French lawmakers will continue to discuss a set of changes to immigration law in early December after the Senate passed a list of repressive articles on November 14. Among the measures passed is a right-wing-backed amendment to scrap State Medical Assistance (Aide Médicale de l’Etat, AME), a program that grants undocumented migrants the right to access healthcare.
Other motions passed by the Senate include new restrictions on accessing social services and limits to the protection of undocumented workers. Worryingly, they also comprise a number of measures which represent a threat to the needs and rights of children.
The proposal to discontinue State Medical Assistance, heralded by the party Les Républicains, is based on allegations that the program is easily abused and serves as a magnet for illegal immigration. Similar arguments have been in circulation ever since the program was introduced in the early 2000s, but they have been debunked on a number of occasions. On this occasion, as before, public health policy experts and health workers voiced loud dissent about the possibility of eliminating State Medical Assistance.
Over the weekend of November 12-13, 3,500 physicians published a statement of dissent, announcing that they would continue to provide care to undocumented people even if the program is discontinued. Not doing so, they said, would go against the professional standards and oaths taken. They promised to fulfill their obligations even if it will mean working without pay. Prior to the doctors’ statement, some 3,000 health workers signed an op-ed in Le Monde, saying that the reform would put people’s health at risk.
Doing away with State Medical Assistance will also increase the risk of unchecked noncommunicable diseases and spread of infectious diseases, including tuberculosis. All of this, despite the reform not bringing any significant savings: in 2022, the implementation of the program amounted to 0.5% of overall public health spending in France. This fact throws serious doubts on the argumentation provided by those supporting the elimination of AME, who claimed that cuts will help reduce high healthcare costs.
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In fact, replacing State Medical Assistance, which covers primary health care as well as hospital care, with the more stringent emergency medical assistance, would likely lead to care provision which comes with a higher price tag, and which is provided too late to make a difference. Previous reforms to State Medical Assistance, which introduced proof of residence in France for 3 months, along with other prerequisites, already made the program less accessible and navigable for users. To this date, the program remains both underfunded and underused – it does not need another push towards eradication.
Along with other France-based health organizations, Médecins du Monde published a report in April this year that pointed out that many undocumented migrants postpone or forgo seeking healthcare, although they fulfill the criteria for accessing it through State Medical Assistance. The reasons for this are multifold. People have a difficult time navigating the administrative process necessary to enter the program and then repeat the procedure each year. They also face financial barriers, for example, not being able to afford Internet or phone credit necessary to bring the process to a close. Many simply are not aware that such a program exists.
The consensus among civil society, health workers, and associations of public health providers is that the road towards better health for everyone in France does not lie in eliminating State Medical Assistance. Instead, better health, at a more reasonable cost, can more easily be achieved by widening the program to be truly universal and scrapping the administrative barriers which have been put in place. As the dissenting doctors summarized in their statement: “Patients from here and elsewhere, our doors are open to you. And will remain so.”
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