Federal Government | Care reform: Coalition postpones the major controversial issues

Carsten Linnemann, Federal Minister of Health, was able to postpone the major points of contention to a future commission. Photo: Kay Nietfeld/dpa After a long dispute, the Union and the SPD launched the first part of their care reform on Wednesday. The Federal Cabinet approved the draft for a nursing care reorganization law. This is intended to initially stabilize the financially troubled social care insurance. The general contribution rate of 3.6 percent should not increase. However, certain insured persons will face higher burdens: from January 2027, those without children will have to pay a surcharge that is 0.3 percentage points higher. The contribution assessment limit will also be raised. In addition, the relief amount will be completely eliminated for people with care level 1 in the future.

At the same time, Health Minister Carsten Linnemann (CDU) made or implemented some changes to the original plans. The nursing care insurance should continue to fully cover the pension insurance contributions for caring relatives. In addition, there will be a regular annual adjustment of the benefit amounts again from 2029. However, the coalition is postponing the decision on the central questions of long-term financing. A structural commission is expected to develop proposals by January 2027. This also includes the question raised by the SPD as to whether and how a financial balance between private and social long-term care insurance is possible.

The reform will be felt most directly by those insured without children. Your contribution surcharge will increase by 0.3 percentage points to a total of 0.9 contribution rate points on January 1, 2027. The general contribution rate for social care insurance, however, remains at 3.6 percent. This corresponds to the requirement to increase income without further increasing the uniform contribution rate for all insured persons. In addition, there is a higher contribution assessment limit. The limit for long-term care insurance will be increased by 300 euros per month and will thus be adapted to the corresponding regulations in statutory health insurance.

Another source of income is expected to be added from January 2028. A surcharge of 0.52 percentage points is planned for spouses and life partners who have previously been insured without paying contributions. There are exceptions to this, including for caring relatives and parents of children with disabilities. Children continue to be exempt from contributions in family insurance.

In addition, contributions to long-term care insurance will also flow from minor employment in the future. According to the financial planning of the bill, the increase in the childlessness supplement for long-term care insurance alone should initially bring in around 3.3 billion euros annually from 2027. The higher contribution assessment limit is expected to contribute another around 500 million euros.

On one of the most controversial points, the coalition has moved away from the original draft. The nursing care insurance continues to fully cover the pension insurance contributions for caring relatives. Linnemann's draft originally envisaged savings at this point.

However, in the draft that has now been approved, the pension contributions are addressed elsewhere. In the future, nursing care insurance will generally only pay contributions for caregivers until they receive an old-age pension and until they reach the standard retirement age. This is intended to end the possibility of continuing to receive full pension insurance contributions from nursing care insurance by drawing a small partial pension even after reaching the standard retirement age. The draft bill puts the expected reduction in expenditure at around 150 million euros annually.

Linnemann viewed the waiver of the originally planned cuts for caring relatives as an important part of the compromise. The minister explained that he did not want to “make any compromises on the pensions of caring relatives.” At the same time, he defended the savings elsewhere. The care system is under massive financial pressure, said Linnemann.

However, the law is not limited to financing. Another focus is on reorganizing services and placing a stronger focus on prevention.

People aged 60 and over should in future be entitled to an additional age-related health check. The aim is to identify risks and stresses earlier that could lead to a loss of independence or the need for care. Health insurance companies should be allowed to make greater use of existing insured person data to recommend suitable prevention offers.

Nursing assessments should also be carried out more closely according to the principle of “rehab before care”. In the future, it will be examined more systematically whether rehabilitation can reduce the need for care. At the same time, the draft law emphasizes greater personal responsibility, according to which those in need of care must "participate in medical rehabilitation and activating care services" after the need for care arises.

However, for people who will be rated as care level 1 in the future, the previous relief amount will no longer apply. This represents a drastic change in current practice. Instead, care support should be given greater importance there. For existing cases, there should be grandfathering for certain services.

Organizing care should also become easier for those in need of care and their relatives. In the future, a digital “care cockpit” will bundle information, applications and offers in one place. A single log-in should be enough, for example, to submit applications, search for providers or get an overview of the services you have already received.

Care facilities should also have more scope for technical and organizational innovations. A total of two billion euros in funding is available for digitalization in long-term care: 1.6 billion euros come from the federal government's special fund, and the states are expected to contribute up to 400 million euros.

Further savings should be achieved through a changed assessment. The federal government wants to change the criteria for care levels 1 to 3 and redefine the relevant threshold values. At the same time, a scientific advisory board will be set up to regularly review the review process in the future and adapt it to medical, technical and social changes.

For people who already have a level of care, grandfathering should apply. Nevertheless, people who apply for a nursing degree in the future will find it more difficult to get something from the nursing care insurance into which they have paid for years. Millions of people will therefore receive no or only lower levels of care in the future and therefore fewer services.

This means that the core of the conflict between the Union and the SPD remains. The Social Democrats had pushed for the financing of statutory long-term care insurance to be broadened. In particular, the financially better off private nursing care insurance companies should also be involved in the stabilization.

There is no such direct participation in the financing package that has now been decided. Instead, a structural commission that has yet to be set up will examine fundamental questions about long-term care insurance. This also includes whether compensation mechanisms between the nursing care funds are legally possible.

The commission is expected to work from October and submit proposals by the end of January 2027. A new bill will then be drawn up. Linnemann names Easter 2027 as the target for a cabinet decision. The Bundestag and Bundesrat should deal with this by the summer. The second reform step is scheduled to come into force on July 1, 2027.

The law that has now been passed also states that from this point onwards, proposals from the Structural Commission are to be implemented, with which long-term adequate financing of social long-term care insurance is to be achieved.

The coalition's compromise lies primarily in the division of the problem: the Union receives short-term savings and additional income without increasing the general contribution rate. The SPD can point to changes compared to Linnemann's original draft - for example in the pension contributions of caring relatives. However, your central demand for private nursing care insurance to be involved or for a nursing care cap will only be debated in a future commission.

The political dispute over the scope of the first reform step is unlikely to be over. The Greens speak of an agreement on the lowest common denominator and criticize that the actual structural reforms would be delegated to a commission again. The leader of the Green Party in the Bundestag, Britta Haßelmann, explains: “The government lacks the vision and the strength for real structural reforms. They will be outsourced to a commission again."

The Left also criticizes the draft law. Left-wing parliamentary group leader Sören Pellmann accuses the SPD of having given in to the involvement of private nursing care insurance: "Today the cabinet decided on a nursing care reform that largely remains exactly as Health Minister Linnemann wanted it." The SPD's central demand "for the participation of private nursing care insurance is off the table and has been postponed to a commission that is supposed to develop proposals by January. But the cuts are already in effect now.”

Eugen Brysch from the Patient Protection Foundation also criticized the draft law. It is “questionable whether the increase in the contribution assessment limit and the surcharges for those without children can compensate for the deficit in long-term care insurance in the next twelve months.” With agencies.

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