Health Minister Karl Lauterbach (SPD) has just presented the key points for a law intended to alleviate the financial misery of the statutory health insurance companies (GKV) in the short term, and it quickly became clear that Finance Minister Christian Lindner (FDP) had almost completely enforced his ideas .
The GKV members in particular now have to pay, they expect higher contributions than ever before from next year. In return, the tax subsidy demanded by Lauterbach and the cash registers is far lower than hoped.
But the “contribution shock” that many are now talking about is actually just a first warning shot: Because the situation of the health insurance companies and thus the insured persons threatens to get much worse in the coming years. It’s a drama that’s announced – only the warnings can no longer be ignored, as in previous years.
The GKV will be short of at least 17 billion euros in the coming year, but the Ukraine war could well increase the deficit to well over 20 billion. Contrary to what is commonly believed, the minus is not a consequence of Corona, but largely the result of the failures of the past few years. It wasn’t that long ago that health insurance companies had a lot of money at their disposal.
Lauterbach’s predecessor Jens Spahn (CDU) was therefore tempted to take all-too-popular measures during his tenure. For example, setting up appointment service points and paying additional doctors who take on new patients. That’s what Lauterbach meant when he accused Spahn of leaving him a backlog of reforms and expensive laws.
But, and Lauterbach seems to have forgotten this: As an SPD health expert, he was not only in the grand coalition boat, but was even at the wheel. As parliamentary group deputy, he negotiated every Spahn law and repeatedly emphasized that it would bring a clear SPD handwriting to health policy – especially with the Appointment Service Act, which, according to Lauterbach at the time, confidently helped to end “two-class medicine”.
As a minister, Lauterbach is now faced with the shards of health policy not only from Spahn, but from many previous incumbents. Urgently needed reforms were delayed during this time because the financial reserves were there.
In addition to the contribution increase of 0.3 percentage points, Lauterbach is now emptying the penultimate reserves of the health insurance funds – i.e. funds from the GKV members. He is also urging the GKV to take on a “federal loan” to get into debt. With a bit of luck, that’s enough to survive the coming year, but not for more.
According to estimates by GKV experts, the deficit will increase by an additional four to five billion euros every year if no countermeasures are taken. However, since there are no more reserves to be drawn from the health insurance companies in the coming year, there is a risk of contribution increases that could well exceed the current jump by a multiple. And that on an annual basis.
In addition, there could be cuts in performance, which Lauterbach has so far ruled out. However, he has not yet been able to keep the promise: Because of course it is a reduction in benefits when particularly “complicated”, i.e. multimorbid patients, soon find it more difficult to get doctor’s appointments because doctors no longer receive an additional fee for new patients.
The urgently urged statutory health insurance reforms should have been tackled when the necessary start-up money was available. Now they become open-heart surgery while the lights are already flickering in the operating room.
Lauterbach’s biggest health policy challenge remains the same as it was before the key points were presented: sustainable statutory health insurance reform that prevents an exodus of those who can afford private insurance. The search for culprits and pointing the finger at Spahn may temporarily distract. But that doesn’t get anyone any further.