Health insurance: Bundestag and Bundesrat vote for reform

The Bundestag and Bundesrat have passed the law stabilizing contribution rates for statutory health insurance. The skilled trades sector sees significant wasted potential for relief and is calling for further reforms.

The German Bundestag has passed the financial reform of the statutory health insurance (GKV) system proposed by the Federal Government . The aim is to address the precarious financial situation of the GKV and to keep the healthcare system affordable. The law combines various measures to offset the looming deficit of €15 billion next year and up to €40 billion by 2030. Shortly after its passage in the Bundestag, the Bundesrat also approved the law.

The reform focuses on reducing the rate of expenditure growth to align the high increases in spending with revenues and thus stabilize contribution rates. The statutory health insurance system is expected to see a reduction in costs of €16,3 billion in 2027 through increased revenues and reduced expenditures, and up to €38,1 billion in 2030.

The plan includes various measures: Expensive special payments and double funding are to be eliminated. Annual salary increases in all service areas and administration are to be limited to the actual cost increases or the average percentage increase in contribution-based revenue. A one percentage point reduction is to apply for the years 2027 to 2029.

Partial sick leave is coming

Spouses and registered civil partners will only benefit from free family insurance in the future under certain conditions. If these conditions are not met, members will pay a surcharge of 2,5 percent of their income subject to contributions for their spouses starting in 2028. Free co-insurance for children will remain in place.

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Co-payments will be increased by 50 percent to a minimum of €7,50 and a maximum of €15. The federal subsidy to the health fund is to be reduced by one billion euros to €13,15 billion in 2027, and from 2028 onwards it is expected to be €12,95 billion annually. Revenue from a higher tobacco tax and a new levy on sugary drinks will play a role in this reduction.

Partial sick leave and partial sick pay will be introduced: Three levels of partial work capacity are planned, at 25, 50, and 75 percent. Exemptions from co-payments and hardship provisions will remain unchanged. The employers' flat-rate contribution for marginally employed workers will be increased to the general contribution rate of 14,6 percent, plus the average supplementary contribution.

Criticism from the craft industry

"The contribution rate stabilization law for statutory health insurance falls far short of what is needed and largely misses the opportunity for noticeable relief. While the legislature is moving in the right direction with a revenue-oriented spending policy, this is insufficient given the financial situation," criticizes Jörg Dittrich, President of the German Confederation of Skilled Crafts. 

The relief measures did not fully utilize the proposals put forward by the Finance Committee on Health. "This is all the more serious because, while the planned pension reform makes old-age security more sustainable, it is also linked to a significant short-term increase in contributions. This additional burden must be offset by further social security reforms, and non-wage labor costs must be noticeably reduced again," said Dittrich. 

During the legislative process, relief measures amounting to more than three billion euros were dropped. The savings potential calculated by the Commission, at 42 billion euros, is significantly higher than the now targeted 16,3 billion. Dittrich: "Individual measures, such as limiting the free co-insurance of spouses, are a step in the right direction. However, policymakers must exploit the full potential for contribution reductions."

Dittrich calls for a second reform package

This includes a primary care physician system, a greater shift of treatments to outpatient care, and closer intersectoral collaboration. It is unacceptable that non-insurance-related services should continue to be financed predominantly by contributors. "Societal responsibility for tasks that affect society as a whole should also be shared by society as a whole, and these services should therefore be financed through taxes."

Dittrich criticizes a one-sided shift of burdens to the detriment of businesses and employees through the increase of the contribution assessment ceiling by around 300 euros, the reduction of the federal subsidy by two billion euros each in the years 2027 to 2030, and the increase of the health insurance contribution for marginally employed persons in order to relieve the federal budget.

"The contribution rate stabilization law can therefore only be the beginning. The coalition parties must quickly present a second reform package for pensions, health and long-term care in order to reduce the non-wage labor costs from the current 43 percent to at least 40 percent. Only with an efficient organization of social security, fair financing and more personal responsibility can competitiveness and growth in the labor-intensive skilled trades be secured in the long term."

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