Overview
Federal Health Minister Nina Warken has presented a wide-ranging health and care reform package she describes as “balanced.” She argues the measures are necessary to close an estimated gap of more than 16 billion euros in statutory health insurance (GKV) for 2027 and to keep contribution rates stable over the long term. The plan combines spending limits, higher contributions from some groups, and structural changes across health and care systems.
Why the reform now?
The government cites a sharp deterioration in the finances of both the statutory health insurance and long-term care insurance. Without reforms, contribution rates would have to rise significantly. Warken frames the package as a means to protect contributions for insured people while making the system more sustainable.
- Large projected deficit in the GKV for 2027 (over €16 billion)
- Need to avoid steep increases in contribution rates for employees and employers
- Goal of broad-based contribution so “everyone pays a bit, no one faces the unbearable,” in the minister’s words
The reform is being introduced just before the first parliamentary readings in the Bundestag and the Bundesrat, and it has already sparked strong reactions from trade unions, medical associations, regional governments and industry. Supporters emphasize fiscal stabilization and broader burden-sharing; critics call it a savings program that risks worsening care and access.
Key measures in statutory health insurance (GKV)
The reform package targets several touchpoints in the GKV to reduce costs and increase revenues. Central measures include tightening entitlement rules for free family co-insurance, raising the contribution assessment ceiling for high earners, increasing patient co-payments for medicines, and introducing spending caps across care providers.
Changes to coverage and contributions
One proposed change would limit the previously free co-insurance of spouses or partners in certain situations. The contribution assessment ceiling (Beitragsbemessungsgrenze) would be raised, bringing higher earners into a larger contribution base. These steps are intended to increase revenues from those with above-average incomes.
- Restrict free co-insurance for certain partners
- Raise the contribution assessment ceiling to capture more income from high earners
- Higher employer and employee contributions in absolute terms for those affected
Supporters say these measures will spread the burden across patients, providers and industry. Critics warn that caps and spending brakes could undermine hospital capacity, strain staff, and reduce incentives for pharmaceutical investment.
Higher co-payments and spending controls
The plan would increase patient co-payments for prescription medicines at pharmacies from the current range of about €5–€10 to roughly €7.50–€15 per medication. At the same time, the government proposes spending brakes and caps for contract physicians, hospital budgets and pharmaceutical industry discounts, and tighter liability for pharmacies.
- Medicine co-payments rise to €7.50–€15
- Elimination of certain special payments to outpatient doctors
- Capping hospital care budgets and the clinical care budget for nursing
- Stricter discount obligations and cost containment in the pharmaceutical sector
Pflege (long-term care) reform highlights
The government is advancing a parallel reform of the long-term care system, framed as necessary to handle a rapidly growing population of care-dependent people and a tense financial situation in the Pflegeversicherung. The package links revenue measures with changes to entitlement rules.
Contributions, entitlement and incentives
Key elements include an increase of the additional care contribution for childless adults, higher hurdles for qualifying for care grades, and a mechanism tying some annual benefit increases to inflation. The reform would also largely abolish free co-insurance of spouses in the care insurance, replacing it with a contribution of 0.52 percentage points on the partner’s liable income, with exemptions for retirees and caregivers of small or disabled children.
- Higher care surcharge for childless people (from 0.6 to 0.7 percentage points)
- More stringent criteria for assigning care grades
- Indexing some benefit increases to inflation to provide predictability
- Abolition of broad free co-insurance in care, with a new partner contribution model and limited exemptions
Critics argue these steps risk offloading costs from the solidarity-based system to families and private insurers, while proponents say they will better secure the solvency of the mandatory care insurance and encourage precautionary savings.
Family responsibility and private insurance
One controversial idea is to reintroduce broader recourse to adult children for parental care costs, reversing a 2020 rule that had limited such claims to very high earners. At the same time, the government seeks to incentivize private long-term care insurance by allowing tax deductions for private supplementary policies, effectively shifting part of future care funding toward private provision.
Structural and preventive policy changes
Beyond immediate financial measures, the reform package includes structural changes intended to affect behavior and system operation. These range from new working-sickness options to changes in covered benefits and a planned tax on sugary drinks from 2028.
Benefit scope and prevention
The government proposes removing certain benefits from standard coverage, such as homeopathy and cost coverage for cannabis flowers. Preventive care would be adjusted by spacing out some skin-cancer screenings and tightening rules for orthodontic treatments. A sugar tax on sweetened beverages is planned from 2028, positioned both as revenue and as a public-health measure.
Work re-entry and sick leave
The package discusses a partial sick leave model (Teilkrankschreibung) that would allow patients to return to work in reduced capacity while receiving a reduced sick-pay entitlement. The goal is to improve reintegration and reduce long sick-leave spells, though details and safeguards remain under debate.
Reactions: protests, industry warnings and political debate
From the outset, the plan has prompted broad criticism. Trade unions and professional associations call the package a cuts program that threatens quality and access. Hospital groups and worker representatives warn that spending caps could lead to staffing shortfalls and compromised patient care. Several regional governments have demanded improvements for doctors to protect rural care.
Industry and opposition responses
The pharmaceutical industry has warned it may scale back investments if discount and reimbursement changes undermine research incentives. Opposition parties in parliament have used strong language, arguing the draft is “unbalanced” and may worsen structural problems like workforce shortages and underfunded care areas rather than solving them.
Public demonstrations and timing
Protests and demonstrations have been organized in parallel with the first parliamentary readings. Unions and associations have staged visible actions at prominent health sites to call attention to risks they see in the reform. The government is pushing to complete the legislative process before the summer recess, making the coming weeks politically intense.
What to expect next and concluding assessment
The outcome hinges on committee discussions, negotiations with states and continued public pressure. The minister emphasizes a narrative of shared sacrifice and balance: measures that affect all groups, she says, are fairer than targeted cuts. Critics view the same measures as an unequal shift of burdens onto patients, providers and families.
Key decision points
- How parliamentary committees amend spending brakes and provider caps
- Whether compensation measures for rural care and hospitals are strengthened
- How the care reform balances public solidarity with incentives for private provision
- Timing and scope of the sugar tax and preventive-care adjustments
In short, the reform is positioned as a fiscal consolidation package with structural elements. Whether it will be judged “balanced” outside the government will depend on final compromises, mitigating measures for vulnerable groups, and how well the promised stability in contributions is achieved without harming care capacity or equitable access.
