Statutory health insurance companies spend billions on insured people who pay little or no contributions. This principle of solidarity is politically desired. As an important branch of social insurance, health insurance takes on “tasks motivated by family policy and society as a whole,” as the Federal Ministry of Health puts it.
The biggest chunk of the so-called non-insurance benefits is the contribution-free co-insurance of children and spouses or life partners if they have no or only a low income. In 2010, the federal government put the expenditure on this at around 20 billion euros; more recent projections put it at around 27 billion.
Contributions for children and spouses as a solution?
BR24 user “PeeGee” comments: “If one person pays in, but five are insured as a result, solidarity has limits.” And “PeeGee” added: “It would be long past time to collect at least a symbolic contribution for co-insured people: €10 for spouses and €5 per child. Something would come together.”
The calculation example “One pays one, five are insured” would apply, for example, to a family with three children in which only one parent pays contributions and the children and the other parent are also insured. Overall, the figures are different: of the total 74.3 million people insured by the GKV, around a fifth are insured without contributions, namely 15.9 million. This means: For every four contributors, there is one insured person who does not pay their own contributions.
Large sums in play
“PeeGee’s” proposal for a contribution for co-insured people makes it clear what sums the health insurance covers. If, for a calculation example, you take 7.50 euros as the average of the proposed five euros for children and ten euros for spouses, “PeeGee’s” proposal results in additional annual income for the statutory health insurance of 1.43 billion euros. This does not include possible administrative costs for collecting contributions.
In statutory health insurance, one contribution rate point corresponds to income of 17.9 billion euros. If “PeeGee’s” idea were implemented, the contribution rate could be around 0.08 percentage points lower on average. This means: The GKV contribution rate, which is currently on average 16.6 percent, could fall to 16.52 percent. Anyone who has a gross monthly income of 4,000 euros and pays the average health insurance contribution would have savings of 1.60 euros. The employer would save the same amount.
Or to put it the other way around: In order for “PeeGee’s” proposal to really bring about noticeable relief for contributors who pay for co-insured people, significantly higher contributions would have to be due for children or spouses.
Problems with definition
One problem in the discussion about “non-insurance benefits” is that different discussants mean different things by the word pair. The Federal Audit Office (BRH) states soberly: “In science and literature, different definitions are presented as to which services are not covered by insurance.” According to BRH, this explains why the calculations of how much the health insurance companies spend on such services vary greatly: they lie between four and 54 billion euros.
Since 2004, the federal government has been paying a subsidy from tax revenue to the health insurance companies as at least partial counter-financing for non-insurance benefits. Taxes are not only borne by statutory health insurance contributors. That is why they are considered the right source when it comes to financing tasks for society as a whole. Previously, the health insurance companies had for decades derived their income exclusively from contributions from insured people. The tax subsidy initially amounted to one billion euros, currently it is 14.5 billion.
Underfunding for citizens’ benefit recipients
Health insurance companies and social associations have long criticized the fact that the federal government does not come close to compensating for the health insurance funds’ expenses for those receiving citizen’s benefit, and previously unemployment benefit II. According to a report commissioned by the National Association of Statutory Health Insurance Funds, the gap is around nine billion euros. If the federal government were to pay this amount to the coffers from tax revenue, the average contribution rate could be 0.5 percentage points lower. This means: Instead of 16.6 percent on average for all health insurance funds, the contribution rate would be 16.1 percent. With a gross monthly income of 4,000 euros, the insured person and their employers would each save ten euros in contributions.
In their coalition agreement, the SPD, Greens and FDP had resolved to at least partially remedy the underfunding in this area: “We are financing higher contributions for those receiving unemployment benefit II from tax revenue,” it says in the agreement. However, after the breakup of the coalition, it is very unlikely that there will be any movement here.
