PLFSS 2026 The most vulnerable are being targeted by the cost-saving measures
Under debate since 4th November in plenary session at the National Assembly, the 2026 social security funding bill (PLFSS) has earmarked 7.1 billion euros of savings in the field of health. To achieve that target, a combination of measures intended to make the public aware of their responsibilities will threaten access to healthcare for those who need it most, in particular those suffering from long-term conditions.
Thrown out by the social affairs commission, the text of the social security budget – PLFSS – is generating much debate, particularly regarding the effects that such health expenditure economy measures will have on the most vulnerable.
Measures aimed at generating savings
Presented by the Government as measures to enhance the sense of responsibility of all the players in the healthcare system, the measures aim to reduce the level of cover by health insurance of certain treatments and medicines:
- Doubling of the level and the ceiling of excess on medicines and standard contributions, and extension of such excess and standard contributions to dental treatments and medical apparatus.
- Reduction of the cover on certain medicines, considered as providing “limited medical benefit” for patients suffering from long-term conditions (ALD: Affections Longue Durée). These medicines had until now been refunded at 100 %. Their refund would now fall to 15 %.
- Restriction on the length of prescribed sick-leave for those suffering from “non exempting” long-term conditions.
- Taxation of sickness benefit daily allowances for patients suffering from long-term conditions (this funding bill measure was deleted from the text during the examination session).
Measures having significant effects on patients suffering from long-term conditions (ALD)
The cumulative effect of these measures will be far from negligible for patients suffering from long-term conditions (ALD). Currently, people suffering from chronic pathologies such as diabetes, cancer or cardio-vascular disease enjoy a 100 % cover of their health insurance costs, in the context of the ALD system. Currently, some 14 million patients benefit from the system, i.e. around 20 % of the population. This figure is expected to rise to 18 million by 2035, i.e. 26 % of the population, and the expenditure for ALD patients will then represent three quarters of health insurance costs.
Even if they do enjoy 100 % cover of their health insurance expenditure, patients suffering from long-term conditions must, on average, pay a greater contribution than the rest of the population. A study by Malakoff Humanis published in June 2025 based on 2019 data shows that, “For an average expenditure on local and hospital medicine of 1,408 euros, the final contribution after refund by health insurance amounts to 572 euros, representing 41% of the expenditure. For an ALD patient, the final contribution amounts to 1,055 euros, corresponding to 15% of an expenditure of 6,948 euros.”
The doubling of the amounts and the ceilings of the excess and standard contributions introduced under article 18 of the PLFSS will affect long-term ALD patients more severely than the rest of the population, as indicated by the PLFSS impact study : “On the single subject of excess, whereas ALD patients already pay on average 42.6 euros per year compared with 20.7 euros for non-ALD patients, with the new measure, they will pay 85.3 euros, as well as 9.2 euros for transport costs (compared with respectively 41.9 euros and 0.8 euros for non-ALD patients) on the assumption of the doubling of the amounts and ceilings”.
The impact study notes that this measure “generates a risk of accentuation of the phenomenon of healthcare rejection, insofar as it can generate a yearly cost of 350 euros, for those already facing high contributions (ALD patients, pensioners)”.
The fragility of access to healthcare
As recalled by the CESE (Economic, Social and Environmental Council) in its contribution to the PLFSS, “Currently, one in four people decide against healthcare: financial difficulties remain a major obstacle for the access to healthcare and are added to other difficulties (medical deserts, complexity of the healthcare and social protection system…)”.
The measure doubling the excess and standard contributions, combined with the reduced refund on certain medicines and possibly the taxation of sickness benefits, increases the fragility of access to healthcare for ALD patients, who are seriously affected by this PLFSS, whereas they are the people most in need. That is all the more worrying since the Government has recently confirmed its intention in January 2026, to submit to the Senate its bill establishing “assistance in dying”. The text provides that “assistance in dying”, assisted suicide or euthanasia, would be accessible to adults, of French nationality or resident in France, “suffering from a serious and incurable condition, whatever its cause, threatening life expectancy, in an advanced or terminal phase.” However, as explained by Dr. Olivier Trédan, an oncologist, in an analysis in June 2025, “If a broad definition is used for the term ‘advanced’, diseases impacting functionality and the general condition of the patient, such as diabetes, cardio-vascular diseases (when there are complications), most forms of cancer, neuro-degenerative diseases and chronic diseases (such as kidney failure or chronic respiratory difficulties), would fall within the scope of the law.”
Faced with ever increasing costs for healthcare due to the need to balance the social security accounts, people suffering from long-term conditions could be pushed towards the exit by authorising them to apply for assisted suicide or euthanasia.
Alliance VITA warns against any challenging of the principle of solidarity with the most vulnerable. Our healthcare system must not abandon them. Access to healthcare for all must be maintained as a top priority.
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