Berlin. For those with statutory health insurance, there is a very specific question: Will they have to pay more for their health insurance again in 2027? “This is absolutely on point,” says DAK CEO Andreas Storm to the Handelsblatt about the federal government’s austerity package passed in July, which is intended to prevent exactly that.
According to current estimates, health insurance companies will be short of around 18.8 billion euros in 2027 if contributions are to remain stable. According to Storm's assessment, the package can close this gap - but only if spending does not increase more than expected and the planned savings are actually implemented.
The Federal Audit Office also warns against too tight a calculation. In a report for the budget committee from September, which is available to the Handelsblatt, the auditors write: “There is no longer any buffer, and any uncertainty in estimates has a full impact on the GKV finances.”
An argument for stable contributions: The federal government has once again significantly improved its austerity package in the legislative process. The Ministry of Health initially assumed that health insurance companies would be short of around 15.3 billion euros in 2027. This gap was later revised upwards to 18.8 billion euros. The previous government draft would not have been sufficient for this.
In the meantime, the planned measures should close the entire gap mathematically. An important approach: In the future, health insurance companies' expenses should no longer grow significantly faster than their income in key areas. The Federal Audit Office also considers this basic idea to be sensible.
Health economist Martin Albrecht from the Iges Institute therefore believes stable contributions are possible. “If the austerity package is implemented as the federal government intended and the savings effects occur as they are estimated in the law, no jump in the contribution rate is to be expected,” he says.
Storm also sees this opportunity. Based on developments in the first half of the year, the additional contribution could remain stable in 2027 provided the situation does not deteriorate further. The additional contribution is the part of the health insurance contribution that each insurance company determines itself. If it increases, health insurance will become more expensive for employees and their employers.
The support of the federal government also plays a role in whether this holds hope. According to his updated plans, he will pay the health insurance companies more in 2027 than initially planned for insured people who receive basic security. At the same time, however, the federal government is reducing its regular subsidy to the GKV.
The federal subsidy will fall from 14.5 to 13.15 billion euros in 2027. The Federal Audit Office criticizes the fact that the changes to federal payments in the first few years actually mean that funds are being withdrawn from the GKV. At least the cut is less severe than in the federal government's first draft.
Together with the higher payments for basic security recipients, health insurance companies will have around 1.4 billion euros more available to them in 2027 than originally planned. Compared to today, however, this is not a relief, just a less severe deterioration.
It was also still unclear whether the federal government would have to save the additional money for basic security recipients elsewhere in the budget - and whether that could become a problem for the health insurance companies. The Federal Office for Social Security (BAS), which monitors financial flows between the federal government and health insurance companies, expressly denied this to Handelsblatt. The authorities say that the payments to the GKV are ultimately stipulated by law.
What matters is whether the planned savings actually end up being as high as expected. Health economist David Matusiewicz from the FOM University warns against too much security. “The statement that there will be no jumps in contribution rates in 2027 needs to be formulated much more carefully,” he says. The goal can only be achieved “if the austerity package actually works in full and very quickly”.
Because the 18.8 billion euros are not simply transferred to the health insurance companies. A large part of the relief will come from the fact that their expenses will increase less in the future. Whether this will actually succeed can only be estimated in advance. Albrecht also warns against viewing the bill as secure. “Experience shows that savings targets are not always achieved,” he says.
There is also a political risk. Many austerity measures affect doctors, clinics or pharmaceutical companies and are met with resistance there. If individual regulations are later weakened, the savings will also be smaller. One example concerns the pharmaceutical industry. From 2027, manufacturers should pay higher discounts to health insurance companies for patent-protected drugs, as is planned in the austerity package.
At the same time, discussions are already underway about the conditions under which individual companies could be exempted. The more exceptions there are, the smaller the planned relief for the health insurance funds will be. Results should be available at the end of this month.
An example from recent years shows how far apart political expectations and actual effects can be. Doctors received additional money so that insured people could get an appointment more quickly. According to the Federal Audit Office, the target was missed, but costs rose significantly.
The Court of Auditors also doubts the expected savings in individual measures of the current austerity package. The federal government expects savings of 50 million euros per year if health insurance companies are no longer allowed to pay for homeopathic and anthroposophical services. The Federal Audit Office writes in its report: “However, the savings potential is likely to be lower than the 50 million euros annually assumed by the federal government.”
At the same time, new costs could arise - of all things as a result of political concessions in the austerity law itself. In order to defuse the states' resistance to the cuts in hospitals, former Federal Health Minister Nina Warken (CDU) pledged an additional 550 million euros for clinics in the Bundesrat. These funds would be financed by statutory health insurance. However, this has not yet been decided. According to the Federal Audit Office, this requires new legal regulations.
Overall, the issue is politically sensitive. A further jump in contributions would directly affect millions of employees. At the same time, the federal government must implement austerity measures that clinics, doctors and other affected people are already resisting. Albrecht therefore also refers to the political mood and recent election results. “It cannot be ruled out that individual measures will be weakened or corrected later,” he says.
There is an even bigger problem behind this: the expenses of statutory health insurance have been rising faster than their income for years. The austerity package can slow down this development. But the financial problem cannot be solved permanently. Therefore, a finance commission should present proposals for further reforms by December.
According to the current calculation, the savings package could be enough to prevent another jump in contributions in 2027. There should be more clarity in October. The GKV estimators will then make a new forecast of how much money the health insurance companies are likely to receive in 2027 and how much they will spend.
