The Green parliamentary group in the Bundestag is calling for a comprehensive reform of statutory care insurance (SPV). In a motion (21/8398), it criticises the cabinet draft for the Care Reorganisation Act as inadequate. The draft does not live up to the mandate for action, the motion states, as reported by the Bundestag. A financial equalisation between social and private care insurance is merely being examined, tasks unrelated to insurance and of overall state responsibility continue not to be financed from tax revenue, and an effective cap on personal contributions is absent. A reform that aims to strengthen trust in the SPV must distribute the burden fairly, the MPs say.
What the Greens are specifically demanding
The Greens’ concept provides for broad-based care prevention, anchored in a federal care prevention act with binding targets up to 2035. They also demand the introduction of a full risk structure equalisation between social and private care insurance as well as subsidies from the federal budget for the SPV. Civil servants and the self-employed are to be integrated into the SPV when they enter the profession.
The SPV must be relieved of tasks that cannot be assigned to it under the regulatory framework. According to the motion, these include the full reimbursement of pandemic-related additional expenditure (around 5.2 billion euros), the permanent assumption of pension insurance contributions for caring relatives from the federal budget (around 4.5 billion euros annually), and the gradual removal of care training costs from personal contributions and their financing by the responsible federal states. Medical treatment care in the inpatient sector should in perspective be transferred to health insurance.
To strengthen caring relatives, the Greens propose bundling the previously fragmented relief services into a flexibly usable relief budget. Duplicate documentation obligations are to be reduced and digitalisation expanded. Competence-mix models including academically trained nursing professionals, community health nurses and advanced practice nursing are also to be expanded. Personal contributions for those in need of care in inpatient long-term care must be capped in a solidary, needs-based and generation-appropriate manner. Accommodation, food and investment costs would remain unaffected.
Government postpones appointment of care commission
Meanwhile, the federal cabinet has postponed the appointment of the commission for the reform of care insurance. Health Minister Carsten Linnemann (CDU) had actually wanted to appoint the body this Wednesday, as tagesschau.de reports. However, there is still a need for coordination with the SPD. The commission is now to be appointed only next week, said the parliamentary managing director of the SPD parliamentary group, Dirk Wiese, in Berlin. There are still discussions about the composition of its members. Wiese also stressed that the SPD insists that a so-called care cap for costs in care homes as well as a risk structure equalisation from private to statutory care insurance must be examined by the commission.
The black-red coalition agreed last week to split the reform of care insurance. In a first step, measures were adopted to prevent an increase in the care insurance contribution for those with statutory insurance. Proposals for structural changes are to be made by the new commission. According to tagesschau.de, the federal government points out that it has had good experience with commissions on pensions and health, for example, because scientists and politicians sit on them.
At the end of September, the federal cabinet had already launched part one of the package. According to Handelsblatt, this includes a planned increase in contribution rates for the childless from 1 January 2027 by 0.3 percentage points. The contribution rate for care insurance currently stands at 3.6 per cent of contributory income and 4.2 per cent for the childless. Their rate is to be 4.5 per cent from next year. In addition, the contribution assessment ceiling in care insurance is to be raised by 300 euros per month, as in health insurance. High earners will therefore pay more.
The National Association of Statutory Health Insurance Funds, which also represents the care funds, expects a deficit of 1.2 billion this year. A shortfall of 7.6 billion euros is expected next year, and deficits in the double-digit billions for the coming years, according to the draft law. Whether the measures will be sufficient to stabilise finances next year will have to be examined closely, the funds association said. More will have to be added for this year.
The economic expert Veronika Grimm criticised the coalition’s plans. “It is completely unclear why another commission is to be appointed,” she told the “Rheinische Post”. The pressure to reform is immense and the problem has long been analysed. “Of course, the level of benefits that has meanwhile become established cannot be maintained in this way,” she said. The longer one waits for a solution, the more unfavourable the effects on growth and employment will be.
Care insurance has been under financial pressure for years. According to Health Minister Linnemann, the number of people in need of care has tripled in 20 years: from two million to six million today. In a commentary, the taz points out that statutory care insurance has been underfunded since its introduction in 1995. In Denmark, for example, there is no care insurance; provision is entirely tax-financed and borne by the municipalities. Caring relatives can, under certain conditions, be employed by the municipality. The taz calls for a paradigm shift that focuses on the needs of those receiving care.
Outlook: The Greens want to use their motion to put pressure on the coalition. Whether their demands will prevail is open. The care commission is to present proposals for structural reform by the end of January 2027. Health Minister Linnemann plans a second reform on this basis by summer 2027. Until then, the financial holes in care insurance are likely to grow further.
