French Lawmakers Approve Financial Contribution for Non-EU Foreigners Seeking Medical Care in France
Introduction
As France searches for ways to balance its social security budget, the National Assembly has just passed a highly symbolic amendment: non-EU foreigners will now be required to pay a financial contribution to access healthcare in France. This measure, part of the 2026 Social Security Financing Bill (PLFSS), comes amid a massive deficit in the general social security system and ongoing debates over how to fund public healthcare.
Why is this decision such a turning point? Because it challenges one of the founding principles of French Social Security: universal access to healthcare, regardless of nationality or immigration status. But with a projected deficit of over €23 billion in 2025, the government is looking to curb rising costs and encourage all users—including foreigners—to share responsibility. Passed by a wide majority, this reform is already sparking heated debate on both economic and social justice grounds.
In this article, you'll get a comprehensive look at the background and implications of this new contribution, its potential impact on Social Security, the state budget, immigration policy, and the future of national solidarity. Dive into a current issue where healthcare, public finances, and immigration intersect.
Background and Origins of the Measure
Social Security Under Budgetary Pressure
France is facing a critical budget situation: the Social Security deficit is expected to exceed €22 billion in 2025, far above initial forecasts. According to the news site La Finance pour Tous, controlling healthcare spending is now a national priority, as the growing deficit alarms policymakers.
Healthcare funding—a cornerstone of the French social contract—has historically relied on national solidarity extended to all residents, including foreigners under certain conditions. Since the 2016 law establishing Universal Health Protection (Puma), any foreigner with legal status and a long-stay visa could have their medical expenses covered, provided they could show minimum income and insurance covering at least €30,000 in medical costs. Many would then cancel this insurance, relying solely on France's famously generous Social Security system.
The Debate Over Foreigners' Healthcare Coverage
This system benefited many Americans, Canadians, Japanese, and Gulf nationals who moved to France, sometimes to escape the high cost of healthcare in their home countries, as recently reported by TF1 Info. The fairness of this arrangement was increasingly questioned, especially as some lawmakers denounced France as a "free healthcare paradise" for foreigners who often had substantial resources.
This situation raised two main issues:
Details of the New Financial Contribution
A Key Budget Amendment at the Heart of Reform
On Saturday, November 8, 2025, lawmakers passed a key amendment to the 2026 PLFSS by a vote of 176 to 79: it establishes a mandatory financial contribution for non-EU foreigners holding a long-stay "visitor" visa who seek medical care in France. The goal is to help reduce the Social Security deficit and limit abuse or misuse of the system.
François Gernigon, the lawmaker behind the proposal, explained that French Social Security needs to handle this issue with greater rigor. In his view, it makes sense to require a minimum contribution to guarantee access to a "defined package of care," similar to a private insurance plan. A forthcoming decree will set the minimum amount and specific implementation details.
Who Is Affected?
The measure applies exclusively to:
Not affected:
How Will It Work? What Will It Cost?
At this stage, the minimum contribution amount hasn't been set and will be determined by decree in the coming months. However, parliamentary debates have suggested several options:
A detailed timeline and list of included healthcare services are expected to be published before the end of the first half of 2026.
Economic and Budgetary Stakes
The Main Goal: Reducing the Social Security Deficit
At its core, this reform is about controlling public spending. With healthcare costs rising steadily—State Medical Aid (AME) alone cost nearly €1.39 billion in 2024, according to the latest Senate report, a 68% increase over ten years—there is little room to maneuver.
The government, also needing to fund energy transition, defense, and education, faces tough choices. Healthcare accounts for nearly €200 billion in annual spending, 80% of which is covered by Social Security. In this context, requiring non-EU foreigners to contribute is seen as a matter of financial fairness and accountability, without undermining the principle of access to care for all.
The Real Cost of Healthcare for Non-EU Foreigners
Precise data is hard to come by, as the number of foreign patients fluctuates by year and visa category. However, several parliamentary reports note:
These figures also include undocumented individuals covered by AME, but they illustrate the scale of public spending. The total cost for non-EU foreigners with long-stay visas isn't officially published but is estimated at several hundred million euros annually.
