Manitoba Premier Brian Pallister staged a one−man protest of sorts Friday, refusing to sign on to Justin Trudeau’s pan−Canadian climate change framework without first getting an agreement on more federal money for health care.

Manitoba is one of only two provinces that wouldn’t support the climate agreement finalized in Ottawa following a first ministers meeting between the premiers and Prime Minister Justin Trudeau.

It came as no surprise that Saskatchewan wasn’t on board: Premier Brad Wall has long opposed putting a national price on carbon.

But Pallister’s opposition was unexpected, his rationale even more so.

When asked his reasons, Pallister indicated that the Trudeau government’s intention to cut in half the annual rate of increase on health care transfer payments to three per cent in April was simply unacceptable.

The provinces and territories are united in their opposition to changing the funding formula, saying they fear a dramatic impact on health delivery. The premiers have called for a separate meeting to discuss the issue.

"I am concerned about the health of our health care system and so I have an obligation because that’s the first concern of the people of my province to raise the issue," Pallister said. "We need to have a partnership on supporting health care in a sustainable way and right now we don’t."

Trudeau did not acknowledge Pallister’s concerns during Friday’s joint news conference with the premiers and indigenous leaders, other than to say the issue will be discussed in earnest at a meeting of federal and provincial health and finance ministers on Dec. 19.

However, health funding was a hot topic of discussion among first ministers at a later working dinner, which lasted some three hours. Provincial officials said no progress was made on the issue over dinner.

"Absolutely nothing changed," confided one.

Earlier in the day, the premiers tried but failed to push health care funding onto the formal agenda of the first ministers’ summit on climate change.

As chair of the premiers, Yukon’s Sandy Silver advised Trudeau at the outset of the meeting that premiers wanted to talk about federal funding for health care, said sources familiar with what was going on behind the closed doors.

The prime minister quickly directed the discussion back to the environment.

Push−back against the federal health plan was on full display Friday morning as the premiers emerged from their own meeting, which was focused on health spending, before joining Trudeau.

Wall said he wished there was more time to discuss health with Trudeau.

"We could have been talking about it last night, but there was this other thing," the Saskatchewan premier said, referring to a state dinner Trudeau hosted Thursday for U.S. Vice−President Joe Biden.

Wall said he hopes the federal government is urgently looking to get a new health accord with the provinces in place by year’s end.

Some provinces have shown a willingness to accept a reduced annual increase in health transfers if, at the same time, the federal government agrees to put more money, over a longer period of time, into a health accord that targets improvements in home care, mental health services and innovation.

So far, the federal Liberals have promised $3 billion over four years, specifically for home care, but they’ve signalled a willingness to expand that.

Ontario Premier Kathleen Wynne said she wants the federal government to present an "evidence−based" increase in the annual transfer, stressing that the offer presented so far "is not enough."

"It is not going to meet the needs of the people in this country," she said. "It is not going to meet the needs in each of our individual jurisdictions."

Wynne said there is room to talk about trade−offs between the health transfer payments and additional targeted health investments.

"I think those areas are things that we need to talk about, but that’s why we need to have this conversation about health care and that’s why we need to have it at the first ministers level," she said.

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