A government-commissioned report proposing a major shift in how health expenditures are managed has sparked concerns among patient advocacy groups in France. The report suggests moving funding for certain healthcare services—such as optometry, audiology, and medical transport—from the public system to private or complementary health insurance. This change has raised fears among patient associations, including France Asso Santé, about increased inequality in access to care. The group released a statement on September 25 expressing concerns about how the proposed restructuring might affect out-of-pocket costs, insurance premiums, and the ability of lower-income individuals to afford necessary medical services. Currently, these services are mostly covered by mutuals and private health insurance, especially since the 100% health reform introduced during President Emmanuel Macron’s first term, which aimed to reduce out-of-pocket expenses for essential care. However, the new report proposes replacing the existing "responsible contract" with an "essential contract," which would focus only on a scientifically defined basket of care. Services outside this basket would no longer receive the same tax and social benefits, potentially reducing the scope of care covered by both public and complementary insurance. France Asso Santé argues that this approach does not adequately address the existing inequalities in coverage among patients. The report acknowledges that 7% of the 20% least affluent French citizens and 11% of the unemployed currently lack access to complementary health insurance. While it suggests expanding access to the Solidarity Complementary Health Insurance (C2S), a low-cost or free insurance for very low-income households, the report does not propose increasing the income thresholds for eligibility. This means some individuals who exceed the C2S limits may still struggle to afford complementary insurance. Additionally, the report allows complementary insurance providers to offer lower premiums in exchange for higher deductibles, a move that could lead low-income individuals to choose less comprehensive coverage, increasing their out-of-pocket costs when care is needed. Starting October 1, the annual limits for medical deductibles and flat-rate contributions will rise from 100 to 140 euros, with further adjustments planned each year beginning in 2028. These amounts are subtracted from reimbursements for medications and medical visits and are typically not covered by most mutuals. With expected premium increases of up to 8.3% by 2027, as predicted by the Addactis firm, these changes could place additional financial pressure on patients, particularly those with limited resources.