Parliament limits SNS access for non-residents and undocumented migrants
They will be required to provide proof of health coverage and other necessary documentation, except in emergencies.
What?
Last night, Parliament passed a controversial bill restricting access to the National Health Service (SNS) for undocumented migrants and non-residents.
Under the new law, proposed by the ruling PSD (Social Democratic Party) and CDS (People’s Party), with support from far-right Chega, undocumented migrants and non-residents will no longer receive free healthcare services from the SNS.
They will be required to provide proof of health coverage and other necessary documentation, except in emergencies. Even in urgent cases, these documents must be presented afterward.
The list of foreign beneficiaries of the SNS will now include only those “with regular residency status in national territory, or in a temporary stay or residence situation in Portugal, who are nationals of EU member states or equivalent, nationals of third countries, as well as stateless persons or applicants for international protection.”
All the other parties in Parliament, including the right-wing Liberals (IL), voted against the proposal.
Two additional initiatives by Chega were also approved (also with votes against from the left and IL, and in favor from PSD and CDS): one stipulates that foreign nationals, stateless persons, migrants ‘without legal status,’ and ‘international protection applicants whose requests have not yet been approved’ must pay to access the National Health Service (SNS), except in emergency situations.
The other requires non-resident foreign nationals to pay “moderation fees or the full costs of medical procedures”—including in emergency cases where there is a prior referral by the SNS or emergency hospitalization, as far as the fees are concerned.
Recommendations from the PS were also approved, calling for the government to monitor foreign nationals’ access to the SNS (with Chega voting against) and from IL to require that non-emergency healthcare costs be paid in advance (with Chega, BE, PCP, and Livre voting against, and PSD and CDS abstaining).
The remaining initiatives from Chega were sent to the health committee for further review during 60 days. The party aims to require health insurance from foreign nationals as a condition for obtaining a visa and to limit the granting of nationality.
It also recommends that the Government conduct a review and disclose the financial terms of bilateral agreements with other countries in the healthcare sector and implement measures to increase transparency in non-residents' access to healthcare.
Unconstitutionality concerns
The decision has sparked a heated debate. Right-wing parties argued that free access for undocumented migrants strains the SNS and creates inequities for Portuguese taxpayers.
Former President of Order of Physicians Miguel Guimarães (PSD) and João Almeida (CDS) highlighted instances of foreign nationals allegedly exploiting the healthcare system, asserting that such practices impose financial burdens and reduce access for Portuguese citizens.
Left-wing lawmakers, however, condemned the move as discriminatory and unconstitutional.
Alexandra Leitão of the Socialist Party (PS) reminded Parliament that the Constitution guarantees equal rights and duties to foreign nationals. She accused the AD coalition of conflating short-term visitors with undocumented residents, many of whom contribute to Social Security.
In Portugal, before signing a bill into law, the President of the Republic can request the Constitutional Court to conduct a preventive review of its constitutionality. If the court determines the bill is unconstitutional, the President must veto it and return it to Parliament. Parliament may attempt to amend the bill to address the identified issues or abandon it altogether.
Other critics, including Paula Santos (from the communist PCP) and Marisa Matias (from the Left Block, BE), described the policy as inhumane and a violation of basic rights. They warned that denying healthcare to undocumented migrants could exacerbate vulnerabilities within immigrant communities and endanger public health.
Paulo Muacho of ecosocialist Livre emphasized that excluding certain groups from healthcare access could increase risks for everyone.
Meanwhile, André Ventura of Chega doubled down on his party’s stance, asserting that those benefiting from the SNS must pay for it.
What the data says
A report from the General Inspectorate of Health Activities (IGAS) released earlier this month indicated that, in almost four years (from 2021 to September 30 of this year), nearly 330,000 foreign individuals not residing in Portugal were treated in public hospitals.
In 2023 alone, 102,182 foreign individuals not residing in Portugal were assisted in the emergency services of the National Health Service (SNS) hospitals.
Regionally, the report shows that, over the past four years, three units saw a demand of over 40,000 people in these conditions: the Local Health Unit (ULS) of Algarve, the ULS of Oeste (which serves the population of the municipalities of Caldas da Rainha, Óbidos, Peniche, Bombarral, Torres Vedras, Cadaval, Lourinhã, and part of the municipalities of Alcobaça and Mafra), and São José, in Lisbon.
In July, Minister Ana Paula Martins had already acknowledged in Parliament that there are foreign patients who come to Portugal specifically for expensive treatments in the SNS, explaining that she didn’t have the figures but that the reality was known to hospital administrators and that the ministry would study the issue for potential intervention.
“To be able to intervene, we need to have the numbers,” the Minister said. At that time, the person responsible for the Health portfolio also mentioned that the academy would conduct a study on immigration in Portugal.
She also noted that “the Central Administration of the Health System (ACSS) currently has a monitoring line exclusively for international patients, who, through a special health tourism program, end up receiving treatments, some of which are quite costly in Portugal.”
It is estimated that the debt left in hospitals by these patitiens could be in the millions of euros. However, in a parliamentary hearing this week, the President of the Ministry of Health’s Shared Services didn’t reveal figures.