Federal Government | Care dispute in the coalition: SPD calls for improvements

Federal Health Minister Carsten Lindemann is under pressure. Photo: dpa/Michael Brandt The dispute over the planned care reform is coming to a head. The SPD does not want to support the bill from Federal Health Minister Carsten Linnemann (CDU) in its current form and is threatening to block the cabinet decision planned for Wednesday. On Monday, representatives of the Union and SPD wanted to negotiate changes again. Despite the resistance of the SPD, Federal Health Minister Carsten Linnemann (CDU) is sticking to his timetable for the planned care reform. The draft law is still to be passed in the federal cabinet this Wednesday, a spokesman for the Ministry of Health said on Monday.

The Social Democrats particularly criticize the fact that Linnemann's draft initially only envisages savings, while fundamental structural reforms will only be discussed later. SPD parliamentary group leader Matthias Miersch explained that his group would not support a pure cuts package. General Secretary Tim Klüssendorf and several SPD state politicians also called for changes.

Linnemann rejects the accusation that it is purely a program of austerity. The CDU minister argues that nursing care insurance is structurally underfunded. First, financial stability must be secured. He is planning a commission for the end of October that will set up the structure of nursing care insurance for the coming years.

The federal government is currently trying to present the dispute as a dispute about the specific form of the reform. Deputy government spokesman Steffen Meyer said that the discussion was not about the “whether” of reforms or nursing care reform, but about the “how.” The financial challenges must be brought together with the interests of those involved in care and the citizens. Negotiations are taking place in different constellations.

The SPD combines potential approval of the plans with two central demands. On the one hand, privately insured people should be more involved in financing care. On the other hand, the party wants to limit the personal contributions of those in need of care in homes.

SPD health politician Christos Pantazis spoke of a “blatant justice problem” between statutory and private nursing care insurance. Since private insurance has a structurally more favorable risk structure, the average expenses per insured person are lower. The SPD is therefore calling for at least a financial balance between the two systems. In the long term, leading social democrats are aiming for a common long-term care insurance policy for everyone. The SPD parliamentary group vice-president Dagmar Schmidt explained: "That's why we want a common solidarity system or at least a fair financial balance between private and social care insurance."

The private insurance industry rejects such a transfer. The CEO of the Association of Private Health and Nursing Care Insurance, Thomas Brahm, described financial equalization or a transfer of aging provisions as constitutionally untenable. Brahm argued that those with private insurance were already paying for nursing care and demographic precautions. Interference with private provision could also damage trust in funded protection.

The SPD proposal is also met with resistance within the Union. CSU regional group leader Alexander Hoffmann spoke out against “reaching into private nursing care insurance.” The CDU employee wing CDA, on the other hand, is also calling for structural changes. Its chairman Dennis Radtke explained that the care reform should not become just a savings law again. In particular, non-insurance benefits should be given greater consideration.

The second major point of contention is the so-called care cap. According to a proposal from the SPD-led Saarland, the personal contribution for pure care costs in inpatient facilities should initially be limited to 1,500 euros per month. The Saarland Health Minister Magnus Jung (SPD) initially estimates the resulting additional expenditure on nursing care insurance at around one billion euros.

According to a possible second step, the nursing care insurance subsidies, which increase with the length of stay, could also be calculated based on the cap. This would provide greater relief. Jung expects additional costs of around three billion euros.

Linnemann rejects the cover. The 1,500 euros only apply to the so-called facility-wide contribution, not the entire cost of a home place. Accommodation and meals as well as investment costs would also be added. The total personal contribution could therefore still reach 3,000 to 4,000 euros. According to his calculations, limiting care costs would only save around 300 euros per month and would not solve the basic problem.

The SPD, on the other hand, argues that the increasing personal contributions are putting more and more strain on those in need of care and their relatives. Lower Saxony's Prime Minister Olaf Lies (SPD) said that it must first be about structural reforms and not about cutting services and increasing burdens. He also warned of additional costs for municipalities, as they would have to step in more often for so-called care assistance if their own contributions increased.

When looking for additional funds, Linnemann also refers to the Federal Minister of Finance. During the corona pandemic, the state used five billion euros from nursing care insurance for appropriate assistance. According to the Health Minister, there was a promise at the time to return the money. If the Ministry of Finance now repays the funds, the nursing care insurance would have more financial leeway, said Linnemann.

Pantazis did not want to commit to whether Finance Minister Lars Klingbeil (SPD) should actually pay back the five billion euros. He referred to the tense budget situation. At the same time, the SPD also sees the states as responsible, for example for investment and training costs, for which they are responsible, but which, according to their representation, are not adequately covered.

Meanwhile, the financial pressure to act seems high. According to the umbrella association of nursing care insurance funds, a deficit of 4.4 billion euros is expected for statutory nursing care insurance by the end of the year. Association leader Oliver Blatt therefore warned against blocking the reform. There is a “red alert” in nursing, he said.

The Joint Association is also demanding a repayment of the contribution funds used during the pandemic. Managing director Joachim Rock also advocates that the long-term care provision fund with more than 14 billion euros should also be included in the considerations. This is an option in a financial emergency. In the long term, however, the association is calling for comprehensive nursing care insurance that fully covers care-related costs and ends the separation between social and private nursing care insurance.

Despite the open conflict, Linnemann considers the disputes within the coalition to be “nothing unusual.” The most recent reform of statutory health insurance was also only agreed upon shortly before the cabinet discussion. At the same time, he criticized that the dispute over care should better be carried out “behind closed doors”.

The dispute comes at an unfavorable time for the coalition. After the recent state elections in Mecklenburg-Western Pomerania and Berlin, Chancellor Friedrich Merz (CDU) announced that he wanted to speed up the upcoming reforms. The CDU general secretary Franziska Hoppermann recently called on the SPD to move more quickly with the federal government's projects. At the same time, she emphasized that the reforms are necessary so that the social security systems remain sustainable in the long term.

The left-wing faction fundamentally criticizes the draft. Parliamentary group leader Sören Pellmann also described Linnemann's plans as a program of austerity and at the same time criticized the fact that the SPD only implemented its demands immediately before the planned cabinet decision. "If even the CDU employee wing warns that this is just an austerity law, then the verdict on Linnemann's care reform has long since been passed," says Pellmann. "Deleted relief amount in care level 1, the definition of care needs and thus benefits, suspended tariff obligation until 2030: This is not a reform, this is a cutting program on the backs of those in need of care, their relatives and the nursing staff." With agencies.

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