On October 16, Portugal’s parliament gave initial approval to two bills concerning the country’s public healthcare system, SNS (Serviço Nacional de Saúde). Foreigners who do not live in Portugal would have to pay for treatment or show proof of insurance. The proposals are not yet law: they will be discussed further in committee before a final vote.
Who would be affected
Foreigners without a Portuguese residence permit, as well as those staying in the country illegally. Portuguese citizens and foreign residents with residence permits would not be affected.
What would change
To receive treatment through the SNS, non-residents would have to pay, show proof of insurance, or provide a document confirming that another country would cover the cost. Emergency care would continue to be provided as before, with patients allowed to submit the required documents afterward.
The key question: who counts as being in the country illegally?
The published descriptions of the bills do not address this. Many foreigners in Portugal wait months for a decision from AIMA, the agency responsible for immigration. Some have applied for their first residence permit and are waiting for the card to be issued; others have expired permits and are still waiting for their renewals. Technically, these people may not have a valid document in hand even though they are living in Portugal legally. Whether they would have to pay for treatment remains unclear. The answer will likely emerge as the bills are revised in committee. Chega’s proposal explicitly includes another group: asylum seekers whose applications have not yet been processed.
Who voted for the bills
The proposals were backed by the ruling PSD and CDS-PP parties, which form Prime Minister Luís Montenegro’s coalition, as well as the far-right Chega party. All other parties voted against them. Parliament rejected a more restrictive bill proposed by Chega that would have required patients to pay for treatment immediately upon discharge.
Why the changes are being proposed
According to the bills’ sponsors, between 2021 and 2024, non-residents visited emergency departments more than 140,000 times without insurance, and many of the resulting bills went unpaid. Critics counter that mechanisms for recovering these costs already exist and simply need to be enforced.
Parliament approved similar legislation in 2024, but it had to be introduced again following the snap election.
