Economically Inactive EU Migrants and the NHS: Unreasonable Burdens Without Real Links?

Abstract

Under pressure to make healthcare provision more affordable, questions of access to healthcare have gained prominence in most countries in recent years. In light of these concerns, this article examines a grey area of EU law: can economically inactive EU migrants rely on entitlement to the United Kingdom’s NHS to satisfy Directive 2004/38’s requirement for them to have “comprehensive sickness insurance”? In particular, it considers whether the United Kingdom can rely on the EU law concepts of “unreasonable burden” or “real link” to restrict economically inactive EU citizens’ access to the NHS. It finds that neither concept effectively prevents those who are not “contributing” to public finances from accessing publicly funded healthcare. The article concludes by recommending EU-level co-ordination of responsibility for social security coverage in order to ensure that universal, residency-based healthcare systems like the NHS remain sustainable in a post-citizenship European Union.