N.S. government tables $14.4B budget dominated by health-care spending

The Nova Scotia government's 2023-24 budget shows major increases in tax revenue and much of it is being spent on projects related to health care.

Finance Minister Allan MacMaster tabled his government's second budget on Thursday, a document aimed at meeting the Tories' ambitious promise of fixing health care while signalling that promise will take time.

"As a growing province, we have the capacity to make significant investments in health care to fix it," he told reporters.

"This budget provides faster access to health services, delivers solutions to build the health-care workforce, offers improvements for seniors and long-term care and advances our plan to build more health-care facilities sooner."

The budget shows $14.2 billion in revenue and $14.4 billion in expenses, with a deficit of $278.9 million, an improvement on last year's estimate of $506 million. The lion's share of expenses — $6.5 billion, or 45 per cent of all government spending — will go toward health-care projects.

Tax revenue up $1.5B

Driving this new spending is an increase in tax revenue of $1.5 billion, about two thirds of which comes from provincial sources. The government is seeing increased personal tax revenue as a result of more people moving to the province, and a major increase in corporate taxes.

The estimate for 2023-24 is $204 million higher than the previous fiscal year, a reflection of strong corporate profits, Finance Department officials said during a briefing.

Equalization funding from Ottawa is up by $344.5 million, accounting for the majority of the $562.7 million the province is scheduled to receive from the federal government.

Department expenses are up 11.5 per cent, or $1.4 billion compared to last year. As usual, the Health and Wellness Department leads the way at $4.85 billion.

The government pointed to a variety of spending initiatives, many of which have already been announced or are continuations of existing programs. They include:

• $110 million for the second year of retention bonuses announced earlier this week for health-care workers.
• $46.6 million to improve surgical access and increase operating room hours, although the Health Department confirmed that no operating room has the necessary staffing yet to extend hours immediately.
• $22.2 million for efforts related to a new health-care workforce strategy.
• $17.7 million for initiatives related to expanding mental health-care services.
• $22.6 million to expand EHS transfer units and a new fixed-wing LifeLight aircraft.
• $1.7 million to hire 10 physician assistants for primary care clinics.
•  $4.7 million to make the high-dose flu shot free for everyone 65 and older.
• The program that forgives provincial income tax on the first $50,000 earned by people younger than 30 is being expanded to include nurses.
• $25.9 million more for home-care services.
• $1.7 million to help with increased demand for gender assignment surgeries.
• The government is adding 14 new cancer drugs to the pharmacare program.

New details on health-care projects

The budget includes more details about major health-care infrastructure projects, such as the expansion of the Halifax Infirmary and projects in Cape Breton Regional Municipality.

In total, those efforts will cost $275.1 million this year.

That breakdown includes $130 million for the multi-year expansion project at the Halifax Infirmary and $20 million for the site's new MRI machine. There is $14 million for the design and renovation work at the hotel the government recently purchased in Bedford to convert into a transitional care unit.

In Cape Breton, major projects include $23 million toward the new cancer care unit and $35 million for the Northside Health Complex.

There is money to maintain and expand long-term care sites and $10.7 million to help more long-term care homes provide 4.1 hours of care per resident. And while staff challenges persist in the long-term care sector, the province is budgeting $15 million for travel nurses to help fill gaps.

Major drivers of spending in education include the continuation of the program to reach $10/day childcare across the province and money to renovate existing schools and build new schools.

The government will also spend $1.5 million on the Nova Scotia Loyal Program, an incentive program the Tories hope increases spending on local products and businesses. MacMaster said in his budget address that the program is expected to launch this year.

Child benefit gets a boost

On the social front, the government is increasing the Nova Scotia Child Benefit by $8 million.

For a family making between $26,000 and $34,000, that will mean an additional $250 a year for one child and an additional $125 a year for any subsequent children. Families that make less than $26,000 would get an additional $250 for each child in the house.

The disability support program is increasing by $28.7 million. There is $6.2 million for the redesign of the province's foster care program and $4.4 million more to help people transition from residential centres to community-based living options.

There is $8.2 million aimed at homelessness and supportive housing initiatives, and the government will spend $21.6 million to create 1,000 new rent supplements, bringing the total in the province to 8,000. Although there is money for maintenance of existing government-owned housing, there is no money to add to that stock.

Despite the social spending, the Tories are not increasing income assistance rates, marking two years in a row that the rates have remained the same.

Opposition wants more help for those most in need

NDP Leader Claudia Chender said the government missed an opportunity to help the people who struggle the most with cost of living pressures. 

"No one feels it more than the people who are on social assistance," she told reporters.

"The fact that in this inflationary period we are not seeing any increase to those amounts means that it is harder and harder for people to simply live day to day. There's not affordable housing, everything has gotten more expensive."

Chender said she also wanted to see more of an investment in affordable housing and ways to cut into the province's growing number of people looking for a primary health-care provider.

Liberal Leader Zach Churchill said the government could have reinstated incentives for family doctors in the urban area of Halifax Regional Municipality to help cut into the list of 137,000 Nova Scotians looking for a family practice.

By not increasing income assistance rates or doing more to increase affordable housing, Churchill said the government risks placing a larger strain on the health-care system.

"I do think we have a risk of health outcomes getting worse for people as a result of where they're spending their money," he said.

MacMaster said his government is choosing instead to focus on targeted initiatives to help the most vulnerable members of society. But he noted that the government could revisit the issue of income assistance rates if deemed necessary.

"Today's budget is an estimate. They're estimates," he said. "They're not locked in stone."

The province's net debt is projected at $19.5 billion for the new fiscal year, with a 33.6 per cent net debt-to-GDP ratio. The province is estimating deficit spending through the next four years.

MacMaster said that's an indication of the work that will be required to address the needs of the health-care system, but he said the spending is sustainable thanks to the growth Nova Scotia is experiencing.

Update on 2022-23 fiscal year

Thursday's budget also included details about the fiscal year about to close.

In March alone, the government approved $577.9 million in unbudgeted spending, the majority of which went to bonuses announced this week for nurses and other health-care workers. In total, the government signed off on almost $1.6 billion in unbudgeted spending in 2022-23.

None of that money was debated in the legislature, which is an issue the auditor general has flagged. Although MacMaster told reporters that the practice is a continuation of what past governments have done, Chender said it flies in the face of the Tory election campaign in 2021.

"The fact that there is this massive loophole that allows the government to do whatever it wants is troubling, especially for a government that came to power arguing for transparency and accountability," she said.