The New American Expat: Remote Workers Leaving the US for Healthcare Stability

For years, the image of the digital nomad revolved around freedom.

A laptop near the beach. Flexible schedules. Temporary living. Lower costs abroad.

But according to relocation specialists, visa advisors, and international moving companies working directly with Americans, a new type of expat is emerging, one driven less by lifestyle optimization and more by long-term stability.

Increasingly, remote American professionals are not simply looking for adventure overseas.

They are looking for healthcare systems they can trust.

This analysis is based on insights collected during Get Golden Visa’s 2025-2026 expat mobility research and the development of its upcoming white paper, Measuring the Pressure: The Migration Stress Index of Expat Life in the US, including practitioner interviews and migration observations shared by Hugh Dixon, Allan Hou, and Kristin Wilson.

But Hugh says the most important shift is not simply the number of Americans moving abroad.

It is why they are moving.

Healthcare access now appears almost as frequently as cost of living concerns in conversations with prospective expats.

Similarly, Allan H. says his company has observed a steady rise in relocation requests from North American remote workers seeking European residency structures while maintaining US-based income streams.

According to Allan, healthcare concerns appear in roughly two-thirds of conversations with prospective clients considering Spain or Portugal.

The $15,000 Emergency Room Bill

One relocation specialist interviewed during the research process shared the story of a Seattle-based remote tech professional who began researching Portugal after a medical emergency involving one of his children.

A single emergency room visit reportedly resulted in a bill of approximately $15,000.

Shortly afterward, the family began exploring residency options in Portugal.

The appeal was not luxury.

It was predictability.

Public healthcare access, lower recurring medical costs, and the ability to build a more stable structure for their family became central to the decision.

Kristin W., who advises Americans on international residency pathways, says healthcare concerns often emerge most strongly among families with children or aging parents.

Remote Income, European Infrastructure

What makes this migration wave unique is that many of these Americans are not leaving because they lost economic opportunity.

In many cases, they are bringing their US-based income with them.

Remote work has fundamentally changed the equation.

For a growing number of professionals, earning American salaries while accessing European residency systems creates a new type of migration strategy — one centered around stability infrastructure rather than geographic freedom alone.

That infrastructure includes:

• residency-backed healthcare access
• lower and more predictable living costs
• safer urban environments
• long-term residency pathways
• stronger public systems
• family-oriented social policies

As one relocation expert summarized:

Why Portugal and Spain Keep Emerging

Portugal and Spain consistently appear as leading destinations in these relocation patterns.

Both countries offer residency pathways that are comparatively accessible for remote professionals with stable income streams.

But beyond visa structures, they also provide something many Americans increasingly describe as difficult to quantify inside the US:

Peace of mind.

According to practitioners interviewed during Get Golden Visa’s expat migration research, Measuring the Pressure: The Migration Stress Index of Expat Life in the US, conversations that once focused primarily on weather, lifestyle, and affordability now increasingly center around:

• healthcare access
• political stability
• safety
• burnout
• raising children abroad
• and long-term quality of life

In practice, many Americans who initially planned to “try Europe for a year” eventually begin exploring permanent residency pathways.

What starts as temporary mobility increasingly evolves into long-term relocation planning.

The Rise of “Infrastructure Migration”

This shift reflects a broader trend explored in Get Golden Visa’s upcoming expat migration white paper and Migration Stress Index research, alongside Measuring the Pressure: The Migration Stress Index of Expat Life in the US, which examines how Americans are increasingly using international residency structures as tools for financial, emotional, and social resilience.

In many ways, this new migration wave is no longer purely about lifestyle.

It is about systems. Healthcare systems… Education systems…  Residency systems…  Safety systems…

For a growing number of remote American professionals, the question is no longer:

“Where would I like to live?”

But rather, “Where can my family build a stable future?”

Note: This article is a trend-backed composite case story developed as part of Get Golden Visa’s Measuring the Pressure: The Migration Stress Index of Expat Life in the US white paper. The analysis combines practitioner interviews, anonymized client examples, relocation industry insights, and broader migration patterns shared by international mobility professionals. Certain details may represent blended experiences intended to illustrate emerging migration behavior rather than one single identifiable individual.