The Stories We Tell about Refugee Claimants: Contested Frames of the Health-Care Access Question in Canada.

Author:Beatson, Jesse
 
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Abstract

A contested issue is the extent to which refugee claimants should have access to health care in Western host countries with publicly subsidized health-care systems. In Canada, for a period of over fifty years, the federal government provided relatively comprehensive health coverage to refugees and refugee claimants through the Interim Federal Health Plan (IFHP). Significant cuts to the IFHP were implemented in June 2012 by the Conservative federal government (2006-15), who justified these cuts through public statements portraying refugee claimants as bringing bogus claims that inundate the refugee determination system. A markedly different narrative was articulated by a pan-Canadian coalition of health providers who characterized refugee claimants as innocent victims done further harm by inhumane health-care cuts. This article presents an analysis of these two positions in terms of frame theory, with a greater emphasis on the health-provider position. This debate can be meaningfully analyzed as a contest between competing frames: bogus and victim. Frame theory suggests that frames by nature simplify and condense, in this case packaging complex realities about refugee claimants into singular images (bogus and victim), aiming to inspire suspicion and compassion respectively. It will be argued that the acceptance of current frames impoverishes the conversation by reinforcing problematic notions about refugee claimants while also obscuring a rights-based argument for why claimants should have substantial access to health care.

Resume

L'etendue de l'acces aux services de sante pour les demandeurs du statut de refugie dans le contexte des pays d'accueil occidentaux munis de regimes de sante finances publiquement constitue un enjeu controverse. Au Canada, pendant plus de 50 ans, c'etait le gouvernement federal qui fournissait une couverture relativement integrale de services de sante aux refugies ainsi qu'aux demandeurs du statut de refugie par l'entremise du Programme federal de sante interimaire (pfsi). Des reductions importantes au pfsi ont ete effectuees en juin 2012 par le gouvernement federal conservateur (2006-15), qui a justifie ces reductions par des declarations publiques accusant les demandeurs du statut de refugie d'avoir encombre le systeme de determination du statut en presentant des demandes non legitimes. Un recit nettement different avait ete articule par un regroupement pancanadien de fournisseurs de services de sante qui representaient les demandeurs du statut de refugie comme des victimes innocentes dont les reductions inhumaines aux services de soins de sante n'avaient fait qu'aggraver leur situation. Cet article presente une analyse de ces deux positions par l'entremise de la theorie de l'encadrement, en mettant l'accent particulierement sur la position des fournisseurs de services de sante. Selon la these proposee par l'article, il serait profitable d'analyser les arguments emis dans ce debat en tant qu'affrontement entre deux cadres en concurrence, notamment le cadre de la non-legitimite et celui de la victimisation. La theorie de l'encadrement propose que les cadres, de par leur nature, simplifient et condensent le sujet dont il est question, dans ce cas les realites complexes autour des demandeurs du statut de refugie, en les reduisant a des images uniformes (non-legitimite et victime), avec le but d'inspirer soit la mefiance ou la compassion, respectivement. Le fait d'accepter ces cadres tels qu'ils sont presentes actuellement appauvrit le discours en renforcant des notions problematiques concernant les demandeurs du statut de refugie, tout en refoulant des arguments fondes sur les droits qui favorisent un acces integral aux services de sante pour les demandeurs.

Introduction

A central question for any publicly subsidized healthcare system is the extent to which non-citizens should be granted access. Refugee claimants, by definition, are not yet citizens of the host state, and a continued debate is over what legitimate claims they have on social resources like health-care vis-a-vis citizens. Many scholars assert that refugee claimants should at the very least have access to emergency medical care, what Gibney argues is part of a "moral minimum" owed to precarious migrants. (2) Beyond this baseline of care, opinions vary widely about whether any additional health-care benefits should be provided and under what conditions.

