Germany’s statutory health insurers (GKV) are taking the federal government to court, demanding €10 billion in compensation for what they call systematic underfunding of health care for Bürgergeld recipients.
At the heart of the dispute: the federal government reimburses health funds only partially for the medical care of welfare recipients, leaving a significant financial gap.
The GKV-Spitzenverband, the umbrella organization for statutory insurers, argues that this gap is being unfairly shifted onto the 75 million insured Germans and their employers, who already face rising contributions.
“A social injustice”
“The federal government seems to be closing its eyes to this social injustice at the expense of contributors and employers,” said Susanne Wagenmann, co-chair of the GKV’s administrative board.
She stressed that insurers have been warning of the imbalance for more than 15 years—yet the current black-red coalition’s contract contains no plan to address the issue.
Her co-chair Uwe Klemens echoed the criticism, accusing politicians of prioritizing short-term political gains over long-term stability in the health system.
“The result is clear: record-high contributions, almost no reserves, and a health fund that is in just as bad shape.”
Kassen see violation of financial autonomy
The lawsuit, filed at the North Rhine-Westphalia State Social Court, challenges the allocation decisions expected this autumn from the Federal Office for Social Security (BAS) for 2026.
The GKV-Spitzenverband claims the current system violates both the financial independence of social insurance providers and the principle of earmarking social contributions strictly for their intended purpose.
Bürgergeld and health care
Bürgergeld, Germany’s reformed basic welfare system for employable people in need, also covers health insurance.
The state has tasked the statutory health insurers with providing care, but according to the GKV, reimbursements fall far short of real costs.
The result, they argue, is that ordinary contributors subsidize state responsibilities.
Growing deficits despite high contributions
The financial strain is already visible. Rising expenditures, especially for medical services and personnel, are colliding with stagnant federal transfers, pushing insurers deeper into deficit.
Although energy-driven inflation has eased, the health sector continues to face climbing costs.
This lawsuit is seen as a landmark case in testing the limits of federal responsibility for welfare-related health care.
A ruling in favor of the insurers could force the government to significantly increase its contributions—or risk even higher health insurance premiums for millions of citizens.
