Among these proposals is the suggestion to abolish or restrict the non-contributory co-insurance of spouses (“family insurance”), a long-standing element of the German solidarity-based system.
Germany is currently witnessing an intensified political debate on the future of its statutory health insurance system (GKV, gesetzliche Krankenversicherung). In the context of rising costs, demographic pressure, and structural deficits, an expert commission has recently presented a catalogue of 66 proposals aimed at stabilising the system financially.
Among these proposals is the suggestion to abolish or restrict the non-contributory co-insurance of spouses (“family insurance”), a long-standing element of the German solidarity-based system. This proposal has sparked considerable concern. The German system of statutory health insurance is built on the principle of solidarity rather than strict equivalence between contributions and benefits. Non-contributory co-insurance allows spouses without their own income – often due to caregiving responsibilities, part-time work, or family-related career interruptions – to remain covered without additional financial burden.
Critics of the reform proposal argue that abolishing this mechanism would disproportionately affect families, especially those with multiple children or caregiving responsibilities. In many households, one partner (still most often women) reduces or pauses employment to provide childcare or care for dependent relatives. Removing co-insurance would effectively penalise these family arrangements and could create significant financial pressure.
Moreover, families not only contribute to the system through current payments but also ensure its long-term sustainability by raising future contributors. From this perspective, weakening family support structures within the health insurance system risks undermining its demographic and financial foundations.
It is important to note that the proposal is only one of many options under discussion, and no political decision has been taken so far. The German case illustrates the importance of carefully designing reforms so that cost-saving measures do not disproportionately burden families or discourage caregiving and child-rearing – both of which are essential for the long-term resilience of social security systems across Europe.