Although the Canada Health Act (CHA) (1985) has largely achieved its original purpose over the past 40 years, the challenges facing the Canadian health system today call for substantive updating and strengthening. This CHA 2.0 would recognize a major shift in primary care and include as insured services primary care providers beyond physicians. Other areas that should be addressed include ensuring substantive and timely access to insured services (with a proposed primary care guarantee) and provisions for greater transparency and accountability. These improvements would be better achieved through a CHA 2.0 and a more accountable Canada Health Transfer rather than companion legislation or time-limited federal transfers to provinces and territories. Unlike the CHA, companion legislation would be more easily dismantled by future governments and work against efforts to better integrate health service. 

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