New year, new government for Spain
After 254 days of interim government, Spain started 2020 with a new cabinet. The leader of the socialist party Pedro Sánchez was reappointed President with the support of left-wing Unidas Podemos, and the abstention of Catalan republican independentists, Basque nationalists and other regional parties. The far-right has gained force and appears, for the first time in Spanish politics, as the third force in the Spanish Congress of Deputies. As for healthcare, Mr Sánchez chose Salvador Illa, a Catalan politician, as Health Minister.
Spain’s 2019: snap elections, failed investiture, snap elections
After snap elections on April 2019 that led to a highly fragmented parliament and a failed investiture process from May to September 2019, Spain once more held national elections on 10 November 2019 resulting again in a highly fragmented parliament. While socialists won the elections with 120 seats out of 360, far-right VOX managed to double its seats, 52, and conservatives now have 88. Left-wing Unidas Podemos suffered a decrease to 35 seats, while Ciudadanos suffered a major collapse, down from 57 to 10 seats. The latter, created in 2006 in Catalonia, saw its leader Albert Rivera forced to resign after a disastrous election night. In an unexpectedly quick move, acting Prime Minister Pedro Sánchez and Unidas Podemos’ leader Pablo Iglesias announced that they had reached a preliminary agreement to form a minority “progressist government coalition”.
The first progressist coalition in Spanish democracy, with a twist
After months of negotiations, on 8 January 2020 Mr Sánchez was sworn in as President with the support of Unidas Podemos, as previously agreed, and the abstention of Catalan republican independentists (ERC) and other regional parties. This allowed him to get 167 votes in favour, a majority of only 1. The emerging progressive government, which constitutes the first coalition government since the 2nd Spanish Republic in 1931, will nonetheless need support from other parties to pass essential legislation such as the state budget law.
The abstention of the pro-Catalan independence ERC was the result of negotiation talks that aimed to lower tensions in the region of Catalonia. The new government has vowed to create a dialogue between the parties to find a solution to non-accommodated claims.
While the support of the independentists to form a government was somehow anticipated, the rise of far-right Vox in the elections and its notable presence in the Spanish Congress came as a twist. While Spain was one of the only countries in Europe where the far-right was insignificant or even non-existent, VOX has now institutionalised the far-right for the first time in the Spanish democracy. In this context, key topics in health such as euthanasia, assisted suicide or abortion will most likely find the opposition of a large number of MPs.
How important will healthcare be for the new government?
The new government vows to put social services including healthcare high in the political agenda. As such, the ruling coalition announced the increase of up to 7% of the GDP in health by 2023. Healthcare expenditure in Spain has never reached higher than 6.8% and is currently below the average for EU countries.
The Health Ministry will focus on making the Spanish National Health System (SNS in Spanish) a reference for other European countries on health technology and digitalisation both for diagnosis and treatment. Other priorities for healthcare are, inter alia, the fight against cancer, mental health, CAR-T cell therapies and euthanasia.
The importance of healthcare has also been expressed by the government through restructuring ministries. Health is now a cross-ministerial matter in which the Health Ministry will be taking a leading role, but other ministries such as the Ministry for Social Rights and the 2030 Agenda as well as the Ministry of Consumer Affairs will also be tackling health-related matters, such as access to medicines and care for people with disabilities.
All in all, Spain is experiencing a moment of policy when it comes to healthcare. The new government has expressed its wish to invest further in keeping a strong welfare state. Parliamentary activity has now started after long months of institutional uncertainty. The division of the Health Ministry into three different bodies opens an institutional window of opportunity for advocacy in several spaces simultaneously. Both policymakers and the civil society are ready to take off in a stable institutional environment allowing room to shape new legislation and are currently establishing the policy priorities for years to come. The time is ripe to make up for the previous parliamentary stalemate and resume government affairs strategies at all levels.