Aligning with European Practices
France isn't alone in this approach. Most European countries require foreigners to pay for access to healthcare. Germany, Italy, Sweden, and the UK generally limit the range of reimbursed care, while countries like Spain and Belgium are more generous. Denmark and Switzerland, on the other hand, sharply restrict access for non-residents.
The French reform aims to bring national policy in line with European norms, while still ensuring access to essential care.
Real-World Impact on Public Finances and Society
Expected Effect on the State Budget
Introducing this contribution should generate new revenue for Social Security and, over time, help reduce the deficit by tens of millions of euros per year. However, this estimate depends on the number of people affected and the final contribution amount.
Beyond the budget, the reform could also make France less attractive to foreigners seeking more generous medical coverage. Some worry, though, that a financial barrier could lead some people to forgo care, potentially increasing reliance on emergency services or last-resort programs like AME.
Impact on Immigration Policy
This measure is part of a broader set of reforms aimed at controlling immigration and better regulating access to social benefits. It echoes the government's stated intention, since 2023, to reform AME to focus it on urgent and essential care.
The goal: prevent misuse of the system, especially requests for medical residence permits, which were sometimes used as a last resort by rejected asylum seekers or citizens of wealthy countries with adequate healthcare.
Public Health Risks
Some healthcare organizations, especially advocacy groups for foreigners and medical unions, warn of the risk of exclusion: requiring a financial contribution could push vulnerable foreigners to delay or forgo essential care, with negative consequences for public health. From an epidemiological standpoint, early treatment of infectious diseases (HIV, tuberculosis, etc.) is considered crucial to avoid much higher costs down the line.
The government insists the reform will guarantee at least minimal access to urgent care and maintain preventive services, especially for infectious diseases and maternal health. The balance between cost control and public health protection will be closely watched in the coming months.
Key Players and Their Positions
Institutions and Individuals Involved
Key players in this reform include:
Affected Businesses and Sectors
The private healthcare sector (clinics, labs, insurance companies) could see some impact, especially if foreigners turn to private insurance or seek care outside the public system.
Public hospitals, meanwhile, will need to adapt their administrative procedures to collect the contribution and inform affected patients.
Looking Ahead: Future Trends and Perspectives
Will the Reform Last?
The big question is whether this financial contribution will be enough to address the structural challenges of healthcare funding in France. Experts agree on one thing: controlling spending will require deep reforms that go far beyond the issue of healthcare for foreigners. Transforming the healthcare system, focusing on prevention, fighting fraud, and optimizing care pathways remain major challenges.
Toward a Broader AME Reform?
The future of State Medical Aid (AME), which covers undocumented individuals, is still undecided. Despite government announcements since 2023, the promised reform hasn't materialized. Some lawmakers want to turn AME into an emergency-only program, limited to life-saving care, while others argue for maintaining broad access for public health reasons.
The European trend is toward restricting rights for foreigners, but France still claims a unique model of solidarity. This delicate balance could be tested in the coming years, with new tensions between budget constraints and humanitarian needs.
International Reactions
France's reform is being closely watched by its European neighbors. Some countries welcome the move toward harmonized rules, while others worry it could shift patients to their own healthcare systems. Conversely, some states may be tempted to adopt similar measures, increasing pressure on European health insurance systems.
Conclusion
Requiring a financial contribution from non-EU foreigners seeking healthcare in France marks a turning point in national health and solidarity policy. Balancing the need to control public spending, ensure fairness, and maintain access to care for all, France is walking a fine line. The budgetary, social, and health impacts of this reform will be closely monitored in the months ahead by both public authorities and civil society.Against a backdrop of record Social Security deficits and ongoing debate over the role of foreigners in the French social model, this measure reflects a desire to reinforce individual responsibility while preserving the foundation of solidarity. The question now is whether this change will truly contribute to the system's sustainability—or if it's just the first step toward a broader, more controversial overhaul of healthcare funding in France.
