2023-12-04 20:40:05
Published on Dec 4 2023 at 7:24 p.m. Updated Dec 4 2023 at 7:40 p.m.
Critics of State Medical Aid (AME) will be disappointed. The system of 100% coverage by Health Insurance for the care of people in an irregular situation is “useful” and “generally controlled”, according to a report submitted this Monday to the government on the subject.
Commissioned by the executive from the former socialist minister Claude Evin, and the former right-wing prefect Patrick Stefanini, also an honorary state councilor, this analysis is published in the middle of the debate on the immigration bill. The AME was the subject of heated debates in the Senate. Anxious to make the system less expensive and to avoid misuse, the right-wing senators proposed via an amendment to the text to transform the AME into more restricted emergency medical aid (AMU). Before these changes were canceled by deputies in committee at the Assembly last week.
Acceleration of the number of beneficiaries
Like many members of the executive, the authors of the report are critical of the Senate’s proposal, seen as a source of complexity and carrying risks of overloading hospitals. However, he suggests adapting the AME to avoid abuse and make it more effective. Knowing that this aid is experiencing a “real acceleration” of its beneficiaries today numbering 440,000 (+8% in 2022 and +13.5% expected in 2023).
Highlighted in the Senate, “the question of the basket of care [couverts par l’AME] is not the only question that arises,” underlines Patrick Stefanini, speaking to “Echos”. To complement the numerous control measures already in existence, the report proposes, for example, to reserve the status of beneficiary of an AME beneficiary only for minor children and not for adults.
No more agreements to obtain before treatment
It also proposes to tighten the conditions of access by asking the beneficiary to be physically present for the submission of the file and the withdrawal of their card. The report also suggests extending the principle of recourse to prior agreement from Health Insurance to provide non-urgent care.
To “reinforce coherence between State policies”, the mission also proposes removing the benefit of the AME from people subject to a removal order from the territory for reasons of public order.
A Vitale card type system
The rapporteurs are also keen to “avoid breaches of rights”. They therefore recommend aligning the aid regime applicable to asylum seekers with the AME. This would further increase the number of its beneficiaries. However, the idea is to prevent asylum seekers, once their request is rejected, from finding themselves without health coverage.
To reduce the formalities imposed on doctors who treat AME beneficiaries, the report also suggests giving them the equivalent of a Vitale card. One way to prevent undocumented immigrants from being refused appointments by doctors worried about administrative burdens, as a recent study suggests.
The cautious government
This computerization would also have the merit, according to the report, of facilitating the cancellation of rights, for example in the event of expulsion of the beneficiary. Other avenues proposed by Patrick Stefanini were dismissed by his co-rapporteur. For example, the idea of making the continuation of heavy chronic care subject to verification that the foreigner cannot be well cared for in his country of origin.
It remains to be seen what the government will take away from this. He insisted that there was no question of touching the AME in the draft law on immigration because this would be considered by the Constitutional Council as a “legislative rider”. “The proposals made by the rapporteurs may be the subject of regulatory or legislative developments in a specific text,” the executive simply reacted on Monday.
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