France’s new Interior Minister Bruno Retailleau says he wants to reduce healthcare funding for illegal immigrants and foreigners in an ‘irregular situation’ in France.
The minister, who is from the right-wing Les Républicains party, was appointed by prime minister Michel Barnier earlier this week. He says he wants to shake-up the current aide médicale d'État (AME), that provides healthcare for immigrants.
“We're one of the European countries that offers the most benefits, and I don't want France to stand out, to be the most attractive country in Europe for a certain number of social benefits and access to healthcare,” said the minister in an interview with TF1.
His plans would see the AME replaced with an urgent care fund for foreigners – which would only cover healthcare costs in emergency situations for illegal and undocumented immigrants in France – with a drastically reduced budget.
AME is a politically contentious topic, and its reduction or removal has been frequently discussed, including in the recent debates on the 2024 immigration bill.
The change cannot be implemented via a governmental decree but must be done by rewriting healthcare legislation (or through a government bill). It would need to be passed via a vote in both political chambers.
During debates on the 2024 immigration bill, Mr Retailleau (then head of the right-wing forces in the Senate) called for AME to be abolished and replaced with an urgent care fund.
His plans have led to criticism, including from members of his own party.
It is one of a number of policies put forward by the new minister, who is seen as a staunchly conservative politician who sits to the ‘hard-right’ on many political issues.
Previously, Mr Retailleau has voted against same-sex marriage and the inclusion of abortion in the French constitution.
He has criticised previous governments for a perceived lax attitude towards immigration, which he wants to make a cornerstone of his tenure.
What is the aide médicale d'État?
The AME is a fund that provides free healthcare to ‘irregular’ immigrants in France, who have been in the country for at least three months and do not have a visa or residency permit, nor medical insurance.
It can be used by illegal immigrants, but also applies to workers and residents who do not have the correct paperwork. It can only be accessed by households with a low level of annual income.
Children can access the funds without having resided in France for three months.
It covers 100% of the costs for medical and hospital treatment, up to the limits covered by the French social security system, and recipients do not pay for care in advance.
You can read more about it on the government website here, in both French and English.
The AME was created in 2000 by Socialist prime minister Lionel Jospin, but is frequently criticised by the right and far-right, who see it as unnecessary expenditure and a catalyst for immigration to France.
In 2023, the state spent €1.1 billion on healthcare provided through the AME, around 0.5% of the total healthcare spending in France.
Read more: How do hospital fees work in France?
‘Not a contributor to immigration’
The argument from politicians on the right – that the AME causes immigration – has been continuously questioned in recent years.
A bipartisan report on state medical costs released in 2023 concluded “the AME does not appear to be an attractive factor for prospective immigrants.”
In addition, a study by the CNRS (French research network) claimed less than 10% of immigrants who come to France do so for healthcare reasons.
Less than half of people eligible for AME actually use it, claimed French media Le Parisien in 2023.
The right, however, claims that replacing the aid with an urgent care fund would not only save the state money, but also reduce the number of immigrants who remain in the country without the correct paperwork.
Read more: Far right publish details on how they would prioritise French nationals for jobs
Project faces criticism
In his first televised interview since announcing his cabinet at the weekend, new prime minister Michel Barnier said there must not be any ‘taboos’ for the new government when it comes to immigration of public finances.
Read more: Immigration and mental health: New French PM outlines his priorities
However, Mr Retailleau’s project has already faced backlash.
“Calling the AME into question would be completely stupid not only for public health, but also for health insurance finances,” said former Health Minister François Braun, who held the role between 2022 and 2023.
Aurélien Rousseau, another former health minister under President Emmanuel Macron, also criticised the plan.
“Let's be clinical: the AME is not a factor in immigration. This is a well-documented conclusion,” he said on social media platform X (formerly Twitter).
“And yet, the Government prefers to immediately evoke its abolition in order to satisfy the extreme right.
A token, a scalp, a totem... without having the strength or courage to tell the truth.”
Members of the president’s centrist group in parliament– expected to vote in line with the new government – have also criticised the plan.
“I don't think [the Minister] has read Mr Stefani's report properly [editor’s note, the 2023 bipartisan study linked above]... which clearly states that the AME is not a question of attracting immigrants... but rather a public health issue” said Agnès Firmin Le Bodo, a member of the Horizons party and briefly Health Minister in 2023 - 2024.
