Will opponents of state medical aid (AME) finally have its skin? The Minister of the Interior, Gérald Darmanin, opened the door, in an interview with Le Parisien published Sunday, May 28, to a reform, as part of his future Immigration bill, of this aid granted to foreigners in an irregular situation. "Should we discuss the modalities of state medical aid? The answer is yes," he said, with the stated aim of satisfying senators and deputies The Republicans (LR) who would like to replace the AME with emergency medical aid.

IMMIGRATION MEASURES
Let us move forward in the interests of the country. We are not going to deprive ourselves, for 4 years, of effective immigration measures. We must act quickly so that a text can be adopted by the autumn. So let's work ensemble.@le_Parisien 👇🏼https://t.co/NA9LZOFwDZ

— Gérald DARMANIN (@GDarmanin) May 27, 2023

Created in 2000 under the government of Lionel Jospin, State medical aid entitles foreigners in an irregular situation who have been in France for at least three months to 100% coverage of their medical and hospital care. Are covered diseases, maternities, but also prostheses and dental care or optical equipment, on the basis of Social Security tariffs.

The question of abolishing the AME is regularly revived by the right and the far right, who see it as a device creating a "call for air" vis-à-vis illegal immigration. During the examination in March in the Senate of the first Immigration Bill of Gérald Darmanin, the LR senators had adopted in committee an amendment hardening the device.

✅ [ AMENDMENT ADOPTED: End of AME]

1/3 - 👉 This morning, in committee, I had an amendment adopted on the PJL Immigration aimed at replacing State Medical Assistance (AME), accessible to illegal foreigners (present on the territory for more than three months pic.twitter.com/eb1Duhrb9v

— Françoise Dumont (@FrDumont83) March 15, 2023

Then, in a parliamentary report published on May 17, it was the turn of LR MP Véronique Louwagie to worry about the increase in the cost of the AME. "Taking into account the costs of managing the scheme and the bad debts of hospitals left by illegal foreigners, the real cost of the AME amounts to approximately €1.2 billion in 2022. In the absence of reform, this amount should continue to grow in the coming years," wrote the MP in her report on "the cost of care for illegal foreigners", examined in the Finance Committee.

An increasing number of beneficiaries

According to the Special Rapporteur on the appropriations of the Health Mission, already author in 2021 of a report on the AME, the number of beneficiaries of this aid amounted to 2022,403 people at the end of September 144, a figure up 5.9% compared to 2021 and 20.5% compared to 2019.

In her report, Véronique Louwagie called in particular to "refocus the AME on urgent care or, failing that, to redefine the basket of care to exclude certain medical gestures", or to "exclude asylum seekers from safe countries of origin from the procedure for admission to stay for care". A philosophy taken up in the recent offensive of LR leaders to force the government to propose a firm text on immigration.

See also Immigration law: LR on the offensive with two bills to "regain control"

If Gérald Darmanin, himself from the Republicans, is open to a discussion on the subject, the abolition or transformation of the AME is however far from being acquired, as this issue divides the presidential majority. MP Sacha Houlié, representative of the left wing of Renaissance, has thus made the disappearance of the AME one of his red lines.

Invited to react on the subject Sunday noon, the Minister of Health, François Braun, recalled that this aid presented "public health issues". "What does urgency mean, how long does it mean? Are we going to treat diabetes that is unbalanced and that we will let unbalance afterwards?" he asked during the Grand jury RTL / LCI / Le Figaro.

If there is "a new Covid coming to people who could benefit from state medical aid, we are not going to treat them (...) And we're going to let the disease develop? We need a global vision of public health," he insisted, while judging "abnormal that there are channels to come and do [in France] care that can be done in the country of origin of these patients."

"A cause of marginal immigration"

Prime Minister Elisabeth Borne herself rejected the idea of a migratory "call for air" linked to the AME during the debate on immigration policy on 6th December in the National Assembly.

"Finally, I want to put an end to one last misconception: no, state medical aid does not feed illegal immigration. It is a matter of protection and public health. No migration project to France is only motivated by the existence of this device," she said at the time.

A speech in line with that of the Defender of Rights, Jacques Toubon, who regretted in October 2019 the spread of "the misconception that the 'generosity' of a device such as the AME would lead to strengthen illegal migratory flows by creating a 'call for air' while several studies show that the need for care is a completely marginal cause of immigration".

See also Day 1 of "appeasement": Bruno Le Maire and the government target foreign fraudsters

Thus, health reasons are mentioned by only 9.5% of undocumented migrants, according to a CNRS study published in February 2022. "And the number of real beneficiaries is much lower than the number of people who could benefit from it, since the rate of non-use [of the rights opened by the AME] is estimated at 49%," said the president of Doctors of the World, Florence Rigal, in an interview with Le Parisien published on March 24.

But beyond the facts, the AME has above all become a political issue. For Gérald Darmanin, it will be a question of acceding to the demands of the Republicans to pass his bill or not to divide the majority. The debate could be perilous.

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