The politics of restricted inclusion: a longitudinal policy analysis of healthcare access for people living as undocumented migrants in Sweden

This study examines how healthcare access for people living as undocumented migrants has been constituted, contested, and reconfigured in Sweden from the early 1990s to the mid 2020s, challenging institutionalist claims that universalist welfare systems reliably generate solidaristic migration policies. Drawing on a longitudinal policy analysis combined with critical framing analysis, we traced legislative debates and policy outputs across more than three decades, identifying four critical turning points: the 1990s framing of “undocumentedness” as an issue of migration control; the growing influence of human rights and public health arguments in the 2000s; the 2013 reform introducing legally ambiguous restricted inclusion; and the post-2022 recentering of healthcare within an expanded migration control and border enforcement agenda. The findings demonstrate that Sweden’s universal welfare orientation structured, but did not determine, policy outcomes. Expanded inclusion emerged when humanitarian, public health, and legal frames aligned across party coalitions, while restriction dominated when deservingness and control arguments converged with fiscal and capacity concerns. Civil society actors and clinicians played a crucial role in sustaining rights-based frames, but without decisively shaping subsequently implemented policies. In conclusion, solidaristic healthcare policies addressing undocumented migration depend less on welfare state design than on shifting political alignments. Policy implications include decoupling healthcare from border enforcement, as a means of maintaining the ethical legitimacy of the welfare state, along with a need to integrate clinical expertise into policymaking.