Franchises médicales, le décret est (presque) totalement légal

FlickR - Creative Commons - Dépôt de boîtes de médicaments vides devant le ministère de la santé en protestation contre les franchises "médicales" par William HamonVoici une décision majeure du conseil d’État qui risque – à la marge – de modifier la pratique des caisses de sécurité sociale. En effet, saisi par la Fédération Nationale Association des accidentés de la vie (FNATH) et par l’Association Nationale des Victimes de l’Amiante (ANDEVA), le conseil d’État a, par décision du 6 mai 2009, annulé partiellement le décret n°2007-1937 du 26 décembre 2007 relatif à l’application de la franchise prévue au III de l’article L. 322-2 du code de la sécurité sociale.

Plus précisément, l’article 2 dudit décret a été annulé en ce qu’il obligeait les caisses à prélever le montant des franchises sur les autres prestations perçues par les bénéficiaires du tiers payant, en méconnaissance des dispositions de l’article L. 322-2 du code de la sécurité sociale.

Le respect des exigences primordiales de solidarité nationale découlant du 11ème alinéa du Préambule de la Constitution de 1946 doit être apprécié :

  • d’une part, compte tenu de l’ensemble des dispositions en vertu desquelles des sommes sont susceptibles d’être laissées à la charge des assurés sociaux à raison des dépenses de santé qu’ils exposent, notamment au titre des participations prévues à l’article L. 322-2 du code de la sécurité sociale ;
  • et, d’autre part, au regard des incidences de telles mesures sur la situation des personnes les plus vulnérables ou défavorisées.

Les sommes susceptibles d’être laissées à la charge de certains assurés sociaux par la réglementation en vigueur auxquelles s’ajoute, le cas échéant, le coût de la souscription d’un contrat d’assurance complémentaire de santé n’excèdent pas la part de leurs revenus au-delà de laquelle les exigences du 11ème alinéa du Préambule seraient méconnues.

En revanche, en imposant aux caisses la contrainte mentionnée précédemment en contradiction avec le III de l’article L.322-2 du code de la sécurité sociale, l’article 2 du décret déféré à la censure des hauts magistrats a méconnu les dispositions législatives sus-évoquées.

Le principe même d’une franchise médicale suscitant par principe l’hostilité, chacun verra midi à sa porte avec cette décision, les uns considérant que l’encadrement du montant des franchises médicales constitue assurément une petite victoire, les autres ((E. Royer, Les franchises médicales sont légales, AJDA 2009, p. 956.)) s’en tenant à la lettre de la décision pour estimer que la Haute juridiction a délivré un brevet de légalité quasi-intégral audit décret.

De façon générale, le conseil d’État estime que le texte demeure conforme à la réserve formulée par le Conseil constitutionnel dans sa décision n°2007-558 DC du 13 novembre 2007, aux termes de laquelle « le montant de la franchise et le niveau des plafonds prévus par ces dispositions [doivent être] fixés de façon telle que ne soient pas remises en cause les exigences du onzième alinéa du Préambule de la Constitution de 1946. » en vertu duquel la Nation « garantit à tous, notamment à l’enfant, à la mère et et aux travailleurs, la protection de la santé. »


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