficult to determine based on the government’s current numbers, whether they will actually be able to generate the amount of revenue expected, but his office plans to assess that over the next couple of weeks.

What is the Liberals’ rationale?

In defending the capital gains reforms, both Trudeau and Freeland said the way the tax system currently works means a nurse, student, or carpenter could be paying income tax at a higher marginal rate than a multimillionaire who can use accountants to pay a lower tax rate.

“That’s not fair,” Freeland said, speaking in Toronto on Tuesday. “It is fair to ask those who are doing really well to contribute a little bit more.”

In the budget, the Liberals made a point of noting that this change will not impact 99.87 per cent of Canadians. Further, the 416-page document notes that in 2021, only around five per cent of Canadians under 30 had any capital gains at all.

And, next year, 28.5 million Canadians are not expected to have any capital gains income, while three million are expected to earn capital gains below the $250,000 annual threshold.

In an interview on CTV’s Question Period with Vassy Kapelos that aired Sunday, Conservative deputy leader Melissa Lantsman would not say whether her party would reverse the increase in the capital gains inclusion rate.

With files from CTV News’ Spencer Van Dyk 

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