France debates scrapping free healthcare for undocumented migrants
As a new immigration bill goes before the French parliament, right-wing lawmakers are pushing to stop providing healthcare for undocumented migrants. But opponents say the move would endanger public health without reducing illegal immigration, and doctors have vowed to continue treating migrants regardless.
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The Senate, the upper house of the French parliament, voted last week to scrap what's known as "state medical aid" (aide médicale de l'état) for undocumented immigrants as part of a package of reforms to France's immigration laws that are still being thrashed out.
As things stand, foreign nationals without immigration papers can seek free care from public hospitals, clinics and other health providers in France, so long as they have been in country for at least three months and earn well below the minimum wage. The cost comes out of the government's budget.
Instead, senators led by the right-wing Republicans party want access to be limited to emergency treatment only, including serious illnesses, mandatory vaccinations and pregnancy-related care.
The amendment, which needs the approval of the lower house of parliament to become law, does not have the backing of President Emmanuel Macron's centrist government – though without a majority, the government isn't guaranteed the votes to block it.
"State medical aid cares for individuals and protects the population as a whole," Health Minister Aurélien Rousseau told FranceInfo radio on Sunday.
"If we leave everything to hospitals, we'll be making a huge mistake."
Doctors threaten revolt
The proposal has caused outcry among medical practitioners, with thousands pledging to continue treating undocumented migrants even if the law is changed.
In a "declaration of disobedience" published by French news agency AFP over the weekend, some 3,500 doctors from both the public and private sectors stated that they would not change policy.
"We doctors will respect the Hippocratic oath above all, which says that we treat all patients regardless of their income, race or social status," one of the signatories, Frédéric Adnet, head of emergency medical services for Paris, told RFI.
Aside from medical ethics, he argued that scrapping free routine healthcare would end up counterproductive.
"Getting rid of medical aid makes no sense either in terms of ethics or public health, because we know these patients often carry infectious diseases like tuberculosis," Adnet said.
"And unless you treat such illnesses rapidly, there's a risk firstly that it will spread, and secondly that you'll have to treat it at a later stage when it has become much more advanced, which will ultimately cost more than taking preventative measures and providing care from the start."
The federations of public and private hospitals as well as the federation of French health insurers have all publicly condemned the proposal.
Two doctors even filed complaints with regulatory body the Order of Physicians against Republicans senators who are also licensed practitioners and voted in favour of it, accusing them of violating their professional code of ethics.
Bureaucratic barriers
France has already tightened the criteria for accessing medical care without immigration papers.
In 2019, amid contentions that the policy was too expensive and risked being exploited, Macron's government introduced the requirement for undocumented migrants to prove they had been living in France for at least the past three months, as well as making it mandatory to file first-time claims in person.
Those reforms have already dangerously restricted access to care, according to medical charity Médécins du Monde, which together with other NGOs studied the experiences of undocumented migrants in the Paris region earlier this year.
Their report lists a string of barriers, from a lack of information to long waits for appointments, complicated paperwork and unhelpful administrative staff. Two in three of more than 250 undocumented people surveyed said that they had struggled to access healthcare.
"If you don't read and write French, don't have an internet connection or a phone plan that allows you to call [the national health insurance hotline], getting treated becomes an impossible mission," said Florence Rigal, president of Médecins du Monde.
In fact almost half – 49 percent – of people who are eligible for state medical aid never claim it, according to French research institute Irdes, which studies health economics.
It calculates that such aid takes up only a fraction of France's spending on healthcare: around €1 billion in 2022, or 0.5 percent of total spending.
Spain's example
The Senate votes on the immigration bill, including the amendment to scrap medical aid, on 14 November. It is expected to pass easily.
The lower house of parliament, the National Assembly, will begin debating the immigration bill on 11 December.
Those who want French lawmakers to vote against the amendment that would scrap medical aid point to a precedent in Spain.
The Spanish government excluded most undocumented migrants from basic public healthcare in 2012. Though several regional health services refused to stop providing care, the reform was followed by a rise in infectious diseases and an estimated increase in mortality among undocumented migrants – without generating the savings the government has promised.
In the end, Spain restored medical care for undocumented migrants in 2018.
Read also:
- French lawmakers start debating controversial immigration bill
- Macron charts controversial path for French referendum on immigration
- Number of requests for asylum in Europe rises 28 percent in first half of 2023
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