In Saint-Denis, a northern Paris suburb, the teams at Delafontaine Hospital were unanimous. The removal of the State Medical Aid (AME), the only healthcare coverage available to undocumented people, would be catastrophic. The French Sénat voted to abolish this provision when it debated the immigration bill, but MPs reinstated the scheme before the text arrived on the floor of the Assemblée Nationale on Monday, December 11.

This public hospital is among those most exposed to the consequences of a potential reform of this health cover, which is designed to provide basic social security cover for undocumented foreigners who have been in the country for more than three months. And with good reason: Located in the poorest département in mainland France, 8% of patients at Delafontaine are covered by the AME, compared with around 0.5% in other facilities. What will happen if, tomorrow, these migrants are no longer covered?

Without the AME, people with no health coverage will increasingly turn to hospital facilities, whereas today, they can consult city doctors like any other insured person. Some will also forego medical care, at the risk of worsening their condition and ultimately relying on the emergency system. Ultimately, the costs incurred by these patients will be borne exclusively by the hospital, which will not be reimbursed by the health insurance system and will see its deficit increase.

15% rise in mortality rate in Spain

In Spain, where a scheme similar to the AME was abolished from 2012 to 2018, a study showed that, during the first three years without this aid, the mortality rate among undocumented migrants rose by 15%. "Abolishing the AME would likely destabilize our economic model" or degrade the protocol for healthcare, warned Jean Pinson, director of the Saint-Denis healthcare center, which Delafontaine Hospital is part of. "The AME allows us to place people on a standard care pathway, which is less costly for the community and more effective for them."

Contrary to this finding, the Sénat, dominated by the right and center, voted to abolish the scheme, with the aim of "fighting fraud" and "curbing the upward trend in AME expenditure." In 2022, AME expenditure amounted to €1.186 billion, in other words, 0.5% of total health insurance expenditure, for around 411,364 beneficiaries.

The Sénat had planned to replace the AME with emergency medical aid (AMU, Aide ­Médicale d'Urgence), limited to covering pregnancy care, compulsory vaccinations, preventive medical examinations, serious illnesses and urgent care, "the absence of which would endanger life or could lead to serious and lasting impairment of health." "In people's minds, if you don't need urgent, life-saving care, you're in the comfort zone," deplored Pinson. "But chronic care for an HIV patient or a stroke victim is not comfort care."

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