This lecture will focus on mobile EU citizens' pension and health care rights and how European citizenship sometimes become unequal in practice. By practicing their rights, EU citizens become important actors in the process of transforming EU citizenship into a tangible reality as Anoeshka Gehring has put it in her work about mobile pensioners. Pensioners in the EU have the right to reside in another member state when retiring. This has typically been a move from the Northern and continental parts of Europe to the Southern member states. With them, they bring their pension and get access to the healthcare system of their new country of residence. In her work, Gehring looks into the 'lived citizenship'. That is the meaning people attach to citizenship in their daily lives. EU retirement migrants often have a dual orientation. A dual orientation refers to a duality of resources and references. Gehring also finds that identification as European citizens differ between individuals. Some identify with Europe as a post-national entity. Others see themselves as privileged migrants moving between member-states. Looking into the numbers of pensions exported from one member state to the other, we see that Germany is the country that has paid by far the most pension to people residing in other EU countries. Followed by France, Poland, the Netherlands, Austria, Belgium, and Sweden. We also see that the former EU member, United Kingdom, was among the top scorers of exporting pension abroad. At the receiving end, we then see that most pensions are exported to pensioners residing in Spain, in Germany, Italy, and France. Rights are also practiced in relation to health care. Again, these rights are remarkable. Probably nowhere else in the world do states allow citizens from other states to access and be treated in their national health care systems. That is without having to pay or show their insurance card on entry. However, it's important to note that EU citizens have different routes to receive cross-border health care and their rights differ according to which route they take. There are three main routes into health care in another member state. One root is when EU citizens have a right to receive health care in a new country of residence in accordance with the national legislation of that state. If the state offers a public health care system, one has a right to be treated equally in relation to health care with the state's own citizens of that system. An EU citizen residing in a new member state, cannot be exposed to extra waiting time, to different quality or out-of-pocket payment, but shall be treated on equal terms. A second route to take is a different rule and conditions system. That is when EU citizens want to have planned health care treatment in another member state. Let's say that you would rather have your eye surgery in Germany than in your own state of health care affiliation. For example, that could be Sweden. However, here it's very important to be aware of the limits to the right. These limits are result of lengthy negotiations by EU politicians and detailed in the patient rights directive. The directive which is called 2011/24. The most important limits to the rights are, 1st, you can only access treatments that you are already entitled to back home. It is the health care package of your own country of affiliation that sets and details your entitlements. 2nd, you will only be reimbursed up to what a similar treatment is tariffed to back home. 3rd, as a patient, you will have to pay for your own treatment upfront, and then you'll be reimbursed when you return to your own country of health care affiliation. 4th, for hospital care and also for highly specialized and cost intensive care, you have to be authorized by your member state of affiliation before going to another member state of treatment. As a 5th condition, treatment of patients from other member states can actually be refused for capacity reasons, for planning, or for financial reasons. So the second root is about planned healthcare treatment. But the third root is then about unplanned healthcare treatment. That is, EU citizens are entitled to the European Health Insurance Card. The card gives access to medically necessary state provided healthcare during a temporary stay elsewhere than in your state of residence. This will typically be if you as a tourist fall ill and need treatment. Thus, this is one of the benefits granted to EU citizens, which is not work-related. The card entitles to unplanned healthcare treatment under the same conditions and at the same cost, which is free in some countries as people insured in that country. Back then, when first introduced, the president of the European Commission, launched this card as more Europe in your pocket. However, also the third root shows that it is not eventually an equal access. Recent research has shown that the possession and the use of the European health card is very uneven across Europe. In the recent study, Stan, Erne, and Gannon point out that there are considerable obstacles to obtain and make use of the European health insurance card. The main obstacles they find in their work are that EU citizens have to be publicly insured in their country of residence. So those who are not do not have a card. They have to master specific knowledge about the rights and administrative procedures in relation to the card, and they also have to be able to travel abroad and to afford that travel. As there is uneven distribution of these resources, the possession and use of the European health card is highly uneven. The research shows that the possession of the European health insurance card is generally selective in the EU, but more so in Eastern than in Western Europe. In 2016, 45 percent of the population in Western Europe had the card, compared to just 18 percent in Eastern Europe. The findings by Stan, Erne, and Gannon points to an uneven uptake of this social dimension of European citizenship. Dr. Cecilia