## Facts

- Parliament adopted a statute containing multiple amendments in the fields of social security and public health, including changes to physician–health insurance arrangements and a means-tested supplementary allowance funded by a national solidarity fund.
- A group of opposition deputies referred the statute for pre-promulgation constitutional review under the Constitution’s referral mechanism for parliamentary minorities.
- The referral challenged (i) the statute’s enactment procedure, including the government’s use of the confidence/vote-commitment mechanism; (ii) whether certain late-added provisions were impermissible “riders”; (iii) whether provisions on negotiated “conventions” between physicians and insurance bodies unlawfully delegated legislative power and impaired health-protection, equality, and professional freedoms; and (iv) whether new rules governing recovery of the supplementary allowance from estates created unjustified unequal treatment.
- The contested physician provision established a statutory framework in which general principles were set by law, while detailed conditions (e.g., obligations and reimbursement-related rules) could be specified through negotiated agreements approved by supervisory authorities.
- The contested allowance provision modified eligibility and/or recovery mechanics for sums paid, including recovery from beneficiaries’ estates after death, creating distinctions among beneficiaries and heirs in certain situations.

## Issues

1. Whether the statute was adopted through a constitutionally valid legislative procedure, including use of the government confidence/commitment mechanism and proper ministerial countersignature.
2. Whether provisions inserted by amendment (including the physician–insurer framework and the supplementary-allowance provisions) were unconstitutional legislative “riders” for lacking a sufficient connection to the bill.
3. Whether the physician–insurer framework violated constitutional allocations between statute and regulation, and infringed health protection, equality in access to care, patients’ free choice of physician, or physicians’ freedom to practice.
4. Whether the supplementary-allowance amendments violated equality before the law and constitutional requirements of social solidarity by creating unjustified differences in treatment.

## Decision

- The Council upheld the statute’s legislative procedure, finding the confidence/commitment mechanism could be used as provided by the Constitution and that formal requirements were satisfied.
- The Council rejected the “rider” challenges, holding the contested amendments had a sufficient connection to the bill’s subject matter in social security and health.
- The Council upheld the physician–insurer provision, concluding the legislature set an adequate statutory framework and did not, on its face, impair constitutionally protected health-related guarantees or the asserted freedoms.
- The Council struck specified portions of the supplementary-allowance provision as unconstitutional, finding that certain recovery/benefit rules produced unjustified unequal treatment contrary to equality and social-solidarity requirements.
- The remainder of the statute was declared constitutional.

## Legal Principles

- When the Constitution authorizes a legislative adoption mechanism based on governmental responsibility/commitment, constitutional review focuses on compliance with required formal steps rather than the political wisdom of using the mechanism.
- An amendment is constitutionally permissible if it is not devoid of a sufficient connection to the bill under debate; provisions linked to the organization or financing of social security and health policy satisfy this requirement.
- In areas reserved to statute (including fundamental principles of social security), the legislature may set the framework while leaving implementation details to regulatory measures and negotiated instruments, so long as the legislature does not renounce its core competence.
- Constitutional guarantees of health protection and equality require that legislative and regulatory choices not create unjustified differences in treatment; lawmakers retain discretion over means, within constitutional limits.
- Patients’ free choice of physician and physicians’ freedom to practice may be regulated to pursue constitutionally recognized health-protection objectives; a statute is assessed on its own terms and is not invalidated based on speculative future misuse of implementing agreements.
- Social benefits may be adjusted, including financing and recovery rules, but distinctions among similarly situated beneficiaries must be justified by relevant differences or a legitimate public-interest objective consistent with equality and social solidarity.

## Conclusion

The Council sustained broad legislative discretion in structuring social-security and health policy, upheld negotiated physician–insurer arrangements within a statutory framework, and invalidated only those benefit-recovery provisions that created unjustified unequal treatment inconsistent with equality and social solidarity.


Re Amendments of the Code of Social Security & Health, No. 89-269 DC (Fr. Const. Council Jan. 22, 1990)