In Canada, the question of to what extent refugees and refugee claimants should have access to health care was contested in a heated and public manner, in the wake of cuts to the Interim Federal Health Program (IFHP). For over fifty years the Canadian government provided relatively comprehensive health insurance coverage to refugees and refugee claimants through the IFHP. When the Conservative federal government (February 2006-November 2015) significantly reduced the scope of this health coverage on 30 June 2012, all refugee claimants lost coverage of medications, and many others lost access to medical services, except for rare instances where health conditions were deemed a risk to public health or safety. (3) On 19 October 2015, the Liberal Party was elected and in April 2016 restored IFHP health coverage to previous levels.

The scope of this article concerns the status of the IFHP under the Conservative government. It was this era in which the IFHP cuts were made, and accordingly, this is when the event of interest for this study took place: a discursive struggle in the media between the Conservative federal government and refugee health-provider advocates. For each of these two parties, their public statements can arguably be distilled into single generalizing labels applied to refugee claimants. These labels centred drastically different features that claimants allegedly exhibit.

This article demonstrates that these labels acted as short-hands for the more complex political positions of the Conservative federal government and doctor advocates, who were each endeavouring to steer a national conversation about what Canada owes to claimants in health coverage. This period of recent Canadian history (2012-16) presents an opportunity, therefore, to study how conflicting ways of representing refugee claimants in the media are linked to differing determinations about their entitlements to health services. In other words, it is a comparison between two different "stories" that have consequences. The consequences of these media portrayals are significant. We see in the United States the way that the portrayal of the "deserving" vs. "undeserving" poor has justified cuts in the social safety net. (4) To this end, this article borrows conceptually and methodologically from frame theory, a type of discourse analysis. (5)

The literature on frame theory is rich and diverse, with intellectual roots stretching back to the 1970s. (6) The frame theory that is relevant here, however, is its recent application to the collective arena, exploring how frames are used strategically to mobilize people around particular political causes and issues. Attention will be paid to the inability of refugee claimants themselves to have participated as equal partners in the national conversation on their access to health care; the responsibilities that should flow from the fact of refugee claimants' muted political voice to those who speak on their behalf; the main frames that were in play regarding refugee claimant health care and what they highlighted, compared to what they obscured from view; and finally, the tension between the need for frames in an adversarial public dialogue and how even "pro-refugee" framing may have negative ramifications for the claimants who are being characterized.

Background

It is no wonder that refugee claimants are the subject of discursive activity. While the determination of their legal identities follows the relatively fixed process of immigration and refugee boards, their social identities are in limbo because they are between states of civic belonging; they have fled their country of origin and are not yet members of their host country. Lacking the benefits of citizenship in the host country, their political voices are muted. Simply put, they are not in a favourable position to have their own narratives and perspectives heard. Instead, they are an ideal screen upon which various images, conjured by more powerful and civically entrenched actors, can be projected. As noted by Phillips and Hardy, there are two components of refugee identity: first, what a refugee is; and second, who is and who is not a refugee. (7) While the second component is determined largely by the legal and institutional processes of refugee determination, the first is a more open question, influenced largely by the discursive productions of actors who vie to advance their agendas.

Since refugee claimants have limits placed upon their capacity to, as it were, tell their own stories, a lot of power is placed in the hands of those who do this representational work on their behalf. Malkki notes that even when discourses on refugees or refugee claimants attempt to empower and humanize, they inevitably construct a limiting "vision of humanity that repels elements that fail to fit into the logic of its framework." (8) In other words, discursive constructions of refugees necessarily entail generalizations that deny complexity and the uniqueness of the individual. To advance a side of a public debate, even if it is a "prorefugee" stance, generalizations will be necessary. Nonetheless, the degree to which the potential harm of these generalizations is outweighed by benefits is an area for critical inquiry and assessment.

A tension presents itself to those who would put themselves in the role of advocates. On the one hand, there is a responsibility to do justice to the complexities of what is essentially other people's lives, to render into high resolution their diverse experiences...

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