Germany softens health insurance reform plans ahead of key vote
Residents in Germany covered by the country’s statutory health insurance system (gesetzliche Krankenversicherung) may be relieved to hear that several controversial elements of the government's planned healthcare reform have been watered down before a crucial parliamentary vote this week.
Health Minister Nina Warken of the conservative Christian Democrats (CDU) has revised parts of her cost-cutting package after weeks of resistance from coalition partners, state governments, health insurers and industry representatives.
The reform is designed to help plug a major funding gap in the public health insurance system and prevent further contribution increases from 2027.
However, the latest version appears to shift a greater share of the burden onto federal funds, while easing some of the planned costs for insured households.
Although patients and families will still face some new charges from 2028, the changes are now expected to be .
What the changes could mean for you
People who have a spouse or registered partner covered under their family insurance policy will still have to pay an additional contribution from 2028. But the charge has been reduced from the originally proposed 3.5 percent of contribution-relevant income to 2.5 percent, according to reports.
Parents will also benefit from a much wider exemption than first planned. Under the original proposal, co-insured partners would have remained exempt from the new charge only if there were children aged six or younger in the household.
The revised plan raises that threshold to children up to and including age 11, meaning many more families would avoid the additional payment.
Co-payments
Patients will reportedly still face a 50 percent increase in medication co-payments (the amount patients must contribute towards the cost of prescription medicines). The current range of €5 to €10 is expected to rise to between €7.50 and €15.
But a further planned change has been dropped. Warken had originally intended to introduce automatic regular increases in co-payments linked to wage growth from 2028 onwards. Those recurring increases are now expected to be scrapped, making the rise a one-off measure rather than the start of annual hikes.
At the same time, the federal government is expected to provide significantly more money to the health insurance system than originally planned. The additional funding is intended to help close a projected financing gap and reduce pressure for future premium increases.
Why the original proposals have been watered down
The original reform package proposed by Warken faced opposition from health insurers, parts of the governing coalition, several state governments and the pharmaceutical industry.
One of the biggest objections concerned who pays for the healthcare of people receiving basic income support in Germany.
Health insurers pointed out that the federal government does not currently cover the full cost. In fact, insurers receive about €144 per month from the state for each recipient, even though the actual healthcare costs are more than €400 per person, according to Techniker Krankenkasse.
Because the difference is effectively covered by people who pay into Germany's public health insurance system through their contributions, health insurers have been urging the federal government to put more money into the system.
While the state still won't cover the full cost, the revised proposals would increase government support by far more than originally planned.
There was also resistance from within the governing coalition itself and from Germany's states. According to several reports, the CDU/CSU and the SPD ultimately negotiated compromises on both family insurance rules and federal funding to help secure backing for the package.
The pharmaceutical industry also pushed back against parts of the reform. The original draft called for a "dynamically adjustable manufacturer discount". According to ARD, pharmaceutical companies warned they could relocate operations if the measure was introduced. The latest version proposes to replace it with a fixed discount.
What happens next?
The coalition hopes to pass the revised bill through the Bundestag this week. The reform package would then go to the Bundesrat for final approval during its last sitting before the summer recess on Friday.
The measures can only become law once both chambers have signed off on them. While the overall direction of the reform now seems largely settled, the final votes will decide whether the package is adopted in its current form.
