Question 4 and the Price of Access

What charging temporary residents and their families for health care and education would involve, and the questions the ballot leaves unanswered 

At a Glance

• Question 4 asks whether Alberta should charge a “reasonable fee or premium” to people with a non-permanent immigration status, and to their families, for using health care and education. 
• It is the only service question that keeps access and attaches a price to it. Question 2 would remove eligibility and Question 3 would delay it. 
• The ballot sets no amount. The province says the Legislature would decide after the referendum. 
• Question 4 is the only one of the three that omits the word “legal” from its description of status, which leaves its reach unclear. 

Why Question 4 Is Different

The three service questions use three different instruments. Question 2 would decide who is eligible at all. Question 3 would decide when eligibility begins. Question 4 would leave eligibility in place and attach a charge to it. The province presents the three as alternative approaches to determining eligibility, timing, or cost-sharing for services used by temporary residents (Government of Alberta, 2026). A fee may influence how services are accessed, depending on its amount and structure. 

What Question 4 Says

The official wording (Government of Alberta, 2026; Elections Alberta, 2026) is: 

“Assuming that all Canadian citizens and permanent residents continue to qualify for public health care and education as they do now, do you support the Government of Alberta charging a reasonable fee or premium to individuals with a non-permanent immigration status living in Alberta for their and their family’s use of the health care and education systems?” 

Four features of the question’s phrasing are worthwhile to note: 

1. It reaches families, not only permit holders. The phrase “their and their family’s use” brings spouses and children inside the charge.
2. It omits the word “legal.”  Question 3 refers to “non-permanent legal immigration status” while Question 4 does not. The Canadian Bar Association Alberta (n.d.) notes that this creates ambiguity about whether the proposal is aimed only at people with federally recognized temporary or refugee related status, or whether Alberta would define the affected group differently.
3. It sets no amount. The words “reasonable fee or premium” leave the scale open. According to the province’s referendum FAQ, the specific amount would be determined by the Legislature after the referendum (Lakeland Today, 2026). As a result, the practical effect of Question 4 would depend not only on the referendum outcome, but also on the legislation, regulations, fee structure, and implementation decisions adopted afterward.
4. It covers two quite different systems. Health care is insured and billed through the Alberta Health Care Insurance Plan. Education is delivered by school boards with their own fee structures. A single question covers both, and the design problems in each are different.

The Case the Province Makes 

The province argues that temporary residents should contribute a fee or premium toward health care and education for as long as their status remains temporary, and that none of the three service options affect permanent residents (Government of Alberta, 2026). 

It argues that the Canada Health Act does not require provinces to insure temporary residents, and that emergency health care would continue to be provided as it is for visitors (Government of Alberta, 2026). 

It points out that a fee structure already exists in parts of the system, since international students in K to 12 pay between $11,000 and $14,000 in annual tuition depending on the school board, and states that children of temporary foreign workers would not be removed from schools, with any amount to be set by the Legislature (Lakeland Today, 2026). 

It estimates health care costs for temporary residents at about $400 million a year and education costs at about $600 million (Ali, 2026). 

Health Care Today: What Coverage and Charges Look Like

Alberta already charges people who fall outside of their coverage. Coverage under the Alberta Health Care Insurance Plan (AHCIP) is limited to people legally entitled to be in Canada who make their home in Alberta and are present at least 183 days in a 12-month period, and refugee claimants are excluded from AHCIP (Lakeland Today, 2026). The province’s own eligibility page refers to people deemed by regulation to be a resident or temporary resident, not including a tourist, transient or visitor, and notes that Canadian children of refugee claimants and of people with expired immigration documents may be entitled to coverage if they live in Alberta and meet specific requirements (Government of Alberta, n.d.). 

For people outside coverage, charges already exist. Alberta Medical Association billing guidance states that patients from out of country on a work visa must apply for health coverage and are then billed to Alberta Health as usual, while a patient between visas can be charged as an out of country patient at two to five times the Schedule of Medical Benefits rate, with a refund available only if a visa is later backdated to the time of service (Alberta Medical Association, n.d.). The province says that people without an approved status would have to buy private health insurance or pay out of pocket, that employers often pay for such coverage, and that people arriving at emergency departments with urgent needs are not denied care based on eligibility, with billing addressed after care is provided (Lakeland Today, 2026). 

