Traditions of regional citizenship: Explaining subnational variation of the right to healthcare for undocumented immigrants

ABSTRACT

Why does undocumented immigrants’ access to healthcare beyond urgent treatment differ across the territory of the same state? Through a comparison of Italian regions and Spanish autonomous communities, this paper contends that traditions of regional citizenship concerning the protection of vulnerable subjects shape policy choices in significant ways. Left-wing regional governments use traditions as building blocks that enable the protection of healthcare for undocumented immigrants, while right-wing regional governments invoke traditions to delegate intervention to civil society actors. By activating traditions of regional citizenship for different purposes, subnational governments define distinctive preferences concerning migration, healthcare and welfare.

KEYWORDS:

• undocumented immigrants
• multilevel governance
• healthcare
• citizenship

JEL:

• I3
• I18
• R23

View correction statement:

Correction

ACKNOWLEDGEMENTS

The author is grateful to all those who made themselves available for interview and dedicated some of their time and passion to his research. The author is also thankful to all his colleagues who commented on previous versions of this paper: Andrew Geddes, Anita Manatschal, Christina Zuber, Ferruccio Pastore, Giuseppe Sciortino, Irene Ponzo, Jean-Thomas Arrighi, Liesbet Hooghe, Maurizio Ferrera, Nicola Pasini, Rainer Bauböck, Verena Wisthaler and Willem Maas. Finally, the author acknowledges the extraordinary work of the two anonymous reviewers and the editors who went out of their way with constructive ideas and suggestions.

DISCLOSURE STATEMENT

No potential conflict of interest was reported by the author.

Notes

1. In a series of subsequent decisions, the Italian government introduced additional specifications to the type of intervention that must be guaranteed. Today, undocumented immigrants are not entitled to register in the SSN, but can access urgent or essential treatment through a temporarily resident foreigner (Straniero Temporaneamente Presente – STP) code.

2. There are no official statistics on the size of the undocumented population in these regions. However, the relative number of undocumented immigrants is likely to be correlated with the number of the overall foreign population in these regions, which are detailed in Appendix A2 in the supplemental data online. Therefore, it is plausible to conclude that the number of undocumented immigrants in the four regions selected is relatively higher than the average number of undocumented immigrants in the other regions of the state.

3. The national government brought the Tuscan law before the Constitutional Court, arguing that it represented a breach of the exclusive state competence to regulate immigration. In judgments numbers 269 and 299 of 2010 and 61 of 2011, the court upheld the Tuscan law, defending the right of regions to implement effective territorial policies, with particular reference to health and social assistance. On the idea of civicness in Tuscany, see Putnam (1993) and Ramella (1998).

4. Five other autonomous communities filed appeals against RDL 16/2012: the Basque Country, Canary Islands, Catalonia, Navarre and Asturias. The cases raised by Navarre and the Canary Islands referred to the national government's violation of the constitutional right to health, while those of Catalonia and Andalusia were based on the interference of the national government in regional competences.

Additional information

Funding

This research was generously supported by the National Center of Competence in Research (NCCR) for Migration and Mobility Studies on the move, funded by the Swiss National Science Foundation [grant number 51NF40-182897].