A €200m line in the effort asked of national health insurance
On 8 October 2026, Health Minister Stéphanie Rist presented the 2027 social security financing bill (PLFSS) to the board of the Caisse nationale d’assurance maladie (Cnam), France’s national health insurance fund. The breakdown of savings required of the health insurance branch includes a €700m transfer of spending to supplementary health insurers, comprising €200m for reimbursable thermal spa cures and €500m of hospital spending.
The minister’s speech specified neither how the transfer would work nor when it would take effect. The amount did not appear among the detailed savings measures when the bill was presented to the Council of Ministers on 1 October, and the measure went virtually unnoticed for a week.
A deficit brought below €8bn
The government presents the decision as part of a drive to restore the finances of the health insurance branch. Without the PLFSS, the national health insurance deficit would reach €14bn in 2027, according to the minister, who is aiming for a figure just under €8bn thanks to the bill.
The transfer to supplementary insurers comes on top of €1.3bn in drug price cuts, supplemented by a €1.7bn macroeconomic contribution, and €1bn of savings on sick leave, to be negotiated with the social partners.
Stéphanie Rist nonetheless left the door open to adjustments, saying the government was working from an initial draft and was ready to improve it, provided this rested on clear-sighted choices. The Cnam board, whose members include the social partners and patient associations, issued an almost unanimous unfavourable opinion, with 31 votes against, two abstentions (CFTC) and two members formally taking note (U2P). The opinion is advisory only.
A fresh attempt after the 2026 setback
Thermal spa cures are currently reimbursed at 65% by national health insurance under the thermal package (forfait thermal). The government had already tried unsuccessfully to remove their reimbursement in the 2026 social security budget. At the time, the National Assembly rejected an amendment for partial delisting by 167 votes to 24.
According to Les Echos, the saving would this time be achieved by lowering the level of social security reimbursement, a prospect drawing reactions from both the thermal spa sector and mutual insurers.
CNETh denounces a delisting in all but name
In a press release published on 9 October (download it, in French: Thermal spa press release), the National Council of Thermal Establishments (CNETh), which represents all of France’s thermal spa establishments, contests a measure announced with no guarantee of coverage by supplementary insurers and ahead of the conclusions of the scientific evaluation launched by the French National Authority for Health (HAS). The organisation points out that around half a million patients each year follow a cure prescribed by a doctor, notably for chronic rheumatological, respiratory or vascular conditions.
The first argument concerns the very nature of the measure. For CNETh, the word “transfer” masks what is in reality a delisting in all but name, since supplementary insurers’ “responsible” contracts (contrats responsables) carry no general obligation to cover thermal treatment. Patients would lose out either way: without compensation, spa patients, who are often elderly and on modest incomes, would bear almost the entire cost of their treatment; with compensation, the expense would push up their premiums.
The second argument is procedural. As no specific provision of the 2027 PLFSS sets out how the measure would work, parliamentarians could, according to the organisation, vote through a spending trajectory without explicitly ruling on a decision affecting nearly 500,000 patients.
The third concerns timing. Commissioned by the government in February 2026, the HAS is assessing the actual medical benefit of spa cures, and CNETh considers it incomprehensible to change their funding before the findings are known. The trade body is calling for the measure to be withdrawn and urging parliamentarians to take up the issue when the bill is examined.
LTH Analysis • An economic issue for spa towns
Beyond the treatment establishments themselves, reimbursable cures generate a staying clientele on which hotels, residences and shops in spa towns depend. Beyond the risk to the employees of these establishments, spa towns sustain entire regions. Any change to cure funding would come as several players have committed to hotel investments in these areas, such as Valvital, whose thermal establishment in Nancy includes a hotel-restaurant, Groupe HIS with the future Mercure Majestic Luchon, and the Chaîne thermale du Soleil, run by Eléonore and Adeline Guérard.
A tight parliamentary timetable
Scrutiny of the 2027 PLFSS begins on 12 October in the National Assembly’s Social Affairs Committee, ahead of a formal vote scheduled for 27 October. Clarifying how the transfer would work, currently absent from the bill, is expected to be one of the sticking points in the debates for the thermal spa sector.
At a glance by The Hospitality Tribune
France’s 2027 social security budget targets thermal spa cure reimbursement
€200m of thermal cure spending to shift from national health insurance to supplementary insurers in 2027
Part of a wider €700m transfer, including €500m of hospital spending
Around 500,000 patients follow prescribed spa cures each year, according to CNETh
CNETh calls the move a disguised delisting and demands its withdrawal
Committee review from 12 October, National Assembly vote scheduled for 27 October
