Alberta's Bill 11: The Two-Tier Healthcare Gamble That Could Reshape Canada

CALGARY, AB — Alberta's Bill 11 is now law, and the battle lines are drawn. What the United Conservative Party government calls "modernization," critics are calling the beginning of the end for Canadian medicare.

Passed on December 18, 2025, the Health Statutes Amendment Act allows physicians to straddle both worlds—billing the public system while also charging patients privately for medically necessary services. Premier Danielle Smith and Hospital and Surgical Health Services Minister Matt Jones frame it as flexibility to reduce surgical wait times. The opposition sees a rigged game.

The Dual Practice Dilemma

Bill 11 creates "flexibly participating physicians"—doctors who can maintain their public billing privileges while offering private, for-pay services on the side. It also greenlights employers to offer private health services through workplace plans, and shifts the province to "payor of last resort" for drug coverage.

On February 3, the Parkland Institute and the Canadian Centre for Policy Alternatives dropped a report titled "The end of Canadian medicare? Alberta Legislation Opens the Door to U.S. Health Care." Their argument: Bill 11 doesn't just bend the rules—it likely breaks the Canada Health Act outright by creating a two-tier system where those who can pay jump the queue.

The Federal Question

Alberta receives $6.6 billion annually through the Canada Health Transfer—roughly 28% of its $24 billion health budget. If Ottawa determines Bill 11 violates federal law, that funding could vanish. Health advocates, including Chris Gallaway of Friends of Medicare and Jason MacLean of the health coalition, spent the week of February 9 on Parliament Hill, pressing Federal Health Minister Marjorie Michel to enforce the Act.

So far, Ottawa hasn't blinked. But the stakes are clear: if Alberta's experiment stands, other provinces may follow. If it falls, the financial and political fallout could be seismic.

What Happens Next

Alberta's $28 billion healthcare operating budget for 2025-26 includes continued funding for private addictions centres and for-profit surgical facilities. The province is also reorganizing its health system into four new agencies. Bill 11 fits neatly into that larger pivot toward privatization.

The question isn't whether Alberta is testing the boundaries of public healthcare. It's whether the rest of Canada will watch—or push back.