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The meeting, as usual in these times, will only take place as a conference call. But it’s about billions of dollars. And possibly with far-reaching decisions. This Monday, starting at 5 pm, the Minister of Health Jens Spahn and a dozen senior officials of the legal health insurance (GKV) are advising how the financial overload policy of the health system due to the crisis of the crown.
Above all the details, there will be a fundamental question about whether one should help health insurance companies, where all the other industries are already asking for tax money, with generous subsidies to help them out of the emergency situation. Or if you prefer to accept contributions soaring. And the economy, which is already on the ground, is also burdened by higher non-wage labor costs and is prevented from increasing.
Insurers have prepared them for the crisis round with the minister. They calculated and estimated, formulated a need for action, coordinated with each other. In addition to the National Association of Statutory Health Insurance Funds, each type of health insurance fund is also represented at the conference, with both the head of the association and the head of a member fund. It is not so easy to speak with one voice.
But there is a basic consensus, and also a common position document that is already in the Ministry and forms the basis of the conversation. “We will describe the dramatic financial situation to the minister,” says one of the participants. “And we will vehemently demand more federal grants.”
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Without help, contributions would have to increase
There are still no valid figures for the first, much less for the second quarter influenced by Corona. Internal estimates, which the Tagesspiegel Fund was able to inspect, make the nervousness of the savings bank officials understandable. The bottom line is that finance departments expect an additional requirement of more than € 14 billion by 2020 alone.
If the federal government does not intervene, the average additional contribution for the insured should almost double, it is said: from the current 1.1 to 2.0 to 2.2 percent. And the expected Corona Katzenjammer is still not priced for next year, for example, due to high unemployment and the recovery effects of hospitals.
Above all, Spahn will likely articulate the cash register’s current needs first through late payments from the health fund. Guaranteed allocations, at least € 21bn per month, would have to be paid reliably and quickly despite high revenue losses and protective shield costs, they urge. If necessary, also with the help of a federal loan.
It is unacceptable that the Federal Social Security Office (BAS) has passed its own liquidity bottlenecks and delayed payment of individual tranches by up to two weeks.. After all, politicians were forced to pay their own bills particularly quickly in the crown crisis, that is, within five days. And in times of negative interest rates, there are no underwriter reserves in the checking account.
In light of such delays in cash flow, would Spahn allow banks to bypass loans as before? In any case, fund allocations are guaranteed. In this regard, the planned financial gap for 2020 is more serious. In their internal projections, health insurers place it between 14.1 and 14.6 billion euros. Interestingly, the additional crown-related expenses for this horror sum have little effect. By 2020, they are only estimated at an additional € 500 million to € 1 billion. Overall though, because the huge savings are also included here due to severe disruption of medical care in clinics and medical practices.
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1.6 billion just for crown testing
Without this contrary calculation, the Corona editions would appear different. Treating infected people in clinics alone (health insurance companies expect at least 200,000 cases in 2020) will cost the SHI 1.3 billion euros, according to health insurers. The increase in the value of nursing care for clinics caused $ 3.3 billion in additional costs, the exemption mandated to verify hospital bills by $ 1.1 billion to $ 1.2 billion more. And if you assume that 20 million people will be evaluated in Corona by the end of the year, around 1,600 million euros will have to be raised again.
All of this is put into perspective by savings, even if many of the postponed operations have to be offset. Cash registers for 2020 are much more concerned with two items. One is the obviously underestimated follow-up costs of Spahn’s many health reforms. The other is the breakdown of premium income.
Because the group of estimators was already too optimistic when determining the premiums for 2019, the legal insurers are already dragging a less than 1,600 million euros compared to the previous year. And 2020 will be even worse. According to experts, the average additional contribution rate of 1.1 percent decided for this year was “completely illusory”. It should have been 0.3 points higher. This politically desired arithmetic now allowed cash registers to fall into the crumbs with another six billion euros.
Even without a pandemic, there would have been a financial problem
This means: Even without the pandemic, there would have been a huge financial problem for SHI this year. In addition, there is now an estimated drop in revenue of another six billion euros due to the crown crisis. Loss of premiums due to short-term work and unemployment could add up to two billion.
This is based on the assumption of 2.5 million short-term wage earners and an additional 500,000 unemployed. The rest are follow-up costs assumed by the deferral of contributions, which have been and will be awarded to numerous companies and independent workers. As a result, around two billion euros went through the rags in the closing months of March and April alone. “And how many of these companies never pay deferred contributions because they disappear from the market, nobody knows,” said one of the board’s officials.
Wolfgang Greiner, vice chairman of the Council of Experts for Developmental Assessment in Health Care, describes the dilemma that health insurance companies are now experiencing. The increase in spending in recent years would have been easy for a larger number of policyholders to meet, he told Tagesspiegel Background. But the cost-generating performance laws would have created “permanent claims.” “If unemployment now increases, the number of insured tends to decrease again and income increases less than in previous years, there is a financing problem.”
Advisory Council: Premium increases are not enough
The health economist emphasizes that trying to solve this problem only by increasing premiums is “hardly imaginable in a recession.” It probably won’t be possible without such increases. From expert Greiner’s perspective, an increase of 0.5 percentage points would be conceivable. At the same time, however, the $ 14.5 billion a year tax subsidy today should be increased “at least temporarily.” And since the economic crisis was barely over by the end of 2020, this subsidy would probably have to be paid for over a year.
The chairman of the Bundestag health committee, Erwin Rüddel, sees it the same way. The problem of increasing financial needs “must not be left to taxpayers alone, but must be financed by tax dollars,” the CDU politician told Tagesspiegel Background. His reasoning: Many cash expenses in the crown crisis, such as the hospital rescue package or the cost-bearing for the Covid 19 tests, would benefit society as a whole. Furthermore, rising non-wage labor costs also hurt in a recession. The Union politician made it clear that he could “imagine a multi-year expansion of the federal grant.”
One could also argue with the necessary “prevention of danger” that is the task of the entire state and not only of the taxpayer. Or remember the financial crisis of 2009, in which the increase in federal subsidies from 7.2 to 15.7 billion has stabilized enormously. And it may not be so difficult to lure the Minister of Health here, because the billions of additional taxes should not be available to Finance Minister Olaf Scholz.
CDU politicians also demand tax subsidy for care
It is even conceivable that Spahn seizes the opportunity to finally, with state aid, stabilize another pillar of the social system. The need for a federal grant for long-term care insurance has long been a consensus among experts. So far, there has only been one there because long-term care insurance companies so far have provided “almost no non-insurance benefits,” says Greiner. But he also says: “The reasoning could change when referring to Corona.”
In any case, Rüddel believes that “at least we have to talk about a one-time crown allowance for attention.” “I think it is absolutely appropriate that the performance of the nursing staff be rewarded with a special bonus,” says Spahn’s party friend. And he adds: “Also at this point, I think this is a responsibility for society as a whole.”
