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Left to their fate

A year on, the law excluding immigrants from healthcare has given rise to great inequalities

It has been a year since a law was passed that prevents immigrants without papers from accessing public healthcare in Spain, and those affected by the measure are now living in a situation of great confusion, being subject to a sort of lottery that generates huge inequalities.

The decree left more than 150,000 adult foreigners without coverage, and as a result, the last 12 months have seen a number of sad episodes of failure to provide medical care, leading in several cases to deaths. But while some regional governments rigorously enforce the measures introduced by the Popular Party (PP) government, offering medical care only in cases of emergency or childbirth, others have continued to supply undocumented immigrants with the healthcare card that gives them access to normal treatment — although most of them demand a year’s residency, to dissuade immigrants from moving to the area. In the regions that have gone along with the exclusion — the Balearic Islands, Cantabria, La Rioja, Madrid, Murcia, Aragon and Castilla-La Mancha — immigrants without papers are wholly unprotected and receive medical attention only in cases of emergency, with no follow-up care and no financing for medication, unless they find an NGO to pay for these expenses.

When the government brought forward this highly questionable law, it argued that the aim was to combat “medical tourism” — the practice of people from rich countries, where medical care is very costly, coming to Spain to benefit from the relatively low-cost treatment available here, often by a variety of subterfuges. The progress that has been made in this direction is worthy of mention, because it is unfair that citizens of other countries — who have their own medical coverage or possess sufficient resources — should come to Spain and not pay for the care they receive. But this objective might have been attained without leaving the most vulnerable class of people, the immigrants who have no coverage and insufficient income, entirely defenseless.

Unaffordable policies

The government has shown unforgivable disdain for this group. Until the month of July it had not even settled on the concrete terms of the agreement with the Social Security system that had been announced, so that undocumented foreigners might receive assistance upon payment of a special medical care policy. This agreement is to enter into effect today, but the cost of the policy — 60 euros a month for those aged 18-64, and 157 euros for the over-65s — is not realistic for a family with several members and a highly unpredictable income.

A year later, we are still looking in vain for at least some evaluation of the social costs of a decision that should never have been made, because it seems to derive rather from motives of an ideological nature — making it as hard as possible for jobless immigrants to remain in the country — than from any medical considerations. And, as the Constitutional Court has said, it infringes on the right to healthcare enshrined in the Spanish Constitution.

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