German care reform draft draws fire from municipalities, states and coalition partners

The draft and its goals

To close a growing deficit in the statutory care insurance, Health Minister Nina Warken (CDU) has drafted a package of spending brakes and new revenue worth €11.25 billion for 2027. The plan, reported by Politico from a ministry working draft, would delay the schedule of rising co-payment relief for nursing-home residents by six months per tier, saving the funds €2.6 billion in 2027. The contribution rate for childless insured persons would rise from 4.2 to 4.3 percent at the start of 2027. Access to care grades would be tightened and possibly made temporary, while pension contributions paid on behalf of family carers would be cut. Free co-insurance for spouses would also be restricted.

Municipalities warn of a billion-euro shock

German Association of Cities president Burkhard Jung (SPD), the mayor of Leipzig, called the draft "a slap in the face for municipalities" and demanded it be withdrawn entirely. He told the Funke media group the plan would impose an additional annual burden of €1 billion on local authorities. A care-home place already costs an average of nearly €3,400 a month nationwide, Jung told dpa, and when residents cannot cover the personal share the bill falls almost entirely to municipal social welfare. In Leipzig alone, those costs have doubled from €25 million to €50 million in five years. "Leaving older people to the social welfare office is disrespectful," Jung said.

State-level resistance

Berlin health senator Ina Czyborra (SPD) told RBB-Inforadio the reform would cost the city-state a two-digit, possibly three-digit million sum and create a "huge additional workload" for social welfare offices already struggling to process applications. "I currently lack the imagination for how this is even manageable," she said. Mecklenburg-Western Pomerania premier Manuela Schwesig (SPD) labelled the draft a "burden package" and noted that in her state, where elections are due in September, the personal contribution for a first-year nursing-home place already averages around €2,900 per month. "That is far more than the older people in our state have in retirement income," she told Politico.

Coalition fissures

CSU state parliamentary group leader Klaus Holetschek, a former Bavarian health minister, acknowledged "bright spots" in the draft but said the overall package did not convince him. Cutting pension contributions for family carers while claiming to support them was "a slap in the face of the people who keep our care system running day after day," he told the Münchner Merkur and Augsburger Allgemeine. He warned the reform was "a shifting yard towards social welfare." By contrast, CSU Bundestag group leader Alexander Hoffmann defended the minister, telling dpa that "a simple 'no' to necessary structural reforms is not enough." SPD health spokesman Christos Pantazis said the draft contained useful elements but left the central question unanswered: how to finance care fairly and sustainably over the long term.

Professional carers and the opposition

Nursing Council president Christine Vogler told the Redaktionsnetzwerk Deutschland the plan was a pure savings programme. "The focus is not on securing nursing care but on short-term consolidation of the care insurance," she said. Green health expert Janosch Dahmen told dpa the largest single savings item consisted of restricting access to care benefits. Chancellery chief Thorsten Frei (CDU) pushed back on n-tv, arguing that care insurance is a partial, not a full, insurance and that the reforms would ultimately support economic growth and safeguard jobs.

The economists' wider lens

The German Council of Economic Experts used its spring report to propose far deeper changes. It recommended a debate on enrolling new civil servants into the statutory health insurance from 2027, which it calculated would trim the contribution rate by 0.05 percentage points by 2030 and 0.19 points by 2040. Without fundamental reform, the council warned, the total social insurance contribution rate would climb from 42.3 percent today to 45.4 percent by 2030 and 49.7 percent by 2040. The care insurance contribution would grow fastest in relative terms, rising 41 percent from a weighted 3.7 percent to 5.2 percent. The council also advised stopping further payments into the long-term care reserve fund.