With Germany’s long-term care reform facing a potential blockade by the SPD, senior government and coalition representatives held intensive talks on Monday in an effort to find a solution. However, no compromise appeared to be in sight for the time being. Health Minister Carsten Linnemann (CDU) rejected an SPD demand for a “cap” on patients’ out-of-pocket costs for care home expenses. The SPD, meanwhile, insisted that changes be made before the planned cabinet decision on Wednesday.
Germany’s statutory long-term care insurance system is deep in the red. According to the National Association of Statutory Health and Long-Term Care Insurance Funds (GKV-Spitzenverband), the system could face insolvency as early as October without additional funding. A deficit of €4.4 billion is expected for the year as a whole. For 2027, the GKV-Spitzenverband forecasts a funding shortfall of €10 billion.
The coalition therefore wants to push ahead with a reform. Federal Health Minister Carsten Linnemann (CDU) had planned to have his draft legislation approved by the cabinet on Wednesday. However, the plans have faced widespread criticism. The SPD argues that Linnemann’s draft does not address the structural problems and is threatening to block the cabinet decision.
High-level talks were planned for Monday to address the dispute. However, a meeting between Chancellor Friedrich Merz (CDU), Health Minister Carsten Linnemann (CDU) and Finance Minister Lars Klingbeil (SPD) at the Chancellery was not possible due to scheduling conflicts. Both Merz and Klingbeil had a series of appointments throughout the day. A telephone call or video conference between them was nevertheless considered possible. Chancellery Minister Nina Warken (CDU) was also apparently involved in the discussions.
“This is nothing unusual,” Linnemann said on Sunday on ARD, referring to the crisis talks ahead of the cabinet meeting. During the reform of statutory health insurance, he said, “we only became familiar with it and reached an agreement two hours before the cabinet meeting.”
Linnemann rejected the SPD’s demand for a cap on out-of-pocket long-term care costs. Such a measure would “not solve the problem,” he said. Instead, the CDU politician advocated establishing a commission to make the long-term care insurance system structurally fit for the future. The commission is also provided for in the coalition agreement and is due to present its findings by spring 2027.
SPD health policy expert Christos Pantazis reiterated his party’s demand for changes to the reform by Wednesday. There was an “egregious problem of fairness compared with private long-term care insurance,” the health policy spokesman for the SPD parliamentary group told Deutschlandfunk. He called for at least a financial balancing mechanism between the two systems, “because the shared risk of needing long-term care is distributed unequally.”
Pantazis also identified two further areas that could be addressed in the reform. The federal government would certainly have to make a financial contribution, he said. However, he did not commit to whether Finance Minister Lars Klingbeil (SPD) should repay around €5 billion in COVID-era debt to the long-term care funds. Pantazis pointed to the difficult budget situation.
The SPD politician also said that the federal states had a responsibility. They are responsible for investment and training costs in long-term care but were “by no means” covering them sufficiently.
Dennis Radtke, head of the CDU’s labour wing (CDA), warned that the long-term care reform must “not simply become another cost-cutting law.” What was needed were “real structural changes so that people can continue to rely on the system in the future,” he told the Redaktionsnetzwerk Deutschland newspapers published on Monday. In this context, “benefits unrelated to the insurance system’s actual responsibilities” should “especially be brought into focus,” Radtke said.
The issue concerns benefits for which long-term care insurance was not originally responsible and which are considered a responsibility of society as a whole. One example repeatedly cited is pension insurance contributions for family members who provide long-term care. Critics argue that these contributions should be financed entirely through tax revenue. According to the GKV-Spitzenverband, fully funding these costs through other means would relieve the long-term care insurance system by €5.3 billion per year.
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