Strong Opposition to restrictions on Access to Healthcare for Undocumented Migrants
Two decrees published in July 2005, implementing more restrictive healthcare eligibility criteria for illegal foreign nationals has met with robust opposition, particularly among trade unions.
As far as healthcare is concerned, undocumented migrants are not covered by the Universal Healthcare Coverage (couverture maladie universelle - CMU), plan set up in 1999 (FR9904171F). Instead, they fall under a specific scheme known as State Medical Assistance Programme (aide médicale d’Etat - AME). This programme covers foreign nationals not in possession of official residency permits, whose monthly income falls below a preset amount (EUR 576 per month for a single person).
The Government and Parliament moved to restrict access to this scheme in 2002 and 2003. While specific requirements such as proof of at least three month’s residency in France have been implemented, other proposals, such as the introduction of user fees, were rejected in the face of significant opposition from NGOs, trade unions and left-wing political parties. The new restrictions have brought the number of recipients down from 175,000 in 2003 to 148,000 in 2004.
A collective complaint by the International Federation of Human Rights (Fédération internationale des droits de l’homme, FIDH) resulted in 2005 in a decision by the Council of Europe’s committee on the European Social Charter condemning certain aspects of the reform package. The committee laid particular emphasis on the fact that 'all foreign nationals even if they are illegal', must have access to medical assistance, as is their right under the Social Charter. The Hirsch report on poverty reduction, which was submitted to the Government in April 2005, recommends that the State Medical Assistance Programme be incorporated into the Universal Healthcare Coverage Programme.
In February 2004, the Government published two draft decrees designed, among other things, to restrict access to the State Medical Assistance Programme. The new requirements included proof of identity as well as evidence of at least three month’s residency in France and means of support. The board of the National Employed Workers' Sickness Insurance Fund (Caisse nationale d'assurance maladie des travailleurs salariés, CNAMTS), whose most of the members are representatives of the social partners, added its condemnation of the planned measures to the robust action mounted by NGOs. This resulted in the Government opting not to publish the decrees. However, both decrees were eventually published in a slightly amended form on 29 July 2005 (decree 1 and decree2).
As early as 5 August, twenty-five organisations, for the most part NGOs, issued a joint statement protesting against the decrees. By mid-September 2005, the number of signatories to the statement had grown to more than 100, including the General Confederation of Labour (Confédération générale du travail, CGT), the Unitary Union Federation (Fédération Syndicale Unitaire, FSU), the Group of 10 Solidarity (G10 Solidaires) (Solidarity G10 Union Coalition), some unions affiliated to the independent Solidarity, Unity, Democracy (Solidaire, Unitaire, Démocratique, SUD), as well as various healthcare professional unions. The General Confederation of Labour-Force ouvrière (Confédération générale du travail-Force ouvrière, CGT-FO) issued a press release on 9 August, in which it expressed its disagreement with the decrees and pointed to the negative opinion put forward by the CNAM board in February 2004. On 10 August, the French Democratic Confederation of Labour (Confédération française démocratique du travail, CFDT) and the National Federation of Independent Unions (Union nationale des syndicats autonomes, UNSA) education branch, issued a joint press release with the major healthcare mutual body, Mutualité française and two organisations operating in the health and disability sectors, in which they also took the Government to task over its decision. They all shared the view that there had been a failure to measure the initiative’s impact on public health and that any move to restrict access to healthcare among the most disadvantaged would result in an increase in marginalisation-related diseases. The CGT, which had already signed on to the multi-organisation statement, unilaterally spoke out against 'the war being waged on the poor', which was designed 'to cut the number of healthcare recipients by implementing impossible eligibility criteria for claimants, with complete contempt for public health imperatives'.
Lastly, a CNAM board resolution on 6 September 2005 reiterated the body’s opposition to the decrees. It stated that 'this step backwards regarding access to care' flew in the face of the 'fundamental requirements of public health and health safety while actually failing to guarantee any financial savings'. The resolution was passed unanimously by 22 voting members of the board. The CGT-FO, the Movement of French Enterprises (Mouvement des entreprises de France, MEDEF) and the General Confederation of Small and Medium-sized Enterprises (Confédération générale des petites et moyennes entreprises, CGPME) members did not take part in the vote.
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