Last updated: March 2026

Published for general informational purposes. Not affiliated with any clinic or healthcare provider.

In late 2025, Alberta’s United Conservative government passed Bill 11, the Health Statutes Amendment Act, 2025 (No. 2). The legislation was introduced on November 24, 2025, and came into force on December 18, 2025. It makes Alberta the first province in Canada to explicitly create a legal framework for two-tier healthcare and private health insurance for medically necessary services. It allows physicians to work simultaneously in both the public and private systems, charging patients out of pocket for care that would otherwise be covered by Alberta Health Care Insurance Plan. It is the most significant structural change to a provincial healthcare system in Canada in decades, and its implications extend well beyond Alberta’s borders.

Since the legislation came into force, the national response has been substantial. The Canadian Medical Association, Canadian Doctors for Medicare, and more than 20 other organizations have issued a joint call to action demanding the federal government enforce the Canada Health Act. Health coalitions from across the country have called on Prime Minister Mark Carney and Health Minister Marjorie Michel to intervene. Bill 11 is being implemented in phases throughout 2026, and its full impact on patient access is still unfolding.

If you are an Albertan trying to understand what this means for you, or a Canadian watching to see how this experiment plays out, this article explains what the legislation actually does, what the debate around it involves, what has happened since it came into force, and what it means practically for patients navigating their healthcare options right now.

What Bill 11 Actually Does

The legislation does several things that were not previously permitted under Alberta’s regulatory framework. First, it allows physicians registered with the College of Physicians and Surgeons of Alberta to practice in both the public and private systems at the same time, including charging patients directly for services that are covered under AHCIP. Previously, physicians could opt out of the public system entirely, but they could not operate in both simultaneously while charging extra for the same services.

Second, it creates a legal basis for private health insurance to cover medically necessary services. This is significant because the Canada Health Act places conditions on provincial health insurance plans but does not explicitly prohibit private insurance for services already covered publicly. Alberta is now actively creating the infrastructure for a parallel private insurance market.

Third, the legislation enables faster access for those willing to pay for it, alongside the existing public queue. This is the definition of a two-tier system: one queue for people who can pay to move faster, and a second queue for everyone else.

Why the Federal Government Is Under Pressure to Act

The Canada Health Act ties federal health transfer payments to provincial compliance with its principles. Alberta receives approximately $6.6 billion annually through the Canada Health Transfer, representing roughly 28 percent of its total health budget. The Act’s prohibition on extra-billing for insured services puts Bill 11’s framework in direct tension with federal funding conditions.

As of early 2026, the federal response has been measured but is escalating. Health Canada has stated that officials are engaging with Alberta to understand the implications of the changes. The federal government has said it will “always protect the Canada Health Act.” However, no formal enforcement action, including the discretionary penalties the Act permits, has been taken as of this writing.

The pressure on Ottawa to act is intensifying. In March 2026, the Canadian Medical Association’s president publicly stated that doctors across Canada are deeply concerned about Alberta’s plan, and called for a formal federal review of Bill 11. Canadian Doctors for Medicare and 23 other organizations have jointly demanded that the federal government use all powers at its disposal, including discretionary penalties under the Canada Health Act. National rallies have been held, and health coalitions from provinces including Ontario, P.E.I., and Manitoba have added their voices to the call for federal intervention.

The legal and political confrontation is slower to materialize than some critics predicted, but it is clearly building rather than dissipating.

What Critics Are Saying

Opposition to Bill 11 has been substantial and comes from multiple directions. The Canadian Medical Association argued before the legislation passed that it would leave more Albertans waiting longer, not fewer. Their concern is based on a straightforward supply-side argument: there are a fixed number of physicians in Alberta. If some of that capacity shifts toward higher-paying private patients, the capacity available to public system patients decreases. The queue does not shrink. It lengthens for those without the means to pay privately.

Critics have pointed to international evidence from countries with dual-practice models. Researchers have noted that countries allowing dual practice do not generally have shorter wait times than Canada, and some have longer ones. The mechanism is physician time reallocation: once a doctor can earn more per hour privately, they have an incentive to see fewer public patients per day. The Alberta government has proposed minimum public system hours as a safeguard, but critics argue this approach has failed in both Ireland and the United Kingdom, where similar measures were not respected in practice.

A joint report from the Canadian Centre for Policy Alternatives and the Parkland Institute, released in February 2026, argued that Bill 11 violates multiple sections of the Canada Health Act, including the principles of universality and accessibility. The report described the legislation as creating the framework for American-style private health insurance in Alberta, with potential trade agreement implications that could prevent Canada from keeping U.S. private health insurance companies out of the market.

