Berlin Federal Health Minister Karl Lauterbach (SPD) defended his plans for a care reform on Wednesday against criticism. “Since the costs of good care are constantly increasing, the community of solidarity must not look the other way and leave these higher costs to those being cared for and their relatives,” he said. At the same time, the financing of long-term care insurance must be stabilized.
The general care contribution should increase for this. There should also be changes depending on the number of children. Those in need of care at home and in the home are to receive financial improvements at the beginning of 2024.
The cabinet passed a corresponding draft law on Wednesday. The previous coordination between the ministries took longer than expected. Lauterbach had to adapt the law again under pressure from the Ministry of Finance. The improvements in performance are now significantly lower than originally planned in order to compensate for a foreseeable deficit in the billions in long-term care insurance.
Among other things, the joint annual amount for preventive and short-term care of up to 3386 euros per year should not come as announced, which relieves the care insurance funds by around 500 million euros. In addition, Lauterbach forgoes several funding programs, including for pilot projects in municipalities and for the compatibility of family, care and work. Overall, this should reduce the additional expenditure of the long-term care insurance funds from three to two billion euros.
The care reform consists of several parts. An overview:
Higher Contributions
On July 1, the general contribution rate for long-term care insurance is to be raised by 0.35 points. Now it is 3.05 percent of gross wages and 3.4 percent for people without children. This would result in an additional 3.15 billion euros for 2023 and from 2024 onwards annual additional income of 6.6 billion euros. The employer’s share also increases and is always 1.7 percent.
Contribution relief for large families – with some concessions
According to a judgment by the Federal Constitutional Court, parents with several children must be better off than small families and those without children. The draft law therefore provides for raising the childless allowance from 0.35 to 0.6 percentage points. The total contribution for them would then be 4.0 percent.
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For families, starting with the second child, there could be staggered deductions from the regular rate of 3.4 percent in the future: with two children it would be 3.25 percent, with three children 3.1 percent, with four children 2.95 percent. However, the deductions mentioned only apply as long as all children to be taken into account are under 25 years old.
Higher nursing allowance
The nursing allowance, which was last increased in 2017, is now to rise by five percent on January 1, 2024, as will the money for benefits in kind. Care allowance is paid as support when the person in need of care is not in an institution. You can use it freely, for example for supervision. Depending on the level of care, they receive between 316 and 901 euros per month.
Actually, the care allowance should have been raised in 2021 after its last increase in 2017. The planned plus is therefore not large enough in the opinion of the health insurance companies and social associations.
Lower deductibles
For nursing home residents, the co-payments have been increasing for years – also with the relief surcharges introduced in 2022, which increase with the length of care. According to the draft law, they are to be increased from January 1, 2024.
This should reduce the personal contribution for pure care in the first year in the home by 15 instead of the previous five percent, in the second by 30 instead of 25 percent, in the third by 50 instead of 45 percent and from the fourth year by 75 instead of 70 percent. The background to this is that nursing care insurance, unlike health insurance, only pays part of the costs for pure nursing care. In the home, payments for accommodation, food and investments are added.
dynamization
A mechanism is also envisaged to periodically adjust cash and in-kind benefits. According to the draft, there should be an increase of five percent on January 1, 2025. As of January 1, 2028, the services are then to be “regularly and automatically dynamic based on price developments”. At the same time, Lauterbach has to develop comprehensive savings proposals in order to relieve the long-term care insurance.
“Things can’t go on like this,” said Lauterbach in view of the constantly increasing expenditure on long-term care insurance. A commission will therefore now develop proposals. “We have to think about how we will develop the system further, for example in the direction of fully comprehensive insurance.”
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The deliberations in the coalition are likely to be difficult. The law must be passed in the Bundestag. The deputy leader of the Greens, Maria Klein-Schmeink, said on Wednesday that the draft would bring “improvements for those in need of care and for those caring for them”. However, there is criticism that the funds agreed in the coalition agreement for tax financing of tasks affecting society as a whole are not being made available.
Greens are pushing for improvements
In particular, these are the pension contributions for caring relatives in the amount of 3.7 billion euros per year and the costs for nursing training in the amount of 750 million euros. “Since these expenses continue to be borne by the contributors, they are not relieved,” she says. In addition, the agreed simplification when applying for the relief benefit in home care is missing. “In all of these points, we will press for improvements in the parliamentary process,” she says.
Criticism also came from the tills. The reform only addresses a few points, but falls far short. “The federal government is missing the goals it set itself in the coalition agreement,” said Gernot Kiefer, deputy chairman of the umbrella organization of statutory health insurance companies.
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