The Canada Health Act (CHA) (1985) stands as a symbol of Canada’s commitment to universal healthcare. However, there remain critical gaps that undermine the original vision of equity in healthcare. In this rejoinder to Flood and Thomas’s (2025) analysis, we recommend a fundamental reinterpretation of the CHA to address persistent inequities. While the CHA has succeeded in removing financial barriers to medically necessary services, it has not fully achieved vertical or horizontal equity. A broader understanding of equity, extending beyond income, is necessary to address deeper, structural determinants of health. We provide theoretical reflections on equity and applied examples to advance our policy recommendations.

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