The Federal Minister of Health, Nina Warken (CDU), has issued a stark warning to state governments, urging them not to obstruct cost-saving measures for Germany’s statutory health insurance (GKV) system within the Bundesrat. In a letter to her counterparts in the state governments and reported by POLITICO, Warken cautioned that any attempt to block the agreed-upon federal legislation could trigger a significant increase in supplementary contributions for health insurance holders.
The core of the dispute revolves around the Pflegekompetenzgesetz (Care Competence Law), which bundles several crucial GKV regulations slated to take effect on January 1, 2026. The Bundesrat’s Health Committee has recommended invoking the conciliation committee, a move Warken characterized as a “highly problematic signal” that jeopardizes the carefully negotiated budget plans for the coming year.
Should the states succeed in blocking the federal measures, health insurance funds may be forced to revise their budgets, leading to a potential increase in the supplementary contribution rate to 3.0 percent. This would translate to a financial burden of up to two billion euros for contributors.
The contentious aspect underpinning the stalemate is the temporary suspension of the “Meistbegünstigungsklausel”, a provision that limits the budgets of psychiatric and psychosomatic hospitals. Minister Warken defends this measure, arguing that, given the sharp rise in hospital expenditures since 2024, it represents a proportionate intervention necessary to stabilize contribution rates. Critics, primarily within the state governments, contend this suspension unfairly impacts mental healthcare providers.
The Minister’s recent decision to set the average GKV supplementary contribution for 2026 at 2.9 percent underscores the sensitivity of the situation. Warken maintains this decision is dependent on the swift and unhindered implementation of the federal legislation. The potential for political fallout – jeopardizing public trust in the government’s ability to manage the healthcare system – looms large should state governments choose to prioritize delaying tactics over fiscal stability.