Will the SOUL give up the ghost? The question is at the heart of the debates as the immigration bill arrives in the Senate this Monday. In its initial text, the government did not plan to touch State Medical Aid. But when it passed the Law Committee last March, the right-wing senatorial majority restricted this system, which allows foreigners in an irregular situation to benefit from access to care.
The Minister of the Interior, Gérald Darmanin, was in favor of a modification of this aid, unlike his colleague from Health, Olivier Véran. Will the AME become the new point of tension in the presidential camp on this already flammable text? Explanations.
What is SOUL?
Today, State Medical Aid provides full coverage of health costs granted to foreigners in an irregular situation. It is granted for one year, upon request on file, subject to conditions of residence (at least three months in France) and resources (9,719 euros maximum over the last 12 months for a single person, or approximately 810 euros per month). According to the latest national study carried out by Irdes (Institute for Research and Documentation in Health Economics), published at the end of 2019, one in two illegal immigrants benefited.
In a column published last Thursday in The world, more than 3,000 caregivers, including the Nobel Prize winner in medicine (2008) Françoise Barré-Sinoussi and the president of the National Consultative Ethics Committee Jean-François Delfraissy, asked for “the maintenance” of this measure. The signatories believe that limiting access to care for foreigners could lead to “a deterioration in their state of health” and would be “contrary to the majority of texts in force in France on human rights”.
What does the right propose?
In committee, LR senators and their centrist allies voted in favor of an article restricting AME to simple emergency medical aid (AMU). The latter would only concern “the management of prophylaxis and treatment of serious illnesses and acute pain, care related to pregnancy, regulatory vaccinations and preventive medicine examinations”. The AME, set up by the Jospin government in 2000, is regularly the target of the right and the National Rally. Its detractors point out the cost of the AME on public finances: expenditure is estimated at 1.14 billion euros in the initial finance law for 2023, an increase of 12.5% compared to 2022*. Since 2003, the number of AME beneficiaries has increased by 123.4%. The LR and RN elected officials also denounce the supposed “call for air” of a measure considered too “attractive”.
Why is this proposal explosive for the majority?
The abolition of the AME is far from achieving consensus within the presidential camp. Olivier Véran, the government spokesperson, admitted to having “a real disagreement with Gérald Darmanin on this subject”, defending the “balance” of the current systeml, just like his Health colleague, Aurélien Rousseau. To avoid tensions, Elisabeth Borne commissioned an information report to assess possible developments in this aid. The first conclusions, revealed Thursday, estimate “that the AME is not a factor of attractiveness” for immigration, and instead plead for its maintenance.
Enough to resolve the internal debate? Not really, the divisions of the majority should become apparent again when the text arrives at the National Assembly in December. The AMU is thus supported by the Horizons vice-president of the Assembly, Naïma Moutchou, and certain Macronist deputies. “The public agent must always be evaluated, in accordance with our humanitarian principles, but also with regard to what our European neighbors do,” adds Mathieu Lefèvre, Renaissance deputy for Val-de-Marne. Enough to give the government a headache. The latter in fact only has two (bad) possible choices: keep the AME as it is and lose the vote of the right, or support the AMU and fracture its majority.
* Information report on the evaluation of the cost of care provided to foreigners in an irregular situation by MP LR Véronique Louwagie.