Corona: health insurers as paymasters (neue-deutschland.de)

The federal states bear half the costs for the corona vaccination centers like here in Frankfurt am Main. The health insurances pay the staff, the federal government the vaccine.

Photo: dpa / Boris Roessler

The Federal Ministry of Finance expected around 1.5 trillion euros in corona costs in October. This included the corresponding expenditures of the public coffers for the years 2020 and 2021. This includes support and stimulus programs for the economy, international aid payments and state guarantees, for example in the form of guarantees. This also includes the additional costs for the health system and the procurement of medical material. Also included are the dwindling income and higher expenses of the social security funds, i.e. unemployment and pension insurance as well as statutory long-term care and health insurance. The Ministry of Finance estimated additional expenditure and revenue shortfalls in the social security funds at 26.5 billion euros.

In view of the total costs, this amount seems manageable, especially when you consider that the largest item is the expenditure on short-time working allowance. The big cash drop, however, could take place in the weeks before the federal election in autumn. And the foreseeable debate about the refinancing of the corona costs will with some certainty also include the social systems. A weighing up of the expenditures in this area is already demanded – with very different orientations: Neoliberal politicians will try to cut funds and services again, while left representatives will vote for the better organization of services of general interest.

With regard to the financing of the corona costs, the processes relating to the health fund are interesting. This is where the contributions from the legally insured and the corresponding share from the employer flow. In addition, there are grants from the budget of the Federal Ministry of Health. The funds are then distributed to the health insurers – according to the probability of illness of those insured with them, which can vary depending on the average age.

As a safeguard, the health fund has a liquidity reserve with which fluctuations in income are to be balanced out over the course of a year. This reserve should amount to at least 20 percent of the fund’s monthly expenditure. Since it has risen again and again in recent years and this was only partially offset by lowering the contribution rates, Health Minister Jens Spahn (CDU) had an easy time tapping this pot in the pandemic situation. The so-called Covid-19 hospital relief package from March 2020 gave the clinics financial compensation for postponed operations and treatments from this liquidity reserve. The non-occupancy of beds in preventive and rehabilitation facilities as well as additional intensive care beds were also financed from the reserve. Around seven billion euros were withdrawn in total.

Now, with the “Health Care and Care Improvement Act” of December, a one-time grant of five billion euros from tax revenues is to flow into the health fund. But that is by far not enough to close the financial gap of the statutory health insurance (GKV) of 16 billion euros forecast for 2021. Another eight billion are to come from the financial reserves of the health insurances – which they commented with great bitterness, because these are reserves of the contributors. This is also a further “centralized” intervention in the work of social self-administration in the current legislative period, it was said by representatives of the fund. Because actually the cash registers should be autonomous in their finances, according to the legal situation. The Techniker Krankenkasse (TK) alone has to transfer around 1.4 billion euros from its reserves to the health fund, and the members of the AOK family are expected to raise more than four billion euros. In order to close the mentioned funding gap, the additional contribution – a benchmark for the statutory health insurance companies – is now being increased by an average of 0.2 percentage points.

But there are differences between the individual insurance companies. A large part of the smaller health insurance companies do not increase the additional contribution, but a whole group between Continentale BKK and BKK Akzo Nobel Bayern adds 0.1 to 0.8 percentage points. TK is also moving in this field with its ten million policyholders, who demand 0.5 percentage points more. And it is at least questionable whether the health insurers can hold out on the basis of the current additional contribution through the whole of 2021. Even without the pandemic, they will come under pressure. The regular drug costs continue to rise, and the flood of laws from Minister Spahn’s house has a lasting effect. These innovations cause additional expenditure in the double-digit billion range, which will continue over the years, but the cash reserves can only be used once.

However, with the orientation value for the additional contribution, the goal is achieved that in the election year the non-wage costs overall remain below 40 percent. Union and SPD want to have that politically credited. The uncertainty for the budgetary situation of the individual health insurance funds is lost sight of, and obviously other staff should also take care of the overall finances of the statutory health insurance. Achim Kessler from the Left has already warned of an even larger funding gap of over 18 billion euros for the year 2022.

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