What is Bill 11?
The Health Statutes Amendment Act, 2025 (no. 2), formerly known as Bill 11, is a sweeping, 300-page piece of legislation that establishes an unprecedented model of two-tiered health care access in Alberta by allowing physicians to work in both the public and private systems concurrently, including charging patients out of pocket.
Albertans first heard of this bill via a confidential draft obtained by the Globe and Mail back in November 2025. By December 11, while Albertans were focused on the holidays, it had already become law. Despite the massive size and scope of this bill, the government limited legislative debate on its third and final reading to just one hour.
What does it change?
Prior to Bill 11, Alberta’s rules around physicians in the private system were more or less aligned with other jurisdictions in Canada: they could work in the public system providing publicly-insured health care services, or they could un-enroll from Medicare completely, and bill patients directly for private services.
But under Bill 11, Alberta is creating an unprecedented private-pay market in which doctors and facilities are allowed to charge patients for publicly-insured health care services on a case-by-case basis, unlike anywhere else in Canada. Despite this, the Alberta government continues to insist that it’s in line with programs in Quebec and New Brunswick, even after New Brunswick’s Minister of Health publicly denied those claims!
What does it mean for Albertans?
Starting this September, Albertans will be able to for preferential access to some surgical services. Those who can’t afford private surgery, or those with life-saving, ineligible conditions, will be permitted the “choice” to wait even longer.
While regulations were finally announced that are supposed to serve as promised “safeguards” to ensure that it doesn’t undermine our public health care, they leave many questions. For instance, “Physicians must complete a minimum number of hours in the public health system to be able to offer private surgeries.” But what is that minimum number? Still anyone’s guess.
The provincial government is expecting Alberta to trust these vague promises… but they’ve broken such promises before. And let’s not forget that this government is still embroiled in extremely concerning allegations of corruption and interference in Alberta’s surgical procurement and contracting processes, suggesting they have long prioritized lucrative for-profit contracts at the expense of our public operating rooms!
All this begs the question: why weren’t these baked into the legislation before it was passed?
The Alberta Medical Association, the member association for Alberta’s physicians, released a list of seventy(!) safeguards that they have proposed to mitigate what they call “significant and foreseeable risks to Alberta’s public health care system, patients and workforce.” These concerns were only raised after the bill was unveiled, because doctors were not consulted on this colossal change to how health care is provided in Alberta!
As per the legislation, any physician, at any time, for any health care service, could decide to charge you out of pocket on a “case-by-case basis.” Leaving the specifics to regulations could protect patients from harm, but crucially, it leaves the door open to future major changes with no legislative oversight.
Our concern? Bill 11 kicks the door open to two tier, American-style health care.
What does it mean for the rest of Canada?
If two tier health care is permitted to gain a foothold in Canada, it will not stop at Alberta’s borders. Already, we’ve seen Premiers like Saskatchewan’s Scott Moe openly contemplating following Alberta’s suit.
The U.S. private health care insurance industry has been hungrily eyeing Alberta’s steps towards two tier health care as a “market opportunity,” and predicting that this will set a precedent that shapes “private health insurance trends nationwide.”
The United States, our only neighbor, is a global outlier as the only high-income country that does not provide universal health coverage to its public. As such, their for-profit medical insurance is a $1.5 billion industry! Our existing trade agreements have intentional carve outs to protect our public health care against this goliath, but Bill 11 puts these at risk by blurring the line between public and private health sectors.
Moreover, Bill 11 violates the Canada Health Act, federal legislation intended to protect our access to public health care. If Alberta is permitted to go through with setting up a system in which patients are charged for medically-necessary health care services, it presents an existential threat that could upend the very basis of Canada’s Medicare system.
People across the country are watching closely. In April, in recognition of the anniversary of the Canada Health Act, more than 60 organizations signed our joint letter to Prime Minister Carney and Health Minister Marjorie Michel, urging them to take action to save public health care.
What’s at risk?
Higher costs, longer waits, fewer health care workers… to name a few!
We have a wealth of evidence from within Alberta, Canada, and around the globe to show that for-profit health care siphons essential resources and workers out of the public system, resulting in reduced capacity, and longer waits for access. But given that the government has repeatedly refused to invest in our public hospital surgeries (which would have cost 0.0003% of the public health care funding they have handed over to for-profit surgical facilities) it is increasingly clear that the crisis in hospital surgical capacity is overwhelmingly self-inflicted.
