Minister Warken's Care Reform Meets Broad Criticism from SPD, CSU, and Municipalities

The core of the proposal involves higher contributions, stricter access rules, and longer waiting times for relief. The contribution rate for long-term care insurance for those without children is set to increase from 4.2 to 4.3 percent, and the surcharge for childless individuals from 0.6 to 0.7 percentage points. For mini-jobs up to 603 euros, a long-term care insurance contribution of 3.6 percent will be levied for the first time, to be borne solely by employers. The contribution assessment ceiling will be raised, meaning employees with monthly incomes above 5,812.50 euros will pay a maximum of an additional 17 euros per month, according to the ministry.

Stricter Rules for Access to Care

Regarding benefits, the ministry plans stricter requirements for classification into care levels 1 to 3, thereby correcting what it states is a deviation from the scientific recommendation from the 2017 care reform. Existing cases will remain in their current classification under the draft. The relief amount of up to 131 euros per month for care level 1 will be abolished without replacement, and halved for the first three months in care levels 2 and 3. According to Green Party health expert Janosch Dahmen, this means the largest savings item is achieved "precisely" through access to benefits: "the largest savings item consists precisely in restricting access to care benefits."

Longer Waiting Times for Relief

Significant cuts are planned for subsidies towards out-of-pocket expenses in inpatient care. In the future, nursing home residents will only move to the next higher subsidy level after 18 months instead of 12. Due to the extended intervals – 15 percent in the first year, 30 percent in the second, 50 percent in the third, and 75 percent from the fourth year – the maximum relief of 75 percent will only be reached after four and a half years. The draft quantifies the savings from this extension at 2.6 billion euros next year, which will no longer benefit those in need of care. According to the Association of Substitute Health Insurers (Verband der Ersatzkassen), the average out-of-pocket expense for pure care services in nursing homes was recently 1,982 euros per month – an increase of 222 euros since the beginning of 2025. The average total burden, including accommodation, meals, and investment costs, recently exceeded 3,200 euros per month.

Another central point of contention is the pension contributions for family caregivers. The draft stipulates that from January 1, 2027, care insurance funds will only cover 70 percent of the previous pension insurance contributions – currently, they pay up to around 740 euros per month under certain conditions. The ministry justifies this step as a "necessary measure for the financial stabilization of statutory long-term care insurance" and points out that pension entitlements already acquired will remain unaffected, while future entitlements will grow more slowly. The draft estimates the planned savings volume at around 1.8 billion euros in 2027 and about two billion euros annually thereafter.

Cuts to Pensions for Family Caregivers

The tax-free co-insurance of spouses in long-term care insurance is also to be restricted from 2028 – analogous to plans in statutory health insurance. In the future, only partners caring for children under seven years old, children with disabilities, relatives in need of care, or those already retired will remain co-insured free of charge; in all other cases, a contribution of 0.52 percent of the partner's income subject to contributions will be levied.

Co-insurance of Partners and New Benefits

In contrast, the draft also includes new benefits: "care support" for early detection of health deterioration in home care, a "bridging budget" for crisis situations or unplanned absences of the primary caregiver, and the bundling of individual outpatient services into budgets. From 2028, the benefit amounts for outpatient and inpatient care will be adjusted annually for inflation.

Criticism from SPD and CSU

Sharp criticism of the draft comes from within the coalition itself. Mecklenburg-Western Pomerania's Minister-President Manuela Schwesig (SPD) stated that her party rejects the proposals: "We reject these proposals because they place a greater burden on those in need of care and their families and put care workers in a worse position." Warken is also committing "a serious mistake by the Federal Health Minister initiating a bill that has not been coordinated with the federal states, just as she did with the health reform." Schwesig also warned: "a reform that leads to care becoming unaffordable is not a reform."

Clear criticism of the pension cuts for family caregivers also came from the CSU. Klaus Holetschek, CSU parliamentary group leader in the Bavarian State Parliament, said: "Anyone who wants to strengthen family caregivers must not accept cuts to their pensions. This is a slap in the face to the people who keep our care system running day after day." In contrast, CSU parliamentary group leader in the Bundestag, Alexander Hoffmann, defended Warken: "A 'business as usual' with endlessly rising contributions cannot be the goal and would burden people and the economy much more."

Municipalities Warn of Additional Costs

The reaction from municipalities was particularly sharp. Burkhard Jung, President of the German Association of Cities and Mayor of Leipzig (SPD), expressed himself "shocked and angry" and warned: "Leaving elderly people to the social welfare office is disrespectful." The background is the expectation that federal states and municipalities would have to raise an additional approximately one billion euros next year for "assistance with care" under social assistance if those in need of care could no longer cover the rising out-of-pocket expenses from their own income or assets. Furthermore, the draft plans to abolish the limit introduced in 2020, according to which adult children are only required to contribute to parental support from an annual income of 100,000 euros.

Social and welfare associations also reject the draft in its current form. The National Association of Statutory Health Insurance Funds (GKV-Spitzenverband), which also represents the care insurance funds, views the package as one-sidedly burdening those in need of care and contributing payers. The Patient Protection Foundation and the Social Association of Germany see the initiative primarily as a savings law. Ramona Pop, member of the Executive Board of the Federation of German Consumer Organisations (Verbraucherzentrale Bundesverband), spoke of a "massive disregard, especially for women, who keep the care system running at all" with regard to the pension cuts. Janosch Dahmen (Greens) warned: "The costs of care do not disappear – they just reappear elsewhere."

Associations and Opposition

Sharp criticism also came from the opposition. BSW founder Sahra Wagenknecht spoke of a "summer of social cruelty" under Chancellor Friedrich Merz (CDU) and accused the government of recklessness towards those in need of care and their relatives; the reform would hit people in East Germany particularly hard, as reserves there are lower. Sören Pellmann, parliamentary group leader of the Left Party in the Bundestag, fears: "The 'list of cuts' threatens even more old-age poverty, fears Sören Pellmann, parliamentary group leader of the Left Party in the Bundestag, for example, 'both for people in need of care and those who care for them as relatives'."

Overall, the Federal Ministry of Health aims to achieve savings and additional revenue of around eleven billion euros in the coming year and more than 20 billion euros by 2030 with the planned measures, in order to avoid contribution increases. In addition, the tax deductibility of contributions to private supplementary long-term care insurance is to be enabled – however, this is still formulated as a declaration of intent in the draft. With regard to the coalition agreement, which provides for a limitation of care-related out-of-pocket expenses, pressure is growing on Warken to improve the draft in several points. After approval by the Bundestag, the Bundesrat would also have to deal with the proposal.