Immigration, Bruno Retailleau
State medical aid (Aide médicale de l'État): AME reduced to essential care and minors (€0.7bn expected)
Direction of change: decrease, compared with current law.
The lever. Coverage of healthcare for foreign nationals in an irregular situation: maintained, reduced to emergencies or abolished. Direction rule: ↑ broader AME (State medical aid).
« Dès 2027, à droit constant : regroupement familial divisé par deux et convention franco-algérienne renégociée ; minorité des mineurs non accompagnés vérifiée ; aide médicale d’État réduite aux soins essentiels ; […] AME réduite aux soins essentiels et aux mineurs […] 0,7 OID : 0,66 ; crédits 1,2 Md€ »1Translation by the editorsFrom 2027, under current law: family reunification halved and Franco-Algerian agreement renegotiated; minority of unaccompanied minors verified; state medical aid reduced to essential care; […] AME reduced to essential care and to minors […] 0.7 OID: 0.66; appropriations €1.2bn
Encoding
Position linked to an option of the cost schedule, with no parameter to set: see the costing.
Costing
Announced by the candidate
+€0.7bn
per year, saving. €0.7bn in 2032 for the « AME réduite aux soins essentiels et aux mineurs » [“AME restricted to essential care and to minors”] (press fact sheet no. 9), out of €10bn expected from immigration
Published costings
none
No external costing of this position recorded to date.
Our calculation
+€0.4bn
per year for the public accounts, saving, range +€0.2bn to +€0.7bn.
The calculation
- Transformation into emergency medical aid (limited basket: emergencies, serious illnesses, pregnancy, vaccinations): Option costed by the source: a gain of €0.4bn (0.2 to 0.7) per year.
Assumption by the editors. Reading adopted: the AME « réduite aux soins essentiels et aux mineurs » [“restricted to essential care and to minors”] is costed using the cost schedule option that limits the basket of care (emergencies, serious illnesses, pregnancy, vaccinations); continued care for minors is not modelled separately.
Coefficient calculated by the editors from Sénat, commission des affaires sociales, L'Essentiel PLF 2026 « Santé » (avis Florence Lassarade): the position is marked as an assumption by the editors.
Figure announced by the candidate: no gap calculated: costing based on an assumption by the editors.
Current law, sources and limits of the cost schedule
Current law. AME (state medical aid; Code de l'action sociale et des familles, art. L251-1 et seq.): coverage of healthcare for irregular migrants resident in France for more than 3 months, subject to an income ceiling. Prior approval for certain scheduled care during the first 9 months. Actual spending of €1,386.8m in 2024 (+15.5%) and €1,385m forecast for 2025 (DSS), whereas the appropriations in the PLF 2026 are €1,208.3m. 461,833 beneficiaries at 31 March 2025. Spending split 61% hospital care and 39% community care.
Horizon. Full year 2032, current €bn, compared with current law
Limits. 2032 projection calculated by the editors: €1,385m in 2025 × (1+g)^7, with g = 3% (low), 4% (central, rate anticipated by the Senate for 2026) and 6% (high, average since 2009). Abolition: GROSS and static saving. It ignores the shift to urgent care (€132m in 2024, already partly borne by national health insurance), hospitals' unrecoverable debts and health effects. The Évin-Stefanini report (Dec. 2023) considers the AMU (emergency medical aid) « inappropriée » [“inappropriate”] and costs no saving. There is no official costing of the AMU. The range is constructed: the low end takes the order of magnitude of the Senate amendment (-€200m), the high end removes the whole share of outpatient care (39% × 1.82 ≈ €0.7bn), the central value is halfway. Voted appropriations underestimate actual spending every year: the State's debt to social security in respect of AME (state medical aid) would reach €362m to €428m at the end of 2025. The cost schedule therefore costs on actual spending, not on appropriations. The three options are mutually exclusive (overlaps declared).
- Sénat, commission des affaires sociales, L'Essentiel PLF 2026 « Santé » (avis Florence Lassarade), 2025-12-03: « « Les dépenses d'AME ont progressé de 6 % par an en moyenne depuis 2009, et de 40 % entre 2021 et 2025. Alors que les crédits consacrés à l'AME resteraient plafonnés à 1 208,3 millions d'euros en 2026, les dépenses réelles d'AME ont atteint 1 387 millions d'euros en 2024 » ; « La direction de la sécurité sociale (DSS) estime ainsi que la dépense prévisionnelle s'établira à 1 385 millions d'euros pour l'exercice 2025 » ; « En 2026, une progression de 4 % est anticipée » ; « Les prestations hospitalières représentent 61 % de cette dépense » ; « un amendement minorant les crédits de l'AME de 200 millions d'euros » »
- Sénat, rapport d'information n° 841 (2024-2025), Vincent Delahaye, commission des finances, sur l'aide médicale de l'État, 2025-07: « « le coût total réel de l'AME est de 1 386,8 millions d'euros, soit une hausse de 15,5 % des dépenses par rapport à 2023 » ; « l'État ne prend pas en charge l'intégralité de la dépense d'AME pour soins urgents, puisqu'il ne verse que 70 millions d'euros à la sécurité sociale sur un coût total de 132 millions d'euros » »
How to read these amounts. These are static costs and revenues, with no feedback effect, over a full year: nothing on growth, employment or the revenue that economic activity would gain or lose. A higher net cost does not on its own make a worse policy, nor net savings a better one: each programme rests on an economic model (demand-led stimulus, lower compulsory levies, consolidation of the public accounts…) that the cost schedule does not settle. GDP itself measures a volume of activity, not well-being or the usefulness of what is produced. Economic models and feedback effects.
- avecretailleau.fr, fiches presse « Rétablir l'ordre dans les comptes publics » (12 octobre 2026), fiche n° 9, p. 11. Open the document at this page.
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