It is a reform which promises an explosive debate, a few months before the presidential election: the project of “Grande Sécu”, in favor of a wider field of action of Social Security and to the detriment of complementary health, sees its outlines gradually take shape. The High Council for the Future of Health Insurance (HCAAM), which was requested by the Minister of Health Olivier Véran last summer, must submit its report on the project next Thursday, November 18. He already estimates at 22 billion euros the costs of such a reform for the State, according to The echoes.
Enough to cringe the opposition, including Xavier Bertrand, who lambasted the project in a platform in the Sunday newspaper : “It would be financial madness, at a time when France is already the OECD country which taxes the most. The shock to public finances resulting from this measure would be unprecedented on the scale of the Fifth Republic”, denounced the candidate for the LR nomination for the presidential election, arguing that the government “would put our children in debt for several generations”.
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An additional cost of nearly 22 billion euros for the State
The transfer of the reimbursement field provided for by the “Grande Sécu” would have a non-negligible cost according to the HCAAM report, consulted by Les Échos: 18.8 billion euros additional to the charge of the State, with in particular 8, 9 billion for city care (all medical services apart from cases of hospitalization or accommodation in health establishments), 3.3 billion euros for the remainder of the charge in the hospital and 3.1 billion for the reimbursement of drugs. Other costs must be taken into account, such as the shortfall in the additional solidarity tax, which would represent a windfall of 3.5 billion euros for the State.
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Resolve “structural weaknesses”
The idea of ”Grande Sécu” is not new but the health crisis has reinforced it. “Access to quality care is a major concern of the French. And with the health crisis, we realized that to be active, agile, to make new care available to all, it was easier to ‘have a single payer “, explained Florence Jusot, health economist, on France Culture. The scope of drugs fully reimbursed by health insurance has already been extended in the 2022 social security budget, at an additional cost of 370 million euros.
But the objective would be to arrive, in the long term, at full coverage of reimbursements by social security, to the detriment of mutuals. Medicare could even cover optical, dental and hearing aid. These are currently included in the 100% health pack and are therefore reimbursed in full, but with the help of mutual funds. The “Grande Sécu” provides that the expenses of this care, which too many French people renounced because of their cost, return only to the charge of social security. In the end, only fee overruns or private rooms in the event of hospitalization would remain outside the scope of reimbursement of the “Grande Sécu”.
Olivier Véran thus intends to resolve the “structural weaknesses” of the current system, as he wrote in his letter sent to the HCAAM in July, and to reduce “the amounts of management costs which weigh on the purchasing power of the insured”. A project that wants to tackle inequalities in the health system, with 5% of French people, many of whom are unemployed, who do not have mutual health insurance, and retirees who generally pay more for their complementary health insurance than others.
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Complementary health insurance in the sights
The grumbling of mutual health insurance did not take long. And for good reason, the HCAAM predicts that the turnover of supplementary insurance will fall by 70%, or 27 billion euros: 19.7 billion due to the extension of health insurance coverage and 7.3 billion billion due to the disaffiliation of poorly covered policyholders.
Why are complementary health insurance in the eye of the storm? In a period of debate on the purchasing power of the French, mutuals are seen as yet another expense weighing on their portfolio. According to a Meilleurtaux.com study, they are widening territorial disparities, with particularly high subscriptions around the Mediterranean and in Île-de-France (from 2,950 to more than 3,000 euros per year), and generational disparities: for a couple of 60 years in reinforced guarantees, a mutual insurance taken out in Paris will cost for example 3,306 euros per year, much more than the French average established at 2,882.50 euros per year.
Above all, some mutuals have announced that their prices will increase significantly in 2022, as is the case with the Mutuelle générale, which provides for changes in contributions between 0 and + 2.5%. “We intervene in addition to Social Security and, as health expenditure increases year after year from 2.5 to 3%, it is normal that the contributions of mutuals increase at the same rate, justifies Séverine Salgado, general manager of the French mutuality, in The Parisian. They also reflect the level of taxes which, in fifteen years, has gone from 0% to 15%. “Because mutual societies must pay the additional solidarity tax (TSA), paid to the State on the basis of contracts Signed, enough to predict long weeks of negotiations between the different parties.
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