Reimann: Federal government must assume financial responsibility
24.07.2025 14:28
Last week, the Federal Constitutional Court upheld the Statutory Health Insurance Financial Stabilization Act in a ruling that strengthened the legislature's authority to take measures to ensure the financial stability of statutory health insurance. Dr. Carola Reimann, Chair of the Board of the AOK Federal Association, commented:
„"It is very good that the Federal Constitutional Court, in its ruling, once again clearly emphasizes the financial responsibility that the legislature – and thus politicians – bears towards statutory health insurance. And it explicitly calls for healthcare providers to contribute to ensuring the stability of statutory health insurance contributions. This financial co-responsibility of pharmaceutical companies and other healthcare providers for contribution stability is currently far too neglected.".
According to recent statements by Federal Health Minister Nina Warken and hints from Federal Chancellor Friedrich Merz, the Federal Government is aware of the strained financial situation of statutory health insurance and long-term care insurance, but both have so far failed to make any concrete promises or measures on how they intend to hold service providers accountable.
On the revenue side, only inadequate bridging loans have been agreed upon. And on the expenditure side, there is only the Chancellor's vague announcement that they want to discuss the issue of the personal responsibility of those paying contributions and the level of services for patients.
Before we delve into that, we should first discuss the federal government's lack of financial responsibility towards statutory health insurance and long-term care insurance, the additional contribution burdens of recent years – and what those paying contributions have actually received in return. This also includes addressing the efficiency and performance problems of our healthcare system, such as why the enormous sum of around 340 billion euros that contributors will provide this year cannot guarantee high-quality, needs-based inpatient and outpatient care. To borrow the Chancellor's analogy: We're paying for a Mercedes and not even getting a Golf!
Why are pharmaceutical companies, which profit handsomely from the statutory health insurance system, not required to contribute to stabilizing its finances? They benefit from one of the easiest market accesses in the world and exploit this with exorbitant prices. Why must the statutory health insurance system now reimburse hospitals an additional four billion euros for so-called "immediate transformation costs," even though this doesn't "transform" outdated hospital structures but merely preserves them?
Instead of continuing to operate according to the principle of 'spreading water from one source to another', the federal government must finally implement genuine efficiency improvements.‚
background
Two pharmaceutical companies had filed constitutional complaints against key provisions of the German Statutory Health Insurance (GKV) Financial Stabilization Act – including the temporary manufacturer's discount (12 %), the extension of the price freeze, and the combination discount (20 %). The aim of the complaints was to overturn these provisions as an inadmissible burden on pharmaceutical companies. This has now been rejected by the Federal Constitutional Court.
Key points of the Federal Constitutional Court's decision
- The legislature may take measures to limit drug expenditures – even if these lead to cutbacks for pharmaceutical companies;
- Interventions such as increased manufacturer discounts, price moratoriums or combination discounts are constitutionally permissible – the interference with the freedom to pursue a profession is justified (suitable, necessary and proportionate);
- Service providers in the statutory health insurance system enjoy only limited protection of legitimate expectations when it comes to securing the financing of the statutory health insurance system;
- The judges emphasized that the pharmaceutical industry in Germany continues to generate high sales; there is no question of a structural withdrawal from Germany or a serious threat to its existence;
- The service providers must be involved by the legislator in cost-containment measures (paragraph 99);
- The Senate repeatedly emphasizes (paragraphs 87, 98, 99) that the legislature has responsibility for the financial stability of the statutory health insurance system and may not evade this responsibility;
- Pharmaceutical companies have no legitimate expectation of the stability of pricing (Note: this should be applicable to other LEs);
- Due to the complexity of the statutory health insurance system, a reduced plausibility and evidence check of the measures applies (paragraph 89).