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Healthcare anguish for expat retirees

British MPs told if EU health schemes are axed after Brexit pensioners may return in ‘droves’ – but may also have no immediate healthcare rights in the UK

British MPs were told at a House of Commons hearing that there is “a high level of anguish” and “really great fear” among British pensioners in France, over their residence and healthcare rights when the UK leaves the EU.

This is because they risk losing their right to French reimbursements if the European 'S1' scheme ends for Britons – however an MPs’ health committee also heard that those returning may also face having no immediate rights in the UK. 

While the hearing focused on the reciprocal nature of EU health schemes put at risk by Brexit, in reality whether or not Britain continues to pay for its retirees' healthcare is in the UK's gift as it would not involve new costs to the UK. 

At the hearing the chairman of the British Community Committee of France, Christopher Chantrey, told the committee that loss of rights under the EU’s S1 form “is the principal concern of hundreds of thousands of UK pensioners living in other EU states”.

Speaking as one of a panel of experts called by the MPs, on behalf of a coalition of expat groups, he said private insurance is not a practical replacement for pensioners, most of whom have pre-existing health conditions and many of whom live on low incomes – and who he said France would probably not cover because “they have not contributed to the [French] system”.

If there was no replacement system in place by ‘Brexit Day’ he said: “Those people will come back to the UK and be a further burden on housing resources and on the healthcare and social services resources of this country. I can’t see that the government would want that. We’re talking of a figure of possibly 100-300,000 people being forced to return in a state of poverty to this country.”

Another panellist, professor of European public health Martin McKee, noted their finances would be further damaged by the fact that Britons leaving in large numbers from popular expat areas would see the values of their homes plummet and would struggle to sell them, meaning they would “have to throw themselves on the mercy of the state when they get back”.

Mr Chantrey said the fact the government’s Brexit white paper says ‘no deal is better than a bad deal’ was especially bad news for Britons abroad, who he said should be prioritised in the Brexit negotiations before “all the stuff about trade and regulations”.

“It’s about people’s lives and livelihoods,” he said. “If the UK turns its back and says ‘no, we’re doing Brexit’, and they are cut off with nothing, the so-called a ‘cliff edge’, it would have dramatically awful consequences. ‘No deal’ is the worst-possible scenario and would affect hundreds of thousands who have moved abroad in the EU in good faith on the implicit promise that these arrangements would continue. It would be absolutely terrible. They will have to come back in their droves and will be a huge drain on the NHS and the state in general”.

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However another panellist, professor of healthcare law Jean McHale, noted that even in this worst-case scenario pensioners may find they are not immediately eligible for healthcare in the UK.

This is because the UK is meant to apply a test of ‘ordinary residence’, a somewhat vague notion which includes showing that you are “settled” there for the time being, which may be difficult for a Briton who has just arrived after many years away.

Prof McHale said: “They could find themselves in a very difficult situation indeed. In many ways Brexit D-Day will be absolutely critical and there is almost a danger of relying on the fact that we might have transitional arrangements, which might lull us into a false sense of security about what could happen. We must consider the cliff edge scenario and work back from that.

“This needs to be sorted out so people are not stranded in other EU countries after Brexit and being presented with requests for payment and asked: ‘Mastercard, Visa or American Express?’.”

Mr Chantrey noted that even healthcare rights for working Britons in France, or those with French pensions, remain dependent on them retaining their basic right of residence, and though they are unlikely to be “thrown out”, their future position if they cease to be European citizens has yet to be defined. The discussion did not speculate on whether British pensioners in France might become eligible for French healthcare under France's national 'Puma' scheme, which is meant to provide healthcare to all on the basis of stable, legal residence in France (involving a an annual payment at a percentage of income for those - not including French or EU state old age pensioners - deemed 'economically inactive').

The question of loss of European Health Insurance Cards (Ehics) for British residents visiting EU countries – such as French second home owners spending time in France - was also raised. Prof McKee said a week’s full private health insurance for holiday in France for a 70-year-old with typical health conditions costs £800-2,500, though he said that could be a conservative estimate because at present private insurers were factoring in Ehic rights.

“Otherwise they could go without, but they would be taking a significant risk if they did and something went wrong,” he said.

MPs and panellists also considered the issue of the costs to Britain of the EU schemes (Ehic and S1), which were said to be higher than the costs recouped by Britain from other EU states.

However panellists said this may partly be (despite attempts by the UK to tighten up on this in recent years) because Britain has no simple and standardised method for identifying people who are not entitled to NHS healthcare paid for by the UK – as opposed to France where one either has a carte vitale and qualifies, or one does not.

Mr Chantrey said this was not the EU’s fault. “It is because of slackness in the system. I think, if you’re running a health system, from day one in 1948 you should have sussed this out.”

One panellist said another factor is that EU citizens moving to the UK are immediately entitled to a British Ehic, whereas he said in some EU countries new residents do not immediately enter the state system and gain entitlement to a national Ehic. Also Britain issues Ehics for five years, whereas in some EU states they may last as little as 40 days (it is two years in France).

Another part of the equation (not explicitly discussed) is that British expats are often retired people making heavy use of healthcare via S1s, whereas the French in the UK are typically young workers moving for jobs in the south-east. 

It was also pointed out to MPs that Britain pays nothing towards the costs of actually building hospitals in the EU countries, whereas if many Britons came back new infrastructure might have to be built.

The option of Britain simply remaining part of the existing EU schemes may not be possible, said Prof McKee, because it would probably mean the UK remaining subject to changing EU rules and (at least regarding healthcare) under the rule of the European Court for disputes – which the British government is not likely to accept.

One possibility could be bilateral agreements between the UK and other states, but Mr Chantrey said that was likely to be very complex, not least in terms of British health providers trying to recoup costs and having to apply different rules depending on the person’s state of origin.

It was more in the UK’s interest to come to a general agreement with the EU, he said.

The fact that the EU rules currently also allow for free movement between the UK and other countries for planned treatments (paid for by the home state) was also flagged up as another element which could be lost between Britain and EU countries if no replacement is agreed.

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