Will the National Assembly complete its overhaul of the Social Security budget? The deputies continued discussions, Wednesday 12 November afternoon, regarding the “expenditure” section of the Social Security Financing Bill (PLFSS). The “recipe” section was largely rewritten, then adopted on Saturday. After a two-day break commemorating November 11, there are still more than 380 menu changes.
However, his schedule was constrained. The constitutional deadline set for the National Assembly on the first reading will expire at midnight Wednesday. This examination should be followed by an important debate on the suspension of pension reform. This promise from Sébastien Lecornu’s government must try to ward off censorship from the Socialist Party. This is what has been chosen, changed, or rejected to date.
Medical franchise extension: denied
The National Assembly largely opposed expanding the scope of the medical deductible, and several groups also criticized the doubling of this deductible, established through a Social Security extrabudgetary decree, and urged the government to cancel it.
As in committee, an overwhelming majority (197 votes in favor, 23 against) of deputies from all chambers supported the removal of the article from the Social Security Financing Bill (PLFSS). In particular, this regulation regulates the expansion of fixed contribution coverage and deductions for dental consultations and medical equipment. “Quietly, a third level of cuts is underway, in addition to Social Security contributions, in addition to co-insurance,” criticized Thierry Frappé (RN).
Reduction of the ceiling for long-term illness benefits: rejected
One measure of the bill proposes that a person recognized as suffering from a non-excluded long-term illness (ALD) would no longer be entitled to a daily benefit of 1,095 days for three years, but would be entitled to 360 days, like all insured people. Non-excluded ALD “is a condition that requires a break from work or care for a foreseeable period of more than six months, but does not entitle you to waive additional payments”, determine Health Insurance. This includes people with musculoskeletal disorders or depressive disorders. This proposal was removed by the National Assembly.
Expansion of drug consumption space: adopted
The deputies approved, on Saturday, with government support, the extension until the end of 2027 of the experiment with “addiction treatment centers”, drug consumption rooms that at this stage are at risk of being closed at the end of the year. Created in 2016 based on experiments in Paris and Strasbourg, this “stop”, incorrectly called “shooting room”, aimed at drug users who are far from the health care system, allowing them to consume drugs in a controlled manner. This extension was adopted as part of a transpartisan (Liot-PS-Ecologists) amendment to the PLFSS.
Creation of the “French Health network”: adopted
Deputies spoke out on Sunday in support of the creation of a “French Health network”, a measure proposed by Sébastien Lecornu to improve access to care in the region, despite opposition from left-wing deputies who consider it clearly insufficient.
These networks will essentially be based on existing structures such as health homes (run by private doctors) or health centers (where services are provided by salaried doctors). In certain remote areas, pharmacies can fulfill this role.
Mandatory flu vaccination for nursing home residents and certain caregivers: rejected
The Assembly on Saturday rejected, by 108 votes to 95, an article that laid the legal foundation for mandatory flu vaccinations for nursing home residents and certain health professionals, the RN opposed such a requirement, and the LFI asked what would happen if residents refused the vaccine.
The article takes care of that “as recommended” from the High Authority for Health (HAS), vaccination against influenza is mandatory for people living in nursing homes “during the epidemic period”. The same obligations, depending on the recommendations of the HAS, are also provided “health professionals who practice, in a liberal capacity, a profession listed in a decision of the Council of State”.
Evaluation of the “My psychological support” system: adopted
The deputies adopted amendments, carried out by elected environmental activists, to evaluate the “My psychological support” system, which offers up to 12 partial reimbursement sessions with a registered psychologist, as well as “impact on access to mental health”. “Anxiety and depression are increasing (…) We see absolutely no way to counter it,” defended Clémentine Autain, MP from the Ecology and Social group.
Limiting the duration of work stoppages: adopted
Sunday evening, the National Assembly approved limiting the duration of the work stoppage: the maximum duration is one month for the first prescription, and two months for an extension. However, doctors may deviate from the planned upper limit, “in relation to the patient’s situation” and justify it in their recipes.
The government initially wanted to set these limits by decree, namely fifteen days for the first work stoppage determined by the city doctor, and thirty days in hospital. The socialist amendment was eventually adopted so that the time period was one month in both cases, and the time period was included in the law. This was a backup amendment, as socialists originally wanted to remove the act, as did communists, ecologists, and the LFI.
There is no maximum duration of sick leave planned at the moment, however there are recommendations for certain pathologies. The insured person is also subject to a maximum daily allowance of 360 days for three years.
End of mandatory medical examination after maternity leave: rejected
Deputies also reviewed return-to-work examinations after maternity leave conducted by occupational physicians. Currently this is mandatory, but the government wants to make it optional. Elected representatives of the lower house finally restated its mandatory nature on Sunday evening.
Additional charges for overcharge: rejected
The National Assembly also removed regulations from the PLFSS that aimed to overtax, to curb, excess fees for doctors, which according to some reports were increasing rapidly. This would allow the government to increase by decree the fees paid by practitioners on their additional fees. The general reporter of the text, Thibault Bazin (LR), criticized the actions which he said were purposeful “indiscriminately all doctors in sector 2, regardless of the magnitude of the excess, (…) whether they participate in ongoing care or not, whatever their specialty”.
The amendment to delete the article was approved by the votes of the deputies of Renaissance, Horizons, LR, RN and their Ciottist allies, as well as the Communists and Liot. PS, LFI and environmental activists voted against. The deputies of the Demom Ministry have different opinions on this matter.
Mechanisms to limit the price of certain medical procedures: implemented
Deputies on Sunday adopted a mechanism aimed at limiting, or even revising downwards, the costs of medical procedures to reduce the Social Security deficit. Deputy PS Sandrine Runel in particular has a system that allows it to be adopted “to reduce authority” price “action that has excessive benefits”. Elected officials cited several sectors including “medical biology, radiology, dialysis, nuclear medicine, and even radiotherapy”.
The Assembly also adopted government measures which, among other things, provide for identifying sectors, actions or medical services with significantly higher profitability compared to other sectors, when such sectors “comparable investment needs”before launching price negotiations. If negotiations fail, the director general of the United National Health Insurance Funds will be given the authority to carry out price reductions unilaterally.
