Bundestag decides on controversial savings package for statutory health insurance

The background to the savings package is an estimated funding gap of around 19 billion euros at the statutory health insurance funds in the coming year. The aim of the law is to prevent rising health insurance contributions by allowing health insurance expenditure to grow only in step with revenues in the future. Warken described the project as the largest savings package in healthcare to date: "Well, it is the largest savings package we have had in healthcare – to date." At the same time, she acknowledged that the reform was "an imposition"; with the current spending dynamics, it would otherwise sooner or later lead to a "system collapse."

Parliamentary group leader Jens Spahn (CDU) called the law this week a "once-in-a-generation reform of health insurance." Chancellor Friedrich Merz also hopes that the project will pass both the Bundestag and the Bundesrat on Friday. The Bundesrat is also meeting on Friday to deliberate on the reform law. The states do not have to approve the law, but could delay it through the mediation committee.

Spending brakes and cuts for the insured

Spending brakes are planned for medical practices, hospitals, pharmacies, and the pharmaceutical industry. Remuneration increases for doctors and hospitals are to be capped, the extra remuneration for practices is to be eliminated, and the administrative and advertising expenses of the health insurance funds are to be limited. For planned procedures such as artificial knee joints, a second medical opinion will have to be obtained in the future. The skin cancer screening examinations for adults without symptoms, which take place every two years, are to be put under review.

For the insured, the law brings significant burdens. The co-payments of five to ten euros for prescription-only medications in pharmacies, in force for 22 years, are to rise to 7.50 to 15 euros. Co-payments in hospitals and pharmacies will also be increased. The fixed subsidy for dental prostheses is to fall from 60 to 50 percent of costs, although hardship provisions remain. Homeopathic services are to be removed from the benefit catalog of the statutory health insurance funds.

In addition, the insured are to no longer be informed separately about increases in the supplementary contribution – consumer advice centers warn that this effectively hollows out the special right of termination. For employees who are ill for longer periods, partial sick notes of 25, 50 or 75 percent of weekly hours are to become possible, provided employer and employee agree. The coalition of CDU/CSU and SPD also plans to introduce regulations to secure psychotherapeutic care through a Bundestag resolution after the summer break.

The free co-insurance of spouses and civil partners will be restricted, but with expanded exceptions: Co-insured without contributions will in future be parents of children under 12 (instead of the previous under 7), parents of disabled children, persons with limited earning capacity, persons of regular retirement age, and caregiving relatives. From 2028, other co-insured partners who do not meet the exception criteria are to pay a contribution surcharge of 2.5 percent.

Special path for the pharmaceutical industry

The contribution obligation limit, the contribution assessment ceiling, currently stands at 5,812.50 euros per month and is to rise by a further 300 euros in 2027. The regular federal subsidy to the health insurance funds of 14.5 billion euros per year is to be reduced in 2027 only to 13.15 billion euros (instead of the originally planned 12.5 billion euros). The federal government is to additionally provide 1 billion euros in 2027 (instead of the previously planned 250 million euros) for the health costs of citizens' benefit recipients, with the amount set to continue rising thereafter.

For the pharmaceutical industry, the federal government deviated from the principle of linking revenue and expenditure and amended the law at short notice. An originally planned annual dynamic price adjustment for drug manufacturers was dropped in favor of a higher fixed special discount. Pharmaceutical groups such as Eli Lilly and Boehringer Ingelheim had announced that they would scale back planned investments in Germany. Pharmaceutical companies had also written letters to the Chancellor, the Health Minister, and members of parliament, threatening that new medicines would no longer be available in Germany if the law remained unchanged.

Oliver Blatt, board chairman of the GKV-Spitzenverband (central federation of statutory health insurance funds), criticized in the ARD capital studio that the pharmaceutical industry had been "spared too much" and had "evidently done very good lobbying work." Jens Baas, board chairman of Techniker Krankenkasse, called on the federal and state governments to pass the law quickly: "The savings package is already tailored to the limit. Therefore, there is no more room for further concessions to industry or to service providers."

Resistance from hospitals, the medical profession, and the opposition

On the other hand, considerable resistance to the project is forming. There have been demonstrations against the reform plans for weeks, including at hospitals. The German Hospital Federation (Deutsche Krankenhausgesellschaft) warns that half of all hospital locations are at risk. The Greens' health policy maker Janosch Dahmen stated that up to 140,000 jobs could be cut at German hospitals, the largest job cut in the history of the German healthcare system. He also warned of an unstructured wave of hospital closures.

Harsh criticism is also coming from the medical profession. Nicola Buhlinger-Göpfarth, chair of the German Association of General Practitioners (Hausärztinnen- und Hausärzteverband), told the Rheinische Post: "At the latest, the Bundesrat must stop this wild ride. If the savings law comes like this, it is a complete fiasco for GP practices and their patients." She spoke of a "clear-cutting" and warned that the law would "noticeably worsen care for patients." If the federal and state governments continue to want good primary care, the law must be stopped. Specifically, she fears that care on the ground will be guaranteed in fewer and fewer regions, that people will have to wait longer for appointments, and that less time will remain for treatment.

Ates Gürpinar, health policy spokesperson for The Left (Die Linke), also warned that the package was "the biggest clear-cutting in healthcare." Many workers in the healthcare system would leave the system: "It will be ensured that we no longer have the necessary staff in healthcare who have always kept things running." A new sugar tax on beverages such as cola and lemonades planned for autumn is, according to the plans, to create financial leeway for the higher federal funds.

Further agenda items before the summer break

The German Association of General Practitioners had previously appealed to the Bundesrat to stop the controversial savings package to stabilize health insurance contributions. At its core, the reform aims to ensure that in future only services that demonstrably improve care are to be paid for. The plans for the reform are based on recommendations of an expert commission that were presented at the end of March. The commission had recommended applying the expenditure-revenue link to all areas of the healthcare system.

In addition to the healthcare package, further decisions are to be made on the last sitting day before the summer break. This year's pay raise for members of parliament is to be suspended. A reform of the Federal Police Act is also planned. In a current hour on a motion by the Greens, the stricter rules for sick notes at work announced by the coalition are also to be debated. It could be the first reform project to make it through the parliamentary process before the summer break.

In terms of content, Friday is about a political directional decision for the coalition: The savings package is intended to send a signal of financial stabilization of the healthcare system; at the same time, the burdens for the insured, doctors, and hospitals are increasing noticeably. The opposition has already announced that it will seek the route to the Bundesrat and, if necessary, to the mediation committee, in order to achieve delays at the very least.

Outlook: entry into force and consequences

If the law passes the Bundestag and the Bundesrat on Friday, the regulations will enter into force in several stages – the higher co-payments and the restrictions on co-insurance, for example, from 2027, the contribution surcharges for non-privileged co-insured persons from 2028. Observers expect that the political dispute over the consequences of the savings package will shape the health policy debate well into the second half of the year.

With regard to the economic framework conditions, companies in the pharmaceutical sector had signaled investment restraint repeatedly in recent weeks. Associated with this is the concern that innovation- and care-relevant medicines