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This article is based on the latest information available as of November 8, 2025, including reports from TF1 Info, the Senate, the National Assembly, La Finance pour Tous, and official legislative texts.---
❓ FAQ - Frequently Asked Questions
1. What did French lawmakers approve regarding healthcare for non-EU foreigners?
The National Assembly approved a measure requiring non-EU foreigners holding a long-stay “visitor” visa to pay a financial contribution to access healthcare in France. Passed on November 8, 2025 (176 votes to 79) as part of the 2026 Social Security Financing Bill (PLFSS), the reform aims to reduce the Social Security deficit and limit abuse or misuse of the system. It represents a shift from the tradition of broad, largely contribution-free access for qualifying foreigners toward a model where beneficiaries share costs while still ensuring access to care.
2. Who is affected and who is not?
Affected: non-EU citizens who hold a long-stay “visitor” visa and use France’s general Social Security regime for healthcare. Not affected: citizens of the EU, European Economic Area, and Switzerland (covered by European social security coordination); foreign students (covered by a separate system); and undocumented individuals eligible for State Medical Aid (AME), which is a distinct program.
3. What is a long-stay “visitor” visa in this context?
In the context of this reform, it refers to people residing in France for an extended period who are not employed in the country. Under the 2016 Universal Health Protection (Puma) framework, foreigners with legal status and a long-stay visa could have medical expenses covered if they demonstrated minimum income and held insurance covering at least €30,000 in medical costs. Many then canceled that insurance and relied on France’s Social Security; the new contribution targets this category to increase accountability.
4. Why is France introducing this financial contribution now?
France’s Social Security deficit is projected to exceed €22–23 billion in 2025, making control of healthcare spending a priority. Lawmakers argue the measure promotes financial fairness and accountability by asking non-EU visitors who use the system to contribute, aligning with practices in many European countries. It responds to concerns about a growing public burden—estimated at several hundred million euros annually for non-EU foreigners with long-stay visas—and perceptions that France had become overly generous relative to other nations.
5. How much will the contribution be and how will it work?
The amount is not yet set; a decree in the coming months will define it. Options discussed in Parliament include: an annual flat-rate contribution (akin to the former €30 AME entry fee); a basic package of covered care included in the contribution with optional add-ons, similar to private insurance; or aligning contribution rates with those applied to French Social Security members (as referenced in Article 53 of the Social Security Financing Law of February 28, 2025). Exact pricing and covered services are pending.
6. When will details and implementation be finalized?
The reform was adopted on November 8, 2025, within the 2026 PLFSS. A decree will set the minimum amount and operational details in the coming months. Authorities expect to publish a detailed timeline and the list of included healthcare services before the end of the first half of 2026. Implementation will follow those regulatory specifications.
7. How does this change the previous rules under Puma?
Since 2016, Puma allowed foreigners with legal status and a long-stay visa to have medical costs covered if they showed minimum income and initially held insurance covering at least €30,000. Many later canceled that private insurance and relied on Social Security. The new measure adds a mandatory financial contribution and envisions a defined package of care, with potential options to purchase additional coverage, to increase user responsibility while maintaining access.
8. What budget impact is expected?
The contribution is expected to generate new revenue and help reduce the Social Security deficit by tens of millions of euros per year over time. The exact impact depends on how many people are affected and the final contribution amount. Policymakers also expect it may reduce France’s attractiveness to foreigners seeking more generous medical coverage, though some fear this could shift demand to emergency or last-resort programs.
9. What are the public health concerns?
Advocacy groups and medical unions warn that requiring a contribution could lead vulnerable foreigners to delay or forgo care, which may worsen health outcomes and increase long-term costs, especially for infectious diseases like HIV or tuberculosis. The government says the reform will preserve at least minimal access to urgent care and maintain preventive services, particularly for infectious diseases and maternal health. The adequacy of this balance will be closely watched.
10. How does France’s approach compare with other European countries?
Most European countries require foreigners to pay for access to healthcare. Germany, Italy, Sweden, and the UK generally limit the range of reimbursed care; Spain and Belgium are more generous; Denmark and Switzerland sharply restrict access for non-residents. France aims to align with these European practices while still ensuring access to essential care.
11. Who are the key players and what are their positions?
The government is driving the reform through the PLFSS to control public finances. The National Assembly voted in favor with support from the presidential majority and some Republicans. Lawmaker François Gernigon proposed the amendment, advocating for a minimum contribution tied to a defined care package with options. The Social Security administration will implement and collect the contribution. Advocacy groups for foreigners are mobilized to protect universal access and prevent exclusion.