De facto n°31 | February 2022

31 | February 2022

State Medical Assistance and the making of a fake problem

Within the context of the French presi­den­tial elec­tions follo­wing two years of pandemic, the State Medical Assis­tance (Aide Médi­cale d’État or AME) is once again targeted by several presi­den­tial candi­dates. Created in 1999, this medical assis­tance system allows taking care of non-hospital treat­ments for people ille­gally resi­ding in France (depen­ding on their resi­dence and income). Arguing the AME’s supposed finan­cial burden and its pull factor (‘appel d’air1) which would make France parti­cu­larly attrac­tive to migrants, conser­va­tive and far-right parties suggest further restric­ting, if not comple­tely putting it to an end. In other words, the ills of our health system are instru­men­ta­lised, proble­ma­tised and solved only through the AME’s ‘cost’, despite the scien­tific consensus on the merits of this system and the need to preserve it for both medical and ethical reasons. 

Gathe­ring scien­tific exper­tise and profes­sional expe­riences, this issue of De facto accounts for elec­toral news with facts. To the pull factor rhetoric, Céline Gabarro reports the dete­rio­ra­tion of the condi­tions to receive AME cove­rage. Through figures, Paul Dour­gnon, Florence Jusot, Antoine Marsaudon et Jérôme Wittwer demons­trate the AME as being unde­rused. Nicolas Vignier puts the AME’s economic cost into pers­pec­tive by under­li­ning the signi­fi­cant health and budge­tary impacts that would stem from putting an end to the AME. In light of 20 years of debate, Caro­line Izam­bert notices the evident gap between the poli­tical discourse and the scien­tific exper­tise. The enquiry on forei­gners’ access to heal­th­care affects further Euro­pean coun­tries. Roberta Perna recounts how the Italian far-right is criti­ci­sing the universal and inclu­sive nature of the health system, to predo­mi­nantly target migrants. Chris­tiane Vollaire and Phil­lippe Bazin recon­sider the Greek ‘archi­pe­lago of soli­da­rity’ through images where resis­tance is growing towards helping native and migrant popu­la­tions before a collap­sing health system. In fine, Jérémy Geereart expounds on the role asso­cia­tive sectors have been holding in the fight to change legis­la­tion and improve forei­gners’ access to heal­th­care in Germany.

Betty Rouland, Scien­tific coordinator

1 An ‘appel d’air’ trans­lates into an ‘indraught’. It is a tech­nical term used by fire­figh­ters, it describes an air flow that stimu­lates combus­tion. The term is used by right and far right parties to asso­ciate immi­grants with flames that deprive the French of air. The meta­phor has become common in public debates and it stands for a ‘poli­ti­cally correct’ version of an invasion. 

Trans­la­tion by Victoire Hernandez, master student in Migra­tion Studies, within the frame­work of her inter­n­ship at the CI Migration