But the resistance is great: the CSU is mobilizing against the project, even in the SPD there are doubts.
All 16 federal states have spoken out against the opening of the AOK, they fear for their influence in health care. Now Bavaria's Prime Minister Markus Söder could finally bury the project of Spahn.
According to Handelsblatt information Söder intervened on 10 April with a letter to Chancellor Angela Merkel (CDU). "The planned nationwide expansion of all previously state direct health insurance companies and the curtailment of country skills can not be supported," wrote the CSU chief.
The displeasure in the Bavarian State Chancellery was so great that Söder in a first draft of the letter explicitly asked the Chancellor not to pursue the plans of the Minister of Health "in the Federal Cabinet". The letter dated April 1 was then weakened so as not to push the conflict with Spahn to the extreme.
Bavaria knows in his protest the other 15 states at his side. The Health Ministers' Conference passed a unanimous decision in the circulation procedure in which the "replacement without deletion" of the regulation for the nationwide opening of all health insurance funds is required. In the Federal Government there are "tendencies and activities", the possibilities of the countries in the regional supply "inappropriately limited".
The Federal Ministry of Health is of the opinion that Spahn's law does not have to be ratified by the Federal Council. This assessment is controversial. The legal experts of the AOK Federal Association come to the conclusion that the organizational changes are very well subject to approval.
CSU has the means to pressure Berlin
But even if the influence over the Federal Council fell away: The state ministers are making independent of the political couleur pressure on their federal parties in the capital. And Bayern has the most effective lever with the CSU.
"The nationwide opening of the AOKs will not come, that is beyond dispute," said the Deputy Group Chairman of the Union in the Bundestag, Georg Nüsslein, the Handelsblatt. The CSU politician makes it clear: "In the coalition, the SPD and the CSU are against it. The CDU vacillates between solidarity with the minister and rejection. But if two coalition partners agree that something should not come, that will not happen. "
For the SPD, parliamentary group vice-president Karl Lauterbach expresses reservations about the opening of regionally limited funds. "We will not do it that way," he said, quoting from the German Press Agency. It does not make sense to have only one nationwide POS system. More regional competition and regional supply would be needed. "Anyone who wants to opt for a nationwide health insurance fund can now do this anytime."
In Germany there are more than 100 public health insurance companies. Nationwide, for example, are the large Ersatzkassen TK, Barmer and DAK. Many smaller company health insurance funds and guild health insurance funds are also open for the entire federal territory. The eleven general local health insurance funds (AOK), on the other hand, only cover certain areas that are almost equivalent to the federal states.
Spahn plans to allow insured persons from Hamburg, for example, to join the AOK Saxony-Anhalt in the future. With full freedom of choice, the Minister of Health wants to strengthen the competition between the health insurance companies. His criticism: Some funds are so far because of favorable regional conditions in a position to offer a below average additional contribution, but not all insured can benefit.
The planned cash opening is embedded in a far-reaching restructuring of the financial equalization in the statutory health insurance.
The redistributive mechanism for health insurance contributions paid by employees and employers has led to a systemic imbalance in recent years: while the AOK camp in particular has been allocated more money than needed to cover expenditure and has accumulated large reserves, other funds are complaining of a chronic funding gap.
The demolition of regional walls is one of Spahn's proposals to make the financial equalization more accurate. The nationwide opening of all funds would also have a uniform legal supervision by the Federal Insurance Office (BVA) result. The large nationwide coffers complain that the regional local health insurance funds are being examined by the previously responsible supervisory authorities in the federal states too benevolent and thus have a competitive advantage.
The power struggle for Spahn's law is about billions for the health insurance and for the federal states for their influence on health care. The line between the state governments and the local health insurance funds operating in their area is short. "Strong, regionally rooted health insurance funds" like the AOK Bayern "are indispensable for a really fair health care", Söder writes to the Chancellor.
In Bavaria it is feared that a forced opening could lead to mergers up to a unitary cash on federal level. In this score also beats the AOK-Bundesverband. "Good and tailor-made supply contracts arise above all where local knowledge, high market share and regional commitment are available," said association leader Martin Litsch.
The replacement, company and guild health insurance companies rejected the AOK argumentation in a joint statement as "dubious and business-damaging insinuation". Nationwide funds would also provide on-site care in "close cooperation with doctors, hospitals and many other healthcare partners".
Where AOK and the federal states see advantages for the insured due to their familiar relationship, the ticket competition suspects felt and muffle.
Spahn's ministry is narrow lip in the dispute over the opening clause. "We welcome that our reform is so widely discussed," said a spokesman. Proposals were welcome from everyone involved on how to make cash-desk voting and fiscal equality fairer.
Spahn is reported to have asked the state health ministers to provide him with alternatives by mid-May. With a simple no, it seems, the ambitious Minister does not want to resign himself.
Health circles also speculate that Spahn has written the controversial passage as a bargaining chip into the law. Hardly anyone believes that the nationwide opening of all funds is coming. A representative of the Grand Coalition says: "The only question is whether this already flies out in the Cabinet draft or will be cleared later in the parliamentary process of the factions in the Bundestag."
(t) health insurance (t) health insurance (t) statutory (t) social security (t) health care (t) CSU (t) SPD. (tagsToTranslate) Spahn (t) Söder (t) health insurance reform (t) ministers (t); (t) CDU (t) Barmer (t) DAK (t) Federal Insurance Agency BVA (t) Federal Ministry of Health (t) AOK (t) AOK Saxony-Anhalt (t) Technician Health insurance (t) AOK Bavaria (t) Jens Spahn (t) Markus Söder