The equity argument remains the most fundamental critique. The Canada Health Act was designed on the premise that access to medical care should not depend on ability to pay. A system that formally allows wealthier patients to purchase faster access to a physician for the same service that lower-income patients must wait months for represents a structural departure from that founding principle.

What Supporters Are Arguing

Proponents of Bill 11 argue that the existing system is already failing the equity test. If the public queue for a diagnostic scan or a non-emergency procedure is 18 months long, the people who suffer most are those without the resources to travel to another province or pay out of pocket through existing workarounds. A formalized private market, the argument goes, at least creates transparency and accountability around a practice that was already occurring informally.

The government has also argued that private investment in healthcare infrastructure could expand overall system capacity rather than simply redistributing existing capacity. If private clinics build new surgical suites, hire additional support staff, and create new capacity, the total volume of care available increases. Premier Danielle Smith has said the law aims to reduce wait times by increasing the number of surgeries that can be performed while incentivizing doctors to stay in the province. Critics respond that this effect requires significant capital investment in new infrastructure, not just dual practice by existing physicians, and that the evidence for it materializing in practice is limited.

Alberta’s physician agreement framework also includes significant rural recruitment and retention incentives, up to $15 million annually to support full-time practice in underserved areas, which proponents argue reflects a commitment to addressing access gaps alongside the private market expansion.

What Has Happened Since Bill 11 Came Into Force

The legislation is being implemented in phases. Amendments related to advancing the new healthcare model came into force in late 2025. Amendments related to consistent billing practices are planned for early 2026, and amendments related to health information sharing are planned for spring and summer 2026.

On the ground, the infrastructure of private insurance products and dual-practice physician arrangements is still developing. The change most likely to be visible in the near term is not a dramatic reorganization of the healthcare system but a gradual shift in how some physicians structure their practices.

Nationally, Saskatchewan has moved beyond signaling and into action. In March 2026, the Saskatchewan government announced its Patients First Health Care Plan, a comprehensive package of more than 50 actions that includes expanding private surgical capacity, increasing nurse practitioner training seats, broadening scope of practice for pharmacists and other health professionals, and adding 20 new medical training seats at the College of Medicine. While Saskatchewan’s plan is broader than simply replicating Bill 11, it signals that the pressure on the Canada Health Act’s function as a national standard is coming from more than one province.

What This Means for Patients Right Now

For most Albertans, the day-to-day impact of Bill 11 is not yet fully visible. The legal framework is in place, but the operational reality is still catching up. If you have a family physician who moves toward a dual-practice model, you may find that their availability within the public system decreases, or that certain enhanced services are now available to you for a direct fee. If you do not have a family physician, the wait to find one in the public system is unlikely to improve significantly in the near term, regardless of Bill 11, given that the underlying supply-side constraints remain.

Understanding your options is the most practical response to an uncertain environment. Membership clinics that operate outside the insured system, as most established private clinics in Alberta do, were legal before Bill 11 and remain legal after it. These clinics operate under the established model of charging for uninsured services and enhanced access, which is legally distinct from the dual-practice framework Bill 11 creates. They represent one way to access consistent, coordinated primary care without depending on the availability of a publicly covered family physician.

The Broader Canadian Context

Alberta is not moving in isolation. The pressures that drove Bill 11 are present in every province: physician shortages, aging populations, strained emergency departments, and a primary care system under-resourced for the demand placed on it. Saskatchewan has acted. Ontario is watching. Health coalitions from coast to coast are mobilizing to demand federal enforcement of the Canada Health Act.

The Canada Health Act has served as a floor for universal access for decades. Whether it continues to function as one depends on federal enforcement will and on whether the provinces adopting market-oriented reforms face meaningful financial consequences. The next year will clarify which direction the system is actually moving and whether the Alberta experiment produces the access improvements its proponents promised or the queue lengthening and equity erosion that its critics predicted.

For Canadian patients in every province, the lesson is practical: understanding what the public system can and cannot currently provide, and what legal options exist within the private and membership-based sector, is no longer an academic exercise. It is an increasingly necessary part of managing your own healthcare.

Primaris Health in Calgary operates within the established membership clinic model that predates Bill 11 and is distinct from the dual-practice framework the legislation creates. The clinic provides integrated private primary care at #400, 60 Uxborough Place NW, Calgary, AB T2N 2V2, with family physicians, a nurse practitioner, a full allied health team, a Royal College dermatologist, and an optometrist all under one roof. Membership includes a dedicated Personal Care Manager (RN) and same-day appointment access. For Calgarians navigating an uncertain healthcare environment, it represents a stable, legally established alternative to waiting for a public family physician. Call (403) 604-0511 or visit primarishealth.ca.

This article is for general informational and educational purposes only. It does not constitute legal, medical, or financial advice.