Germany's Bundestag has formally passed the government's reform of statutory health insurance, bringing an end to a legislative process marked by fierce controversy and extensive revisions in the Health Committee. The recorded vote took place on Friday, 10 July 2026, with 319 members of parliament voting in favour, 286 against, and four abstaining. The reform is intended to close the funding gap facing Germany's statutory health insurance system, the GKV, for 2027 and the years that follow.
A Charged Final Debate
The closing debate before the vote was charged with emotion. Federal Health Minister Nina Warken of the CDU described the legislation as a milestone on the path toward putting statutory health insurance on a stable footing, acknowledging that negotiators had worked until the very end to reach the right compromise.
She argued the reform was necessary because spending had recently grown at roughly twice the pace of income, and said the law shifts the system's long-term focus toward efficiency and evidence-based spending.
Opposition parties, including the AfD, the Greens and the Left Party, rejected the bill as rushed and unbalanced, arguing that committee changes had not been given adequate time for proper scrutiny and that the burden would ultimately fall on patients and contributors rather than the actual drivers of rising costs.
What the Law Actually Changes
The reform is expected to relieve the GKV of 16.3 billion euros in 2027, a figure projected to rise to as much as 38.1 billion euros by 2030. The savings and new revenue are spread across several areas of the system:
- Spouses and registered partners will only keep free family coverage automatically if the household includes children under age twelve, a disabled child, a family member requiring care, or if the insured partner has reached the standard retirement age; otherwise, a surcharge of 2.5 percent of contribution-liable income applies from 2028. Children's coverage is unaffected, and the qualifying child-age threshold was raised from seven to twelve during deliberations.
- Co-payment amounts rise by fifty percent, to a minimum of 7.50 euros and a maximum of 15 euros, though the increase will not be tied to future wage growth as originally proposed.
- Cannabis flower will no longer be reimbursed by the GKV, homeopathic and anthroposophic remedies are excluded even as optional insurer benefits, and blanket, non-symptomatic full-body skin cancer screening will no longer be billable.
- Annual increases in reimbursement across nearly all areas of healthcare and administration are capped at either actual cost growth or average wage growth, with an added one-percentage-point reduction applied between 2027 and 2029.
- Hospitals face similar payment-growth limits, and wage increases for nursing staff that exceed the relevant ceiling will only be reimbursed at half their value going forward.
- Costly special reimbursements and cases of double financing are being scrapped, and from 2027 the Federal Joint Committee must introduce a mandatory second-opinion requirement for at least one high-volume, plannable procedure each year.
- Several extra-budgetary payments to contracted physicians are being discontinued, including additional fees tied to open consultation hours, patient referrals, and populating the electronic patient record.
- The pharmaceutical manufacturer discount rises from seven to 15.5 percent, though a dynamic component meant to generate ongoing additional revenue was dropped during negotiations.
- The federal contribution toward health insurance costs for recipients of basic income support rises by roughly 750 million euros from 2027, taking the total from 250 million to one billion euros, with further increases planned in later years.
- The federal subsidy to the health fund, frozen at 14.5 billion euros since 2017, will be cut less sharply than originally planned, settling at 13.15 billion euros in 2027 and 12.95 billion euros annually from 2028, with future revenue from a higher tobacco tax and a new levy on sugary drinks factored in.
- Health insurers face administrative costs permanently capped in line with average wage growth, advertising budgets halved, and limits on pay for senior executives at insurers, their regional associations, medical review bodies and physician associations.
- The federal government will delay repayment of 5.6 billion euros in loans extended to the GKV in 2023, 2025 and 2026.
- A new system of partial sick leave and partial sick pay is introduced, offering three graduated levels of working capacity at 25, 50 and 75 percent, with details to be set by the Federal Joint Committee.
Alongside the main bill, the Bundestag adopted a resolution on mental health care and psychotherapeutic services, calling on the government to take further legislative action should service restrictions increase the financial burden on insured members in future, along with a separate resolution addressing the regulatory environment for clinical research and the pharmaceutical industry.
What Happens Next
Although the Bundestag vote represents the decisive parliamentary step, the reform is not yet finalised. Because the law does not require the Bundesrat's formal consent, the states cannot block it outright, but they retain the option of referring it to the mediation committee, which could still delay its entry into force. Provisions of the law are set to take effect in stages, beginning upon promulgation and continuing with further elements on 1 January 2027 and 1 January 2028.