Bruzelius from University of Tubingen, is another scholar who have looked into how EU rights are practiced. To know more about Bruzelius' and her co-authors findings, I interviewed her about her research. You already have a long track record in researching on free movement of persons, of workers in the European Union and their attached social rights. If you were to sum up, what would you say are your main findings? One thing, the debate for generally the public debate as well as, or in particular the research on these issues is very much focused on what happens in the countries of destination and I think what everyone should also add that one thing that leads to is that we look primarily at the richer Northwestern European states because mobility between member states doesn't happen evenly. We look primarily at some member states and not on others. The other issue here is not just, I think countries of destination, but that there is a tendency to look at formal rights. So, that's what I call 'whether' someone has a rights. Researchers will look at EU law. It says, ''Under these conditions, an EU citizen who moved from one member state to another has the right to access this or that benefit or service.'' Of course, what it says in the law is not always what happens in practice and this is not sufficiently looked at. Looking at country of destination as well as formal rights has been the main trend, I think in research on this. According to you, is that a sufficient perspective? No, it is not. There are two reasons for that from my point of view. One has to do with what social rights are and what we need to look at if we want to understand them. The other has to do with how the regulation of cross-border rights in Europe works. In terms of the first thing, what are social rights? If we only talk about legally defined rights, we will miss part of the story, so it's not enough to know that someone has an entitlement to say an unemployment benefit, we need to also consider what it is that they can get, because if that benefit is so low that you are anyway starving when you're looking for new work, it's not much of a social right, it doesn't give you much protection. When studying social rights, you always need to look also at the substantive side of that right. In terms of the second issue, why it's insufficient, the way mobile EU citizens rights work is this is regulated by the so-called EU social security coordination, and that one doesn't just regulate what rights and under what conditions EU citizens have rights in the country of destination, it actually makes certain rights portable between member states. Some rights, some benefits can be exported from one country and imported to others. This is especially important for economically inactive EU citizens' rights. Those who are not workers don't classify as workers, for example, job seekers, pensioners, students, when they move to new member state they have very limited or no rights in the country of destination, so they cannot access the welfare provided there. They're dependent on what they can export from the previous country of residence or work. Especially for that group, we need to look at portable rights. In fact, when we do that, we begin to notice that the rights that someone can export are very, very different so the substantive rights differ very much. Does this mean according to you that we have a European citizenship which differs, diverges in practice? I would say yes, it does. So if we think of the question 'what is EU citizenship', of course, and many academics, but also beyond, legal scholars would define a EU citizenship in terms of rights. So defining citizenship, one way is to define it in terms of rights. And one right that's fundamental to EU citizenship, it is a fundamental right, is free movement. Now, free movement is to me connected in turn to social rights in two ways. So on the one hand, social rights, EU citizens have social rights according, or they're connected to the EU citizenship through free movement in that it's only once you move when you use your right to move that the whole legislation on non-discrimination that gives you rights in another member state is activated as it were. So you need to move first to enjoy the social rights that are attached to EU citizenship. But free movement is itself, one could argue tied to social rights. So free movement is on the one hand about there not being any barriers to movement. So you have the right to leave a country and you have the right to enter another. But in my view and also my co-authors view in the paper that we're backdrop here, we think of free movement as something that requires enabling conditions. So if you can leave a country and enter another, but you have no ability to settle because you don't have the means, the financial means, then you don't have full free movement. You'll be forced to return. Social rights is a way to embed the right to free movement, to make it a meaningful right that you can actually enjoy or use. The idea with exportable rights or the portable rights is the right word, is that, for example, with the unemployment benefits that, the EU citizens should have the opportunity to look for work in another member state. Because there is an unequal opportunity to use free movement, there is not an equal EU citizenship in practice, if we take it seriously that free movement is a fundamental right of EU citizens. Thank you very much Cecilia Bruzelius for presenting your research findings here and also for giving this perspective of portability and the margins of free movement and cross-border welfare, if we could call it that. Thank you very much. Very interesting. Thank you, Dorte. In this lecture we have seen that although the substantive scope of European citizenship is wide, its practice is uneven and stratified. A considerable part of European citizens lack information and also lack the enabling conditions to actually make use of their rights.
