On April 29, the German Council of Ministers approved a health insurance reform that, if it passes the debate in the Bundestag, will impose a monthly surcharge on non-contributing spouses for their medical coverage as of 2028. Until now, these people were covered at no additional cost through the Familienversicherung, The German public family insurance scheme, the German public family insurance scheme.
According to the text approved by Friedrich Merz's executive, the surcharge would be around 225 euros per month or 3.5% of the gross salary of the contributing spouse, although the figures could be modified during the parliamentary procedure. The Government justifies the measure by the need to cover a deficit estimated at 15 billion euros in the public health system.
The people directly affected are overwhelmingly women: family insurance currently covers approximately 2.5 million spouses who are outside the contributing labor market; at home, with mini-jobs, early retirees....
An ideological contradiction within the Government
The reform has not passed without controversy within the ruling coalition itself. The Minister of Health, Nina Warken, belongs to the Christian Democratic Union (CDU), a party which has historically placed the defense of the traditional family model -and of the spouse dedicated to the home- at the center of its electoral program. Various analysts and heads of family organizations point out that the measure economically penalizes precisely this model.
In households with children under the age of seven or with dependents, the reform introduces no changes. However, in those with older children, the economic equation is recalibrated: the spouse who remains at home will no longer be covered, which introduces a structural incentive to join the labor market.
Organizations critical of the measure, the SoVD and VdK social unions, warn that, by monetizing the absence of contributions, the State is directly penalizing women and implicitly transferring the fact that care work within the family - raising children, caring for the elderly, managing the home - is not economically recognized in the system.In a country with a fertility rate of less than 1.5 children per woman and a growing concern about demographic aging, penalizing this model could, in the long term, aggravate the very problem that the reform seeks to solve.
Sitting in Europe
The German reform comes at a time when several European Union countries are debating the sustainability of their social protection systems. France, Austria, Belgium and the Netherlands maintain similar co-insurance or dependent spouse allowance formulas that have begun to be questioned under similar arguments: contributory equity, promotion of female employment and budgetary balance.
When the continent's largest economy adopts a measure of this scope, it can set a precedent or serve as an inspiration for organizations, such as the European Commission and other national governments, which can take it as a reference for their own reforms. The basic debate, in any case, goes beyond taxation: what is at stake is whether the State considers the relevant economic unit to be the adult contributor or the family as a cell with its own social functions.
The proposal will still have to pass the debate and vote in the Bundestag before it enters into force.
