Health insurance for the good European citizen? Migrant sex workers' quests for health insurance and the moral economy of health care

Abstract

European health insurance systems have become increasingly fragmented due to neoliberal health care reforms and the privatization of health care. Attempts to enable transnational access to public health care services throughout the European Union (EU) have contributed to this process by spreading ideas of EU citizens as consumers having to make informed choices about health insurance. However, marginalized populations such as EU migrant sex workers are presented with only limited choices within these systems. This article highlights how these limitations in access to health insurance are not only related to financial precarities, but are also caused by underlying racialized, classist, and sexualized assumptions about citizenship and belonging which influence the legal framework of both national and EU-wide health insurance provision. Based on ethnographic research with migrants from eastern EU countries involved in sex work in Berlin, the article discusses their attempts to gain access to health insurance as a salient example of the moral economy of health insurance provision in a supposedly universal health care system. Following how migrant sex workers from eastern European countries experience and negotiate exclusions from health insurance systems, the article addresses how meanings and interpretations of health insurance change towards an understanding of health insurance not as a right, but as a privilege for those conforming to narrow ideas of European citizenship. This indicates that current restructurings of health insurance systems are not only characterized by increasing privatization. Equally, the (re-)emergence of links between access to health insurance and restrictive ideas of belonging and citizenship rights are undermining aspirations for transnationally available universal health care.

Keywords: Belonging; Citizenship; Eastern europe; Germany; Health insurance; Migration; Privatization of health care; Sex work.