Ignored election campaign topic: gloomy prospects for health insurance companies

The health insurance companies paint terrible scenarios on the wall.

The AOK Group alone expects a deficit of more than 4 billion euros for 2021.

Overall, according to FAZ information, the expenditures of the statutory health insurance (GKV) in the first half of the year were 1.9 billion euros above the expenditures.

In 2020 there had been an increase of 1.3 billion at this point in time.

The rise in costs is justified with expensive laws, higher remuneration and with Corona: Postponed services would now be made up.

Christian Geinitz

Business correspondent in Berlin

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The financing for 2021 seems to be just about secured.

Because the additional contributions and the federal subsidy are increasing and because the cash reserves are being tapped, the missing 16 billion euros can be made up.

But for 2022, when a similar minus is pending, the prospects look bleak.

The federal government cannot increase the contributions any further if it wants to keep its “social guarantee” of a maximum of 40 percent of the insurance contributions.

So where are the missing billions supposed to come from?

Health Minister Jens Spahn (CDU) and Finance Minister Olaf Scholz (SPD) have already agreed to further increase the already lavish federal grant of 14.5 billion euros.

It was increased by 5 billion in 2021, and 7 billion are planned for 2022.

However, that will not be enough either, Spahn had wanted 5.5 billion euros more.

90 percent of the insured are affected

If the predictions of the health insurers are correct, there will be a gap of 10 billion euros in 2022, despite the record federal transfers.

Part of this could be covered again from the cash reserves, which still amount to 16 billion euros.

Nevertheless, an even larger tax participation cannot be avoided.

This is exactly what the law on the further development of health care provides.

Until the end of the year, Spahn is authorized to increase the grant together with Scholz and with the approval of the Bundestag.

After submitting the lousy half-year figures, the cash registers are urging to pull this lever before the election.

The substitute funds are hoping for a special session of the Bundestag on September 9th.

The AOK Federal Association warns, otherwise there is a threat of “contribution rate increases across the board” at the turn of the year.

The financial disaster that affects 90 percent of the insured does not play a role in the election campaign.

With the inconvenient truth that the pay-as-you-go GKV system is no longer sustainable and citizens will therefore have to dig deeper into their pockets in the future - whether as tax or contribution payers - no flower pot can be won from voters.

It should be fine with Ministers Spahn and Scholz to leave the mined terrain to their successors.

Fear of Citizen Insurance

There is little in the programs on the overdue SHI reform. The Union basically wants to leave everything as it has been up to now. It “continues to rely on income-related parity contributions, personal contribution and a tax component for non-insurance benefits”. The FDP would like to “adapt the health system to demographic development. . . adapt ”, but does not say how. After all, the Liberals are committed to a “strong” private health insurance (PKV). The Union, on the other hand, formerly a lawyer for the privately insured, no longer even mentions them. The ideas of the AfD build "on the existing German health system". The party wants many changes, but not in the basic funding.

The left parties are more ambitious. The SPD, the Greens and the Left want the system change to a citizen insurance. If they set up the next government, the financial architecture is likely to change fundamentally. Then all persons and also other types of income would be included in the statutory health insurance. Economists have calculated that this actually relieves the coffers in the short term. The demographic distortions and long-term underfunding could not be cured in this way.

The private health insurance association, which fears nothing more than citizens' insurance, has examined the position paper of the Greens and comes to the conclusion that the inclusion of investment income or rents would primarily bag pensioners who use such income for retirement provision. Those who receive 625 euros a month and an additional 1640 euros pension would have to pay at least 68 percent more GKV contribution with the green model.

The parties avoid another unpopular question: how to cut spending instead of increasing revenue. The Bielefeld health economist Wolfgang Greiner refers to the overcapacities in the clinic. Fewer hospitals with higher quality are needed and in these more outpatient instead of expensive inpatient treatments. Digitization can also help save. At the same time, you have to "check very critically whether something is included in the service catalog". It is important to make higher demands on the new health apps on prescription and to think about whether and how expensive gene therapies or the treatment of rare diseases can be reimbursed.

And what does the economist think of simply increasing the budget for the statutory health insurance as planned? “With higher tax subsidies, you can first avoid unpleasant increases in contribution rates,” says Greiner. "Only subsequent generations of politicians will find out that money does not fall from the sky even with tax subsidies."