Private coverage has a market price. Quotes obtained for a healthy 31-year-old ranged from $273 to $422 for three months of emergency medical insurance and from $1,044 to $1,628 for a year, depending on the level of coverage (Lakeland Today, 2026).

Education: What Families Pay Today

Children of temporary residents currently attend publicly funded schools in large numbers. 46,000 students in Alberta schools are temporarily in Canada, up from 12,943 in 2021 to 2022 (CBC News, 2026). Alberta Education estimates spending $600 million on temporary resident students this year, and the province estimates health care costs for temporary residents at about $400 million, a figure it describes as less precise to track (Ali, 2026). 

A fee structure for international students already exists in the K to 12 system. International students are charged between $11,000 and $14,000 in annual tuition depending on the school board they enrol with (Lakeland Today, 2026). Garrett Koehler, senior press secretary to the Minister of Education and Childcare, said that a Yes vote would not see children of temporary foreign workers removed from schools, but that families may have to pay a fee or the full cost of delivering public education to their children in future school years. The Canadian Bar Association Alberta (n.d.) notes that a law of this kind could exclude or delay children who currently attend as resident students, and that federal immigration law authorizes many minors to attend school even though K to 12 education is governed by provincial legislation. 

The practical question for families is therefore not if a price exists in the system, but which children would move from the funded category to the fee paying one, and at what cost. 

The Legal Frame 

The central legal question is who counts as a resident. The Canada Health Act defines a resident of a province as a person lawfully entitled to be or to remain in Canada who makes his home and is ordinarily present in the province, but not a tourist, a transient or a visitor to the province (Canada Health Act, 1985, s. 2). The College of Physicians and Surgeons of Alberta notes that Alberta’s Health Care Insurance Act defines an insured person as a resident of the province using the same definition (College of Physicians and Surgeons of Alberta, 2014). The same section of the federal Act defines extra-billing and user charges, the two practices the Act restricts for insured persons. 

The two sides of the argument follow from that definition. The province states that the Canada Health Act does not require provinces to insure temporary residents, and that emergency health care would still be provided as it is for visitors (Government of Alberta, 2026). The Canadian Bar Association Alberta (n.d.) notes that any change must account for the Act’s residence-based definition of insured persons. Whether a worker who holds a valid permit and lives in Alberta year-round falls inside that definition and is therefore an insured person who cannot be charged for insured services, is the point in dispute. It is a question for courts rather than for campaign materials. AAISA does not offer a legal opinion on it, and organizations planning for implementation should assume the question would be litigated. Until legislation is drafted, the scope and legal treatment of any fee structure remains uncertain. 

What Remains Unclear

• Would the charge be an annual premium, a payment at the point of service or a tuition style fee per child? 
• Would it be per person or per household, and how would dependants be counted? 
• Who would collect it: Alberta Health, school boards, employers, or a new administrative body? 
• What happens when a family cannot pay? Would a child be removed from a class, or would an unpaid balance follow the family? 
• Would employers be expected to cover the cost for workers they recruit, as many already do for private insurance? 
• How would refunds work for someone who becomes a permanent resident partway through a year? 

These are not abstract questions. Each one influences whether a fee functions primarily as an administrative charge or has a more significant effect on service use and participation. 

Where AAISA Stands 

AAISA does not tell Albertans how to vote. Our role is to make sure the people who serve newcomers understand what each question would and would not do. Question 4 leaves a central question unanswered: what constitutes a ‘reasonable fee or premium’? Its practical impact would depend largely on the amount established and how the fee is implemented. 

Lastly, discussions about immigration, belonging, and future uncertainty can be challenging. If you or someone you know is feeling overwhelmed, 211 Alberta can connect you with local mental health, counselling, crisis, and community supports. Settlement workers, volunteers, community leaders, and newcomers may all experience stress during periods of uncertainty. Reaching out for support is a normal and healthy response.