As part of the examination of the text, the right-wing senators obtained the transformation of State Medical Aid. The new system intends to reduce the basket of care currently granted to people in an irregular situation.
After heated debates in the chamber, the Senate ruled on Tuesday, November 7, on the future of state medical aid (AME), a system of access to care reserved for foreigners in an irregular situation. The Republicans and their centrist allies voted in the evening in favor of removing the system and transforming it, during the examination of the immigration bill. Franceinfo answers four questions about this vote and its consequences.
1 What is state medical aid?
This system, which came into force on January 1, 2000, allows foreigners in an irregular situation to benefit from 100% coverage of medical and hospital care, financed by the State.within the limits of Social Security rates”, specifies the official website of the French administration. To benefit from an AME admission card, valid for one year and renewable, applicants must meet certain criteria, such as having stayed in France for more than 3 months and having an annual income of less than 9,719 euros. (for a single person living in mainland France).
The defenders of the AME recognize in this system “an essential tool for individual health and public health“. This is what 3,000 caregivers, including the former president of the Covid-19 scientific council, Jean-François Delfraissy, recall in a column published in the newspaper The world, Thursday November 2. They pleaded for the maintenance of the AME, a few days before the examination of the immigration bill in the Senate. According to the signatories of the text, the removal of this mechanism “would have the direct consequence of leading to a deterioration in their state of health, but also generally that of the entire population”.
2 Why did senators vote to remove it?
On the second day of examination of the immigration bill in the Senate, right-wing elected officials struck a major blow. The removal of the AME did not initially appear in the version of the text presented by the government. It was introduced by an amendment tabled by the right-wing senatorial majority. By a large vote of 200 votes for and 136 against, conservative elected officials approved, late Tuesday evening, the abolition of the AME and its transformation into emergency medical aid (AMU).
Several arguments were put forward by LR senators for this reform, demanded for a long time in particular by the right. According to them, the health coverage offered by the AME to foreigners in an irregular situation generates “a call of air” for illegal immigration. “A quarter of illegal foreigners cite access to free healthcare as the reason for their migration”, explains Bruno Retailleau, president of the LR group in the Senate, interviewed by Public Senate. The elected official uses a figure published in 2019 in a report (PDF document) of the General Inspectorate of Finances and the General Inspectorate of Social Affairs. Still according to Bruno Retailleau, the current system is too generous and “gives access to a basket of care which is almost that of the residents”.
Critics of the AME also consider it too expensive. An information report published in May 2023 by the Finance Committee of the National Assembly is concerned about the “sustainability” of this system, the cost of which is estimated at 1.2 billion euros per year. “The financial prospects of this system raise questions (…). The financial weight of the AME has in fact been growing continuously since the creation of this aid”, underlines the parliamentary report. In total, expenditure linked to this aid has increased by 47.8% since 2017, this document supports.
3 Why did the government not oppose the abandonment of the AME?
During the vote in the Senate on Tuesday evening, the government did not oppose the elimination of the AME. The Minister for Health Professions, Agnès Firmin Le Bodo, assured that this reform tabled by the right had not “nothing to do” in the bill. “Mixing the debates on the AME and immigration control is nonsense”justified the minister, assuring that “the government is very attached to the AME”.
Despite this opposition in principle, the executive did not provide frank support for the amendments tabled by the various left-wing groups, demanding the removal of the reform introduced by the senatorial majority. The elected LR and centrist representatives of the Upper House have made this subject a means of monetizing their support for the immigration bill, which the executive needs to have the text adopted by Parliament without having recourse to article 49.3 of the Constitution.
However, the presidential camp remains divided on the reform of the AME. Before the vote in the Senate, the Minister of the Interior, Gérald Darmanin, said in the columns of Parisian favorable to “personal title” to a redesign of the system. Without waiting for the end of the examination of the text, the Minister of Health Aurélien Rousseau criticized in the program “Quotidien” the vote of the senators, considering that this elimination of state medical aid was “a profound error”And “even a mistake”.
4 What does emergency medical aid, supposed to replace AME, provide?
The abolition of state medical aid and its replacement by emergency medical aid implies the end of full coverage of health costs for foreigners in an irregular situation. In the text voted on in the Senate, access to care is reduced to a base refocused on serious illnesses, pregnancy-related care, vaccinations and preventive medicine examinations.
Criticized for this transformation of health coverage granted to undocumented foreigners, Bruno Retailleau defended this measure proposed by LR. “We don’t let anyone die”he assured Public Senate, recalling the care provided by the AMU.
At this stage, however, it is not certain that the abolition of the AME will one day be implemented. After the debates in the Senate, the immigration bill must now be studied by the National Assembly. From December 11, the deputies will therefore examine the text, and will have the possibility of withdrawing this measure.