Canadian PR is harder to lose than US PR. Just living in the US with a Canadian spouse can also count for the requirements to keep it.      Now for the Health insurance yes the act of using Canada's health care system can lead to you losing your PR, as US immigration does not allow you to live in other countries permanently. In order to use Canada's health care you must be living there, not just a summer home,  ppl who work on border towns who still work and pay into Canada's heal