Berlin Health Minister Karl Lauterbach (SPD) can apparently not hope for any more billions in taxes from the budget for his care reform. The Handelsblatt learned this from coalition circles. Those insured under social long-term care insurance will therefore have to be prepared for significantly higher contributions this year. The reason for this is not only the upcoming reforms, but also a deficit in the billions from last year, which was mainly caused by pandemic-related expenditure.
Lauterbach had already set the insured for higher contributions at the beginning of January, but was still hoping for additional tax money. “In particular, we want to improve care by relatives and outpatient services,” said the SPD politician. “That’s why we will not be able to avoid the contribution rates increasing.” However, the coalition agreement “rightly also provides for further tax subsidies”. Apparently, this will not happen for the time being – at least not to the extent Lauterbach was hoping for.
Finance Minister Christian Lindner (FDP) wants to ward off the multi-billion dollar wishes of his cabinet colleague as far as possible. “Despite the already tense financial situation, there should be further expansion of services in the billions,” says the Ministry of Finance on Lauterbach’s proposals. There is still a “considerable need for advice”.
Negotiations for next year’s budget and medium-term financial planning are currently underway. Budget Secretary Werner Gatzer has already warned the other departments to exercise restraint. There is a funding gap of twelve billion euros in the budget.
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More expensive projects are not included, was the message in a meeting of state secretaries a week and a half ago. On the contrary: it should rather be saved. Lindner’s budget experts are also keeping an eye on the Ministry of Health, which had increased its spending significantly during the pandemic.
Long-term care insurance has a minus of over two billion euros
However, it is not yet possible to say how expensive Lauterbach’s reform will ultimately be for the insured. Lauterbach had already announced key points for the end of last year. They are now expected in the coming weeks. According to the National Association of Statutory Health Insurance (GKV), a higher contribution of “at least” 0.3 percentage points is necessary just to compensate for the deficit in social long-term care insurance.
At the end of the year, long-term care insurance was down by around 2.2 billion euros, and the liquidity reserves were 1.2 billion euros below the legally stipulated level. In addition, there is a loan of one billion euros granted by the federal government last year, which has to be repaid this year. As a reason for the deficit, the National Association of Statutory Health Insurance Funds cites, among other things, corona expenditure totaling twelve billion euros, in which the federal government only contributed 5.5 billion euros.
>> Read here: Lindner threatens ministries with cuts because of billions gap
“We want long-term care insurance to remain a contribution-financed social insurance system,” said the association’s deputy chairman, Gernot Kiefer, to the Handelsblatt. “But this also means that the non-insurance services that the long-term care insurance takes on instead of and on behalf of the federal government are fully counter-financed.” There must be a significantly higher federal subsidy for this. “A financial reform of long-term care insurance that does not regulate this accordingly falls short.”
Will the reform become a “bureaucracy monster” for companies?
The coalition agreement contains a whole series of reform projects for care that are still pending, such as a higher care allowance. Patient advocates expressed outrage at the end of the year. They are pushing for a rapid increase to provide more support for the 4.2 million care recipients cared for at home.
The planned reform also wants to take care of the labor shortage in nursing.
(Photo: imago/photothek)
The nursing allowance was last increased in 2017, so the demands are aimed at a hefty increase of around ten percent, which would mean additional costs of around 1.7 billion euros. The relief budget for outpatient care that was also announced in the coalition agreement should also cost several billion euros.
>> Also read here: This is how expensive social security could be by 2030
In addition, there is the relief required by the Federal Constitutional Court for the end of July for those with long-term care insurance who have several children, which Lauterbach has already promised. Here, too, it is not clear how the judgment will be implemented in practice. However, in a study for the DAK health insurance companies, the economist Heinz Rothgang estimated that the health insurance companies would lose income of 2.9 billion euros per year as a result.
In return, 16.2 million households with several children would be relieved by an average of 176 euros. Alternatively, the contribution for childless and insured persons with a child would have to increase. It is currently 3.05 percent for insured persons with children and 3.4 percent for those without children. The contribution is deducted from the gross salary.
Statutory health insurance is threatened with a record deficit
In view of Lauterbach’s verdict, the FDP is calling for a concept to be presented quickly in order to eliminate uncertainties in companies as well. “The minister must prevent the care reform from becoming a bureaucracy monster for employers,” said care policy spokeswoman Nicole Westig of the Handelsblatt. “As a rule, employers have no information about how many children their employees have.” “Companies must therefore know in good time what they can prepare for.”
Lauterbach has another construction site with the disastrous financial situation of the statutory health insurance, which has been escalating for years. At the turn of the year, the contribution rates for insured persons had already risen to a new record high, and the Minister of Health also had to support the health insurance funds with a series of emergency measures. The reason was a deficit of 17 billion euros expected for this year, which could be significantly larger again in the coming year.
“The spending spiral continues,” said the honorary chairman of the Association of Substitute Funds (VDEK), Uwe Klemens, at the beginning of the week in Berlin. The association expects spending to increase by around five percent in 2023 and by another four percent in 2024. The health insurance companies would therefore head for a minus of “30 billion euros plus x”. Without measures, the additional contribution would then have to increase by more than two percentage points.
The cash registers are therefore urging, among other things, that the federal government take over the costs for recipients of citizen income, which are around ten billion euros per year. But this coalition project has also failed so far due to the tight budget situation and Lindner’s ministry.
More: Opinion of the Scientific Advisory Board – What to expect from contributors to long-term care insurance