Health insurance for all children in Quebec? Ethical reflections on the implementation of PL 83

The adoption of Projet de loi 83 (PL83) in 2021 aimed to grant previously uninsured migrant children in Quebec access to provincial public health insurance. Three years later, health professionals continue to encounter children who should be eligible for provincial insurance through PL83 but remain uninsured and who face various structural barriers that contribute to this limited access (language, administrative navigation, and access to information). This commentary, based on the conceptual framework of the ethics of care, considers autonomy as the ability to make one's own choices with support from others. Contrary to a conception of autonomy as self-sufficiency, the ethics of care encourages the design of policies and implementation measures capable of helping vulnerable individuals overcome barriers. In the case of access to healthcare for migrant children, we suggest presumptive eligibility and raising awareness among all key stakeholders who interact with parents, from admission and administrative staff to physicians.