On September 21, 2026, at a press conference on the state elections in Berlin and Mecklenburg-Western Pomerania, Chancellor Friedrich Merz publicly put the relationship between statutory and private health insurance up for discussion. Since then, people have been asking whether private health insurance is about to end. This article explains what Merz actually said, which directions are possible at all in political and legal terms, and what this would mean for existing private health insurance contracts.
What Merz said, in his own words
Merz named a problem of fairness: “If the impression becomes fixed in the population that those who are privately insured get every service immediately, and those who are insured in the statutory system have to wait weeks and months for it, then that is a problem of fairness.” He became specific in a second sentence: “We have agreed that we will apply the rules of statutory health insurance to private health insurance.” This had not been put into practice so far, and “we will now make up for that.”
This agreement is not a new initiative. It is already part of the coalition agreement between CDU/CSU and SPD, as a commitment to transfer statutory rules to private health insurance with the same effect, above all for appointment scheduling and access to services. So Merz announced that he would finally work on a point that had already been agreed, not a new project to abolish private health insurance.
Merz did not call for private health insurance to be abolished at any time. He said that the debate must be held: “There are good reasons for both systems. But if the population sees this as such a massive problem, then we have to change something about it.” That same evening, a spokesperson for the Federal Chancellery made clear that Merz had “not called the system of health insurance into question.” This contradicts his own choice of words and explains why part of the reporting speaks of confusion rather than clarity.
The contrast with Merz’s own position from July 2025 is notable. At that time, on the ARD program “Bericht aus Berlin”, he explicitly rejected citizens’ insurance and said that private health insurance contributes “disproportionately to the stability of the system”. He did not explicitly move away from this view on September 21, 2026. He simply did not repeat it.
Reactions at a glance
The Association of Private Health Insurers reacted sharply. Its director Florian Reuther reminded Merz of his own party program: “Poor election results in the federal states must not be a reason for the Union to throw decades of party positions overboard.” The association also stresses that the problem of waiting times lies in the structure of the statutory system, not in private health insurance.
In circles close to the SPD, the statement is, as expected, read as an opening toward a broader reform. The SPD parliamentary group in NRW titles its reaction “Chancellor Merz opens the door to citizens’ insurance.” The Tagesspiegel describes the statement as a surprising step after the election defeats, which the Federal Chancellery tried to play down that same evening. Merz has not yet presented a concrete reform model.
Four directions now being discussed, and what they would mean for your contract
The public debate currently mixes four reform approaches that go very different distances in political and legal terms. Important for the assessment: the further a direction goes, the higher the constitutional hurdle, and the less likely it is to be put into practice soon.
| Direction | What actually changes | Effect on existing private contracts | Status |
|---|---|---|---|
| Transfer of rules with the same effect | Procedural rules such as appointment scheduling and access management, not the catalog of benefits | No effect on benefits or premium | Announced by Merz on September 21, 2026, already agreed in the coalition agreement |
| Reform of the GOÄ (fee schedule for doctors) | Newly calculated doctors’ fees for private patients, adopted by a clear majority at the German Medical Assembly in May 2025 | Indirect: may influence future premium calculations, changes nothing about ageing reserves already built up | Draft regulation from the ministry in preparation, the German Medical Association and the Association of Private Health Insurers name January 1, 2028 as the target, independent of Merz’s statement of September 21, 2026 |
| Comprehensive private health insurance closed to new customers | Only future customers affected, no access to running contracts | Existing contracts unchanged, no compensation needed, as there is no intervention in existing contracts | Model under political discussion, not announced |
| Full citizens’ insurance with forced integration | Comprehensive private health insurance would cease to exist | Only conceivable with a transfer of the ageing reserves, constitutionally the most disputed route | Not announced, not provided for in any current government document |
Merz’s announcement of September 21, 2026 stays entirely on the first level.
Fewer benefits, money back? The legal logic behind it
The obvious worry: if statutory rules are applied to private health insurance, will benefits fall, and will you get money back for it? Based on everything currently available, the question does not arise in this form.
First, the announced transfer concerns procedural rules, not a catalog of benefits. Appointment scheduling and access management are something different from the contractually agreed benefits of a private plan.
Second, the benefits of existing private health insurance contracts are fixed under civil law. A private health insurance contract is a long-term contractual obligation under the Insurance Contract Act. The legislator cannot cut its benefit promise retroactively and unilaterally without interfering with claims protected by Article 14 of the Basic Law. In legal scholarship, the ageing reserves that policyholders have already built up are seen as a position protected in a way similar to property. A scenario of “fewer benefits, same premium, no compensation” would be the route that is hardest for a legislator to defend in legal terms, and it would contradict the principle of legitimate expectations under Article 20 of the Basic Law.
Third, there is already a precedent that shows how a legislator formally transfers statutory rules to private health insurance without cutting existing contracts: the Basistarif under § 152 of the Insurance Supervision Act. Since 2009, every private insurer must offer a plan whose benefits match the catalog of benefits of statutory health insurance and change automatically when the statutory catalog changes, with a maximum premium capped by law. At its core, this is already a transfer of rules with the same effect, only limited to a single plan that people can choose voluntarily instead of the whole of private health insurance.
If politicians ever actually considered a real cut in benefits in existing contracts, the prevailing view in legal scholarship is that a compensation mechanism would be more likely than a cut without replacement, for example a transfer of reserve values similar to the existing transfer value in a plan change under § 204 VVG. However, constitutional lawyers do not even agree on how far the legislator could go at all. Prof. Dr. Sodan considers compulsory insurance for all citizens unconstitutional, because it would violate the general freedom of action and the occupational freedom of private insurers. Prof. Dr. Bieback, on the other hand, considers a carefully designed transfer of the ageing reserves into an extended public system constitutionally possible. Both expert opinions were written for the Research Services of the Bundestag during the earlier debate on citizens’ insurance, but the underlying constitutional questions are the same.
For privately insured people: reason to worry or not?
As things stand, no. Protection of existing private health insurance contracts is taken for granted in practically every model under serious discussion. A retroactive forced transfer or cut in benefits would be the hardest step to defend constitutionally, and none of the current statements has even proposed it. What is actually on the agenda is the alignment of individual procedural rules agreed in the coalition agreement. This concerns how practices work, not the existence of your contract.
If you are currently thinking about a switch to private health insurance, you should keep following the debate, but not make a hasty decision. There is no concrete law, and no timetable has been given.
Our assessment
The excitement about Merz’s statement says more about the political situation after the state elections than about a concrete reform plan. Whether the alignment of rules agreed in the coalition agreement will happen, and what it will look like in the end, cannot be predicted seriously today. That would be pure speculation. What can be said with confidence: abolishing private health insurance was never up for debate, neither in Merz’s own words nor in what could be enforced legally in the short term. Existing customers are the part of the system that is best protected, and that applies regardless of how the political debate continues.