It’s the age-old strategy: first they break the system, then they sell us privatization as our only solution.
Then there’s the cost. In the United States, where the average American pays upwards of $17,000 per year for health care, health care-related expenses are responsible for two-thirds of all bankruptcies! And even if some of us are able to retain our public health care access, the profits of private providers and private insurers will result in significantly higher administrative costs, raising health care costs overall. As of 2024, Canada’s public health care results in per capita costs of $7,301 per year. In the U.S., that number is $14,775 — more than double.
Who asked for this?
Not health care workers, not patients, and not experts. In fact, no one in Alberta voted for this! Danielle Smith’s government ran last election on a “Public Health Guarantee," promising that no one in Alberta would ever have to pay for medically necessary care. But it seems like they intended that as a technicality — if you don’t mind waiting months or years for the life-saving care you need.
Polling from March 2026 showed that health care is the top issue to Albertans, with 62% of respondents placing it within their top 3 concerns. Three months after Bill 11 was passed, just 29% of Albertans polled thought the provincial government had done a “good job” on health care.
Albertans clearly don’t support this direction. But one group does: behind the scenes of this secretive legislative overhaul, private health insurance giants and their lobbyists have been working hand-in-hand with the Alberta government to shape and implement this two tier system every step of the way.
... Deja vu?
In 2005, another set of leaked documents showed that the Ralph Klein government in Alberta intended to implement a “Third Way,” which would have similarly allowed doctors to work in the public and private systems, and lift the ban on private insurance for medically-necessary services. Friends of Medicare, health care workers, and concerned Albertans responded by making thousands of phone calls, sending letters, and collecting 23 thousand petition signatures, all calling for this plan to be scrapped in favour of equitable public health care.
Ultimately: we won.
The Smith government is working from the same playbook. But this time around, they have learned an important lesson from the Klein days: Albertans don’t support private health care. That’s why their legislation didn’t rely on manufacturing consent, but was pushed through as quickly and quietly as possible.
But for those of us who have been paying attention, this didn’t come out of nowhere. Previous sweeping Health Statutes Amendment Acts like Bill 30 in 2020 (permitting, among other things, physicians to be employed by “non-physician corporations”) and BIll 55 in 2025 (which allows government to appoint entities “other than a provincial health agency or provincial health corporation” to operate our hospitals) have laid the groundwork for full scale implementation of two tier health care vial Bill 11. Since then, yet another Health Statutes Amendment Act, Bill 29 has passed, allowing private-pay queue jumping for diagnostic services without referral, quickly followed by an “Activity-Based Funding” scheme, which forces public hospitals to compete for surgical funding by prioritizing quantity over quantity.
This plan is calculated, and has been years in the making.
How do we stop it?
The Smith government has made it abundantly clear that they are not interested in listening to health care workers, to experts, or to everyday Albertans. When the teachers were mandated back to work after striking in 2025, tens of thousands of people protested in Edmonton and Calgary. The government’s response? Enacting the Notwithstanding Clause to dismiss concerns and enforce their decision — a move was swiftly condemned by the Canadian Civil Liberties Association as an “egregious attack on workers’ rights.”
Which is why we are bringing the fight to the federal government. Our recent legal opinion on Bill 11 shows that it breaks the Canada Health Act, the criterion around Universality, Accessibility and Comprehensiveness, and the prohibition of extra-billing and user-charges for medically-necessary care. Alberta is breaking federal law, and with it, putting the $7.04 billion Alberta is expected to receive through the Canada Health Transfer this year.
So far, the Prime Minister and Federal Health Minister have been concerningly silent on this. But the Minister of Health has the authority — and responsibility — to enforce the discretionary penalties permitted under the Canada Health Act to protect patients and our public health care systems from two tier, American-style health care taking hold.
Our representatives aren’t doing their job in representing our interests. But public pressure works! And one thing is on our side: you. With the support of people from all over Alberta, and their willingness to join us in this all-important fight, we were successful in pushing back against aggressive privatization attempts by the Klein government. And with your help, we can do it again!
If ever there was a time to speak out in defense of our public health care, it is now. Here’s how: