Wheelchairs, ALD, co-payment… disabled people, between fear and scepticism as the PLFSS vote approaches

Il y a entre 0,9 et 12 millions de personnes souffrant d'un ou plusieurs handicaps en France. ILLUSTRATION UNSPLASH. – Jon Tyson

In France, the poverty rate among people with disabilities is twice as high as among able-bodied people. This situation can be explained by the difficulty of accessing aid, care, the lack of inclusion in the professional world and an often too high out-of-pocket cost. For people who are sick, injured, aging, etc., the budget vote is a source of concern. A few days before the verdict, associations remain cautious.

Eating meat, heating properly, coping with an unforeseen expense… What sacrifices will disabled people have to make after the 2025 budget vote ? While they are twice as likely to be poor as able-bodied people (Observatoire des inégalités), they are waiting for Parliament's decisions on the PLFSS (Social Security Financing Bill) and the possible adoption of a motion of censure.

Too many uncertainties

François Bayrou has promised to reimburse wheelchairs in 2025, in September a priori. The proposal by Sébastien Peytavie (Ecologist and Social) was adopted by the National Assembly. “This is a big topic, highly anticipated for us. For the moment, we have no visibility, we don’t know if there will be full coverage”, explains Féreuze Aziza, Health Insurance Project Manager at France Assos Santé. Covering wheelchairs; yes, but to what extent? Does the PLFSS plan to reimburse add-ons, i.e. options added to the device to adapt it on a case-by-case basis? Will reimbursement be supplemented by the departments, via the PCH (Disability Compensation Benefit)? And what role will the supplements play?

Another point of concern: the increase in the co-payment, or the remaining cost after reimbursement by health insurance. After the censorship, the government seems to have given up on it, but the mutual insurance companies have already adapted to it. In anticipation of an increase in health spending, they have increased their contributions by 6% on average, notes the Mutualité française. In addition, Féreuze Aziza reminds us, the co-payment had already increased in 2023. “We see that little by little, the government is trying to find solutions in the pockets of users”, she emphasizes. So be careful. If the government, under pressure, has given up for this year, it could try again. To soften the left, he also crossed out the overhaul of the system for taking care of long-term illnesses (ALD).

Still invisible

Disabled people are among those most affected by the decisions that will be made in the Chamber this week. Depending on the criteria used, between 0.9 and 12 million people have a disability in France. If we take the highest figure: at 80%, this disability is invisible. And when you have a serious and lasting illness, you can request recognition as a long-term condition, or ALD.

Most of the time, these conditions are said to be exempt (diabetes, cardiovascular diseases, Alzheimer's, malignant tumors, multiple sclerosis, paraplegia): patients are covered 100% for all care relating to their illness, without any advance payment.

The remaining 20% ​​generally have a disability rate that allows them to have access to a disability pension, or to the Disabled Adult Allowance (AAH), in addition to recognition as ALD by Health Insurance. This assistance and support is essential for people who are unable to work, or to supplement therapeutic part-time work. In addition, it allows patients to follow all of their treatments. For Social Security, ALD represents 12.3 billion euros, points out the Dress.

Double penalty

And that is necessary. Because without this assistance, sick people would have to take out increasingly expensive mutual insurance, the price of which increases as the disability intensifies. It’s a double whammy: not only can they benefit less from company mutuals, because they are less able to work for a salary, but on top of that, individual contributions are soaring. “This particularly concerns the elderly, who are retired, or sick people, the unemployed… they pay the full price” , points out Féreuze Aziza.

France Assos Santé also denounces the invisible remaining costs. Although they do not appear in any database, it is on disabled people that these expenses weigh the heaviest, which is why the organization conducted a survey on the subject. Result: on average, people with disabilities, illnesses, or loss of autonomy spend 1,557 euros per year. Added to this are the visible costs, 250 euros per person on average, and up to 800 euros for people with long-term illnesses (ALD).

This results in a Cornelian dilemma. Between getting treatment and feeding oneself, finding housing… most disabled people give up on care. More than half of the 3,000 people surveyed by France Assos Santé have already given up on care for financial reasons. The biggest losers are recourse to psychology, small care equipment or even products aimed at relieving the side effects of treatments. Although the PLFSS appears to be more lenient under Bayrou than in its initial version with Barnier, the situation does not seem to be improving.

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