Government Faces Backlash Over Rising Health Insurance Contributions Amid Reforms

The German government is under scrutiny following a significant inquiry initiated by the CDU/CSU regarding the hospital reform spearheaded by Health Minister Karl Lauterbach. This discussion comes during one of the final parliamentary sessions before the upcoming elections scheduled for February 23, 2025. While attention is drawn to a controversial migration proposal backed by the AfD, critical issues surrounding social insurance finances are also on the agenda.

Germany's social insurance system is experiencing financial strain due to demographic changes, an economic downturn, and escalating costs. To address these challenges, the CDU and CSU submitted a comprehensive request to the government, which is to be debated in Parliament. A key focus of this inquiry is the contentious hospital reform enacted on November 22, 2024.

This reform aims to alleviate the financial pressures on many hospitals, allowing them to prioritize treatment quality over financial concerns. Smaller hospitals, in particular, face difficulties in acquiring new equipment, leading to a decline in care standards. To facilitate necessary investments, the government plans to establish a transformation fund, which will be gradually developed between 2026 and 2035, totaling EUR50 billion. This fund will be financed equally by federal and state contributions, requiring health insurance funds to allocate EUR2.5 billion annually over the next decade.

However, this requirement has raised alarms among health insurance providers, as they are already grappling with deficits. In 2023, health insurers reported a deficit of EUR1.9 billion, with preliminary figures for 2024 indicating a potential shortfall of EUR3.7 billion in the first three quarters alone. Given these circumstances, the mandated annual contributions to the transformation fund are perceived as not only burdensome but potentially unconstitutional. The argument posits that health insurance funds should not bear the financial responsibility for a reform that benefits the entire populace, especially since private insurers are not contributing to this funding.

The government, when responding to the CDU/CSU's inquiries, asserted that the federal government does not bear responsibility for hospital financing, which is traditionally managed at the state level. The reasons cited for including health insurance funds in the reform financing were based on the anticipated improvements in patient care that would arise from the reform.

Despite this defense, the government has not provided clarity on how insurance contributions will be affected by these reforms. The social welfare organization VdK has announced plans to challenge the funding model legally, arguing that contributions should exclusively support services benefiting insured individuals. They contend that the broader societal gains from the reform necessitate funding from the general state budget.

Additionally, the peak association of health insurers has indicated its intent to explore legal action against the reform. As the debate continues, the implications of the hospital reform and its financial structure remain contentious topics within German political discourse.