The debate on the Social Security Funding Bill (PLFSS) began on 28th October 2024 at the French National Assembly. It appears during an extremely strained economic context. It is the subject of multiple criticism, in particular by those caring for the aged who are highlighting the lack of ambition and anticipation by the Government.
The French Parliament examine the Social Security Funding Bill every year, since the constitutional revision in February 1996 which instituted the principle. It has been separated from the finance law which specifies all the State earnings and expenditure for the coming year. The Social Security Funding Bill concerns the social protection system. The text is intended to control the expenditure by the French Social Security.
Whereas the State expenditure for 2025 is estimated at 490 billion Euros, that for Social Security will amount to 662 billion (versus 640 billion in 2024), included in the 2025[1] Social Security Funding Bill through its five branches : sickness, workplace accidents, old age (pensions), family benefits and, since 2023, the fifth branch which covers dependence and loss of autonomy through the national fund for solidarity of autonomy (CNSA). Social Security, now represents 46% of total public expenditure.
On examining the additional means allocated, it can be seen that this budget attempts as best possible to sprinkle the funds without reforming and rationalising the previous policies.
The commitments for supporting autonomy and inclusion represent an extra 1.8 billion Euros, this must however be put into perspective and considered in the overall economic context. The measures aim to fund emergencies:
• The deployment of 50,000 solutions to better accompany those confronting handicap, by 2030, a commitment taken in the context of the national conference on handicap in 2023;
• Reinforcement of the respite system in accordance with the 2023-2027 national strategy “Acting for carers”;
• A response to the financial difficulties experienced in care homes;
• Diversification of possible living quarters for the aged experiencing loss of autonomy;
• Support for mobility and working partnerships for home helps by the departments providing specific support for the most underprivileged (100 million euros allocated).
The CNSA council consulted for an opinion on the 2025 budget voted against it.
In its statement, the Council members “are concerned however about the negative impact on the budget of the aged and certain economic measures decided for the Sickness and Old age branches.
In particular concerning the increase in patients’ contributions, the transfers intended from Health Insurance to supplementary health insurance, which are liable to result in an increase in the premiums which are already very high for pensioners, as well as the six month delay in the retirement pension increase, which will have an immediate impact on the living standards of those on limited incomes and, in consequence, their ability to fund the needs for preserving their autonomy and their costs in establishments or for access to services.”
According to an official report published in 2023, the French population between 75 and 84 years of age will increase by 50% between 2020 and 2030, increasing from 4.1 to 6.1 million. In a joint statement, all the federations and organisations for old age expressed their concerns regarding the PLFSS. They underline” the inadequacy of funding in the bill in the face of the economic context of old age”.
They also point out the “inadequate employment objectives in view of the demographic crisis”. Whereas the sector will need to recruit some 400,000 carers by 2030, the PLFSS is tabling on the creation of a mere 6,500 jobs for the coming year.
Note that the inclusion in the budget of 100 million euros allocated to palliative care represents the first stage in the realisation of the 10-year strategy presented last spring by the previous Government. That amount is already considered insufficient in view of the true needs, and there is no guarantee that the remaining 100 million more per year will be provided over the next 10 years.
A gradual stacking up of measures is visible. However, from a dynamic viewpoint, the door is open to criticism, as the policies being conducted are never reviewed from top to bottom.
Two major projects are deserving of a coherent long-term policy, and Alliance VITA is appealing for them to be included in any future PLFSS:
• Launch of work on a multi-year programming bill on old age and dependence, as required by article 10 of Law No. 2024-317 dated 8th April 2024 concerning measures for establishing a society for aging well and for autonomy,
• Adoption of a programming law for palliative care, associated with a monitoring and evaluation committee, consisting of MPs, health workers, representatives of associations and qualified workers, charged with reporting publicly, every year, on the state of progress of the programme.
The MPs began debating the PLFSS in the social affairs commission on 21st October. The text amended by MPs was unanimously rejected by the political groups. The debate will continue in session from 28th October with a final vote on 5th November. Before progressing to the Senate.
As intended in the procedure established for the Finance Bill and the PLFSS, the text examined will be the initial text by the Government.
[1] The scope of the Social Security Funding Law is more restricted than for the Social Security administrations (ASSO): it does not include compulsory additional health cover, unemployment insurance nor hospital accounts. If those are included, social security (in the broadest sense) would represent an expenditure of some 795 billion Euros in 2025. As distinct from the total social protection expenditure (including in particular RSA (active solidarity benefit), housing benefit, schooling bursaries, etc…) whose overall total amounted to some 849 billion Euros in 2022, i.e. 32.2 % of GDP.
