“For the previous [right-wing PP-led] government, axing rights was urgent; for the current [left-wing socialist, or PSOE] government, restoring rights is urgent,” announced health minister Carmen Montón in Parliament this week.
Back in 2012, the PP withdrew SIP, or healthcare system registration cards from all non-EU citizens without a valid residence permit and, only in response to pressure from the opposition, agreed to allow them free emergency treatment, all medical cover for the under-18s, and pregnancy, labour and post-partum care.
This mainly affected the very poor, from third-world countries, some of whom had been living in Spain for years but had as yet been unable to find sustainable, non-cash work to enable them to apply for residence.
Given their origin, it mean infectious and tropical diseases could, potentially, go untreated, putting the rest of the population at risk, and as these people were in the most precarious position, were unable to pay for care and what could start off as a minor, treatable condition may end up becoming an emergency – which would have to be treated – or even lead to death.
The ban also affected non-EU nationals whose residence had expired and who were facing problems renewing it, largely due to problems finding work or having to work cash in hand to survive.
One of the most high-profile cases was of 29-year-old Hanane, from Castellón, whose breast cancer had metastasised into her bones and who was unable to get chemotherapy or morphine patches from her nearest hospital.
After 10 years in Spain, she and her husband’s residence had expired, and as their only income was from cash-in-hand sales at markets around the country or seasonal fruit-picking, they could not renew it.
Eventually, however, doctors at surgeries and hospitals in practically every region in Spain defied the government and carried on treating those who were not eligible – even if they were forced to do so out of hours.
By the time the PSOE got into power in June this year, only Murcia and Asturias were not treating undocumented migrants.
Perhaps just as crucially, difficulties faced by foreigners – early retirees or working-age residents not ‘in the system’, even EU citizens – will now be over.
Spain has always allowed universal and free healthcare for anyone legally resident in Spain under Article 43 of the Constitution, signed in December 1978, but confusion and misinformation have long abounded, with non-working expats under State pension age believing, or even being told ‘officially’, they needed private health insurance.
Some confusion still exists, however, since non-EU citizens are needing to show proof of health insurance to be able to apply for residence, even though they will be covered by the State once they are legally resident – but it is likely this will be clarified gradually.
There remains some confusion as to whether Carmen Montón even intends to extend free healthcare to tourists.
EU citizens carrying an EHIC card can obtain treatment for ’emergency’ care, defined as anything that cannot wait until they return home, not necessarily a life-or-death situation, although foreign offices outside Spain still strongly recommend taking out insurance to cover any shortfall.
Non-EU citizens visiting for holidays or more extended periods but not long enough to be considered ‘resident’ should have travel insurance.
Until the situation becomes clearer, tourists in Spain should still take out the usual insurance to avoid unexpected bills for healthcare.
At present, based upon Montón’s announcement, rights to healthcare will be based upon residence rather than as being ‘insured’ or ‘beneficiaries’.
The PP criticised the move, claiming it could open the door to ‘rich Americans’ becoming ‘health tourists’ in Spain if they were not insured for the treatment they needed in the USA.
Montón cited various studies which have shown that reducing healthcare rights to any type of resident, illegal or legal, with or without Social Security cover through their work, had supposed no significant saving whatsoever in financial terms or in medical staff’s workload, meaning there was no practical justification for denying care to those who are not ‘paying into the system’.