The Senate passed the abolition of State Medical Assistance (AME) on Tuesday, November 7th. and converted this public health system, intended for foreigners in an irregular situation, into emergency medical assistance (AMU). The measure was not originally included in the government’s “immigration” law, but this did not go against the wishes of the senatorial right, who voted to abolish the system.

However, the measure may not pass the National Assembly stage – where the bill should be considered before mid-December. The abolition of AME, long wanted by the right and the far right, has been widely criticized by health experts, associations and elected officials on the left.

How does AME work?

The AME is a system introduced by the Left in 2000 and is only granted to illegal aliens who have been in France for at least three months and receive less than 810 euros per month for a single person. With this help, you are entitled to 100% coverage of medical and hospital care within the social security rates.

This does not mean that the system systematically covers 100% of care: the AME provides support limited to basic social security rates, which does not constitute complete coverage. Depending on the procedures carried out, the insured person may incur out-of-pocket costs.

primary care are therefore covered without any upfront costs, always within the framework of the social security rates:

• medical and dental care;
• Medicines are reimbursed at 100%, 65% and 30%;
• the costs of analysis, hospitalization and surgical procedures;
• the most important vaccinations, certain examinations;
• Costs associated with contraception and voluntary abortion.

However, unlike other social insured persons in France, AME beneficiaries are not entitled to certain benefits, such as: B. Thermal treatments or medically assisted reproduction.

Since January 2021, the government has restricted support certain non-urgent care and treatments : A period of nine months is now required between submitting the AME application and accessing certain surgeries or shared care. This is the case, for example, with cataract operations, procedures for protruding ears or knee or shoulder prostheses.

In 2022, the system had 415,000 beneficiaries at a total cost of 1.186 billion euros a parliamentary information report published in May. Compared to health insurance spending in the same year (247.1 billion euros), AME only accounts for 0.47%.

Although the number of beneficiaries and the cost of AME have tended to increase, this proportion has remained stable over the last five years. “It can be assumed that Covid has led to an increased need for medical consultations and the use of AME over the last two years.”explained the report to Parliament on foreigners in France in 2021. The average expenditure per AME beneficiary was 2,685 euros in 2018 (at a stable level over ten years), which is below that of a social insured person (3,087 euros in 2018).

Why does the Senate want to abolish the AME?

The abolition of the AME is a recurring demand of the right and the extreme right, who see the system as a “a wandering air call”. Already in December 2022, Senator Christian Klinger (Les Républicains, LR) had said when examining the finance law for 2023 a the change aimed to replace the AME with a “medical assistance in public health” The focus is on serious illness, emergency care, pregnancy and vaccination. The aim was to cut the AME budget by 350 million euros, but the change was ultimately not incorporated into the text adopted by the National Assembly. Two similar amendments had already been passed by the Senate in 2018 and 2019 without managing to advance past the Assembly phase.

The Republicans used their position of power in the Senate and added an article to the “immigration” bill that was not included in the original version of the government text. This turns the AME into a medical emergency aid with a reduced scope and restricted access conditions.

Beneficiaries of the AMU, in addition to meeting the current conditions of the AME, must pay an annual fee, the amount of which is determined by decree. The health basket would be greatly reduced.

article 1^um The invoice aims to reserve support without prepayment:

• for the treatment and prophylaxis of serious illnesses and acute pain;
• care during pregnancy;
• regulatory vaccines;
• Preventive examinations.

The government, which needs the votes of the right in the National Assembly to pass its bill, issued a “wise opinion” (neither positive nor negative) on this article, which was finally approved on Tuesday November 7th with 200 votes to 136 Several members of the government, including Health Minister Aurélien Rousseau, spoke out against this measure, said Gérald Darmanin “cheap” to LR’s suggestion. The Interior Minister saw October 7th in The Parisian “a good compromise that combines strength and humanity”.

Why is this proposal so criticized?

Health experts have been warning for several weeks about a withdrawal of government medical aid that could have catastrophic humanitarian and health consequences.

“Challenging the AME would entail a major risk of disorganization of the health system, deterioration of working conditions for nurses and significant additional financial costs.”denounced more than 3,000 nurses in a stand at World. “It is better to treat a mild disease before it develops into a serious pathology or before it spreads.” explained that Minister of Health Professions, Agnès Firmin Le Bodo, evoking during the consideration of the text in the Senate “real risks to our healthcare system”.

In 2019 a report from the General Inspectorate of Social Affairs (IGAS) and the General Inspectorate of Finance (IGF) had already addressed the question of a possible reduction in the care basket covered by the AME. He emphasized the withdrawal of certain benefits “Could prove to be a health problem and lead to this ultimately to postponements in hospital treatments, which are more expensive.”

The principle of emergency medical assistance would be to wait for the symptoms to worsen and only treat them when they become dangerous for the patient. With the risk that the costs of care will ultimately increase.

Regarding the introduction of an entry fee for the AME, the IGAS and IGF report recalled the experience with the introduction of an entry fee of 30 euros in 2011, Who “urges great caution”. At that time, the measure had resulted in a decrease in the number of beneficiaries and a very slight decrease in general law AME spending (-2.5%), but was offset by a strong increase (+33.3%) in spending on emergency care by hospitals for foreign patients in an irregular situation who cannot benefit from the AME. “Hospitals often paid the admission price on behalf of their patients to create rights that would allow them to bill for treatment.”, explained the rapporteurs. The franchise was eventually canceled after a yearin July 2012.

The idea that the AME would cause migration for care reasons was again debunked through a survey by the Institute for Research and Documentation in Health Economics, conducted in 2019 on a sample of 1,223 foreign persons in an irregular situation. This indicates that only 51% of those eligible benefited from this support “Most migrants have little knowledge of AME and not all are able to master a complex system.”. People who need regular care, such as those with chronic illnesses, often remain uncared for. According to Médecins du Monde, which assured in a report, the rate of non-recourse claims could be even higher published in October that 86.5% of AME patients admitted to the NGO’s centers in 2022 were not covered by the system.

A re-evaluation of the system is expected in early December, shortly before the text is considered in the National Assembly. Entrusted to Patrick Stefanini, the former head of the campaigns of Valérie Pécresse and François Fillon, and Claude Evin, the former socialist health minister, the report could shed more light on the debates and perhaps dispel fantasies.