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Precarious health

The absence of free medical attention for undocumented immigrants threatens civil rights that are enshrined in the Constitution

From September 1, at least 150,000 non-European Union immigrants whose papers are not in order in Spain will see their access to public health services significantly restricted, endangering their constitutional right to healthcare protection. The decree on urgent measures to guarantee the sustainability of the National Health System, which comes into effect on Saturday, restricts access to healthcare for a group of people who are at the bottom of the social scale to just emergency cases, pregnant women and minors. With this restriction the government aims to save some 500 million euros a year, although more realistic calculations put this figure at half what the administration estimates, roughly the same as what it fails to charge other countries in the European Union because of deficiencies in the system of billing health services provided to foreign nationals living in Spain.

The measure not only puts an end to the system of universal healthcare, but also the concept that this should be free. Undocumented immigrants can have access to full healthcare services if they take out a sort of insurance policy — special agreements with the health authorities — at a cost of 60 euros per month for people aged between 17 and 65, and 155 euros for those over 65 years of age. Little is known of these agreements and how they will be put into practice. This is not the only, nor the most egregious, of the incongruities in the measure. Incoherence bordering on brazenness reigns supreme in this telling manifestation of the government’s remoteness from social reality in asking people without work to pay sums that are beyond their means. Five regions — Galicia, Andalusia, the Canary Islands, the Basque Country and Asturias — have rebelled against an imposition they believe undermines equity and social cohesion. The restriction not only harms the health of this already deprived echelon, but that of society as a whole.

Strains of xenophobia

The grasping intent of the measure has been pointed out, but not its possible unconstitutionality. Jurisprudence of the Constitutional Court has established the right to health protection as a constitutional right of “legal configuration.” It may be limited but not abrogated in its essential aspects. The Ombudsman has latched onto the idea that universal healthcare can be limited as the reason for deciding not to appeal the measure. But an excessive and disproportionate limitation of this right may be unconstitutional, if it is tantamount to it being annulled. The Ombudsman needs to analyze the measure with greater attention to determine whether this is in fact the case. In order to obviate the perversion of this right, the World Health Organization requires primary healthcare, prevention and access to basic medication. It would seem the government’s decree fails to meet these requirements. To leave the decree as it stands could be interpreted as an invitation to these immigrants to go back home, as was pointed out by Popular Party lawmaker Rafael Hernando in Congress — a statement that certainly carried with it a certain ring of xenophobia

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