Transnational Healthcare Rights of Romanian and Bulgarian Migrants in Spain. Between Dilemmas and Coping Strategies

Since 1986 the Spanish National Health System (SNS) gradually expanded its coverage to include all persons residing in the country, regardless of their legal status. In the context of the economic crisis initiated in 2008, the reforms introduced in 2012 (RD 16/2012) meant a radical change in the philosophical foundation of the SNS by reverting its universalistic ethos. Following a narrative of preventing “healthcare tourism”, undocumented migrants (with the exception of minors and pregnant women) were officially left out of SNS, entitled to care only in case of emergency or infectious diseases. The case of EU citizens living in Spain, and notably that of citizens from poorer member states, appeared as a particularly problematic case. While they should be, in principle, covered by EU regulations guaranteeing healthcare for EU citizens throughout the Union, the difference in the situations of nationals from wealthier countries (often retired, or in Spain on tourism, and whose healthcare systems relatively easily assume the cost of the care they may receive from the SNS), and that of citizens from Romania and Bulgaria (economic migrants, with very significant difficulties to get the social security systems of their country of origin to assume those costs), has introduced a very radical distinction between them. This situation reflects on the one hand the difference in the development of social rights in EU member states, but also the complex articulation of healthcare rights within the EU, and the complexity that migration and mobility introduce in the multilevel governance of welfare.