(de-news.net) – Germany’s coalition government remains divided over long-term care reform, with Health Minister Carsten Linnemann (CDU) contending that more extensive structural reform is required, while the SPD is pushing for a 1,500-euro cap on a significant nursing-home co-payment. Protecting care recipients and family caregivers, funding the system, and allocating costs among individuals, insurers, employers, municipalities, and the Federal Government are the main points of contention, while the Greens and Left are calling for broad changes.
The disagreement with the SPD over the proposed long-term care reform is, Federal Health Minister Carsten Linnemann said, neither unusual nor particularly serious, even as differences within the governing coalition remain unresolved. Linnemann pointed to an earlier reform of statutory health insurance, saying that agreement in that case had also been reached only shortly before the measure was due to be considered by the Cabinet. He said he had decided that the roughly 4 million family members who provide care would not face additional burdens. In his view, disputes of this kind should primarily be resolved behind closed doors rather than through public exchanges. The immediate negotiations are now centered on how the proposed measures can be financed.
The SPD is advocating a cap of 1,500 euros on nursing-home care costs. While Linnemann acknowledged that the proposal could be considered, he argued that it would not address the underlying financing problem because the resulting reduction would be small relative to the overall financial burden borne by residents. Out-of-pocket expenses can reach between 3,000 euros and 4,000 euros, he noted, meaning that a 1,500-euro cap on the relevant component would provide only limited relief. Linnemann maintained that the structural underfunding of long-term care insurance could not be resolved through what he characterized as a temporary measure. To address the system’s longer-term financial position, he proposed establishing a commission in late October that would examine how long-term care insurance could be prepared for the 2030s.
The SPD, however, has continued to resist parts of the draft and is seeking additional negotiations before the legislation moves forward. The party has rejected a reform that would reduce benefits or transfer additional financial responsibilities to patients. SPD parliamentary deputy Dagmar Schmidt reiterated the position that the party did not want a measure whose principal effect would be to close another financing gap by passing the costs on to people receiving care. Her criticism echoed earlier remarks by parliamentary group leader Matthias Miersch, underscoring that the disagreement concerns not only individual provisions but also how the financial burden of the system should be distributed. The Cabinet is scheduled to consider the reform Wednesday, while additional negotiations between the coalition partners are reportedly expected beforehand.
Minister weighs billions in savings to limit health insurance costs
Linnemann has identified potential sources of additional funding, including the repayment of 5 billion euros that the long-term care insurance system provided to the state during the coronavirus pandemic. In his view, returning that money could give the system greater financial flexibility without requiring reductions in benefits. The issue is part of a broader discussion over whether the government’s planned savings will be sufficient to contain rising contributions elsewhere in the health insurance system. Jens Baas, the CEO of Techniker Krankenkasse, has questioned whether the government’s proposed savings package will be enough to stabilize health insurance contribution rates. Linnemann did not guarantee that stabilization would be achieved, but said another package involving roughly 600 million to 700 million euros in savings was being prepared.
The debate over long-term care is unfolding alongside broader disagreements within the coalition over the pace and scope of its reform program. CDU Secretary-General Franziska Hoppermann urged the SPD to accelerate implementation, arguing that too many coalition agreements and decisions remained unresolved. She linked the need for faster action to the condition of Germany’s social insurance systems, which she said required modernization to remain viable. In her view, voters were seeking greater stability and direction, making a functioning Federal Government and consistent implementation of previously agreed measures particularly important. Hoppermann also interpreted the latest state election results as evidence of the political appeal of forces on both the right and the left. Against that backdrop, she called for greater urgency and seriousness from the SPD as the coalition continues its reform agenda.
Greens and Left call for broader overhaul of long-term care system
The Greens have likewise warned that the proposed long-term care reform could shift additional financial burdens onto contributors and municipalities. Britta Haßelmann, the party’s parliamentary group leader, instead called for a structurally sustainable approach that would distribute costs more evenly while limiting the growing out-of-pocket burden faced by people in residential care. Such a reform, she argued, should protect both care recipients and the family members who provide care rather than addressing financing pressures through additional burdens on either group. Haßelmann also welcomed Linnemann’s reported decision to reverse planned reductions in pension protection for family caregivers, maintaining that people whose unpaid work helps sustain the long-term care system should not be subjected to further financial pressure.
Haßelmann also called for greater financial equity between statutory and private long-term care insurance. She pointed to differences in contribution levels, arguing that privately insured people frequently pay substantially less even though statutory and private policyholders are entitled to comparable care benefits. In her view, the financing structure should therefore be adjusted to address what she considers a central inequity in the existing system. At the same time, she criticized the coalition’s continuing disagreements, arguing that the government had yet to establish a sufficiently coherent direction for the reform process. The dispute over long-term care thus reflects a wider disagreement over whether immediate savings or broader structural changes should take priority.
Sören Pellmann, leader of the Left parliamentary group, has gone further in calling for a fundamental restructuring of long-term care insurance. He reiterated his party’s demand for a comprehensive, solidarity-based system and sharply criticized Linnemann’s approach as inadequate. The Left proposes abolishing the distinction between statutory and private long-term care coverage and bringing all residents into a common financing system. Under the party’s proposal, income from investments and rental properties would be included alongside wages and salaries in determining the financing base. Pellmann argued that such a broader revenue base could make it possible to eliminate individual co-payments altogether rather than merely limiting their size.
At the same time, Pellmann said that a 1,500-euro cap and a financial adjustment between the statutory and private insurance systems would represent an improvement over taking no action. His broader criticism focused on the distribution of financial pressures within the system. He argued that government policy should reduce rather than add to the financial burdens facing households and opposed further reductions in benefits. Pellmann also attributed the governing coalition’s weak performance in the recent elections to public dissatisfaction with its approach to spending reductions. His comments placed the long-term care dispute within a wider political argument over the coalition’s handling of social policy and public finances.
SPD plan would cap key nursing-home co-payments at 1,500 euros
Under a proposal submitted by Saarland Health Minister Magnus Jung, the SPD intends to introduce a 1,500-euro ceiling on the so-called institution-specific co-payment paid by residents of nursing homes. The proposal would be implemented in stages. During the first stage, the relevant monthly cost would be limited to 1,500 euros, potentially reducing residents’ expenses during the first year by about 275 euros per month. A second stage would provide additional financial relief. The concept estimates the cost of the two measures at approximately 1 billion euros and 3 billion euros, respectively, placing the proposal within the broader debate over how substantial relief for nursing-home residents could be financed.
Nursing-home expenses consist of several distinct components, including accommodation and food, investment and maintenance costs, expenses associated with training elderly-care workers, and the costs of care and supervision. The financial burden on residents therefore extends beyond the specific co-payment targeted by the SPD proposal. According to the Association of Substitute Health Insurance Funds, residents currently pay an average of 3,364 euros per month out of pocket. The institution-specific co-payment accounts for the largest component of that amount and averages 1,775 euros during the first year of residence.
The existing system already incorporates a contribution from long-term care insurance toward the institution-specific co-payment. During the first year, the insurance system covers 15 percent of the relevant costs, with its contribution increasing as the length of residence grows. As a result, the individual’s share of that particular cost component declines over time. The proposed cap would therefore operate within an existing financing structure in which insurance contributions already increase according to the duration of residential care.
The SPD concept also outlines potential mechanisms for financing the additional expenditure. Among the options identified are raising the ceiling on income subject to social insurance contributions, increasing the contribution made by private long-term care insurance, and providing a larger contribution from the federal budget. The financing question remains central to the coalition dispute because the competing proposals differ not only over the extent of relief for people in nursing homes but also over where the additional resources should come from.
