The year 2026 is set to be a pivotal one for Spanish healthcare, with a raft of legislative initiatives poised to reshape the National Health System (SNS). Some proposals are already advancing through Parliament, while others are scheduled to enter the legislative pipeline in the coming months. Among the most significant is a law that will restore universal access to the National Health System, a right curtailed during the 2012 economic crisis. At the same time, legislation is being advanced to protect public management of healthcare services and curb privatisation, following the Torrejón Hospital scandal in Madrid, which exposed weaknesses in the public-private management model.
Preventive measures against tobacco and alcohol also feature prominently on the health agenda, with new laws designed to sharply reduce consumption, particularly among young people. Meanwhile, Spain is pursuing a major overhaul of its pharmaceutical policy to improve access to medicines and reduce dependence on foreign suppliers.
Restoring universal healthcare
The Health Committee in the Congress is currently debating, under urgent procedure and with full legislative powers, the universality law submitted in May 2024. Since its introduction, the bill has seen 57 extensions to the amendment period, reflecting the complexity of parliamentary negotiations. Its primary aim is to guarantee healthcare access to all migrants intending to live in Spain, regardless of their legal status. It also seeks to ensure care for Spaniards living abroad and for foreign nationals arriving through family reunification, groups left unprotected after the 2012 reforms.
In parallel, the Ministry drafted a Royal Decree, which concluded public consultation in October 2024, intended to remove administrative barriers still preventing certain groups, particularly migrants, from accessing healthcare. The move responds to complaints from social organisations over bureaucratic obstacles that, in practice, restrict the right to health.
Protecting public management
Approved by the Government in June 2024, the SNS Equity and Cohesion Bill is in the amendment stage, with nearly 60 extensions so far. The law aims to safeguard public management against privatisation and abolish co-payments that remain for certain services, including non-emergency patient transport and orthopaedic products—measures that would particularly benefit older adults and patients with chronic conditions.
At an earlier stage is the Public Management and Integrity of the SNS Bill, which seeks to drastically limit public-private healthcare agreements. The legislation proposes repealing Law 15/1997, which had opened the door for large private groups to manage public facilities. The Government plans to submit the bill to the Council of Ministers in January 2026, following the acceleration prompted by the Torrejón Hospital controversy.
Crackdown on tobacco and vaping
The reform of the current anti-tobacco law passed its first stage in September 2024 and is now gathering reports from the Council of State and the National Commission of Markets and Competition (CNMC). If approved, vapes will be regulated in the same way as conventional tobacco, with identical restrictions on advertising, sales, and use. The measure addresses the rapid rise in e-cigarette use among adolescents in recent years.
The legislation will expand smoke-free areas across Spain, including bar and restaurant terraces, public transport shelters, university campuses, beaches, playgrounds, and access points to public buildings. The aim is to protect minors and non-smokers from second-hand smoke.
Restrictions on alcohol consumption
Since March 2024, the Health Committee has been debating a law targeting alcohol consumption among minors, though it is not being treated as an urgent bill. The proposal goes beyond existing sales restrictions to directly prohibit consumption by under-18s. Drinking will be banned in locations frequently used by children and young people, such as parks, sports facilities, and recreation areas. Advertising and sponsorship of alcoholic drinks will also be prohibited within 150 metres of schools, healthcare centres, social care facilities, parks, or children's leisure areas.
Pharmaceutical policy overhaul
In December 2024, the Ministry launched the 2024–2028 Pharmaceutical Industry Strategy, promoting research and development, ensuring strategic autonomy, and encouraging the use of generics and biosimilars. The core of this policy is the new Medicines Law, which aims to improve access through updated pricing, the promotion of generics and biosimilars, and innovations such as nurse and physiotherapist prescribing, prescriptions by active ingredient, and pharmacy substitution.
The Ministry is also finalising a Royal Decree on Health Technology Assessment, which will cut the period between European approval of a drug and Spain’s decision on its price and public funding to under 180 days. The aim is to accelerate patient access to innovative therapies, particularly for serious illnesses.
Framework Statute reform and conflict with doctors
Reform of the Framework Statute is progressing after previous disputes with trade unions. Both the Ministry and major unions now foresee an imminent agreement to modernise working conditions for healthcare staff. Medical unions, however, remain outside the talks and predict protests at the start of 2026, demanding a regulatory framework tailored to the medical profession, arguing that the general statute does not adequately reflect their needs.
Among projects already approved but not yet implemented is the Spanish Public Health Agency (Aesap), currently selecting its headquarters. The agency will centralise epidemiological surveillance, prevention, and emergency response, applying lessons learned during the COVID-19 pandemic.