DKV also pulls out of Muface, leaving Asisa as sole candidate

DKV pulls out of Muface, leaving the government with Asisa as its only lifeline

Can a million and a half people be left without the doctor they have been going to for years? That is the question hanging over the Muface contract after DKV withdrew from the second tender offer, the one that raised by 33.5% what the State pays. Adeslas had already got off the train earlier. Asisa is now the only insurer on the board and has not yet said whether it will take part, though it is scrutinizing the terms. Muface will continue to provide coverage until mid-September, so no one will be left without a health card tomorrow. But the clock is already ticking.

DKV drops out of Muface as Asisa reviews the tender alone

The government played its hand twice, and both times it was left with no takers. In October it approved a 17% increase; before Christmas it almost doubled it, to 33.5%. Neither offer convinced insurers, which had been asking for a minimum 40% increase to sign a three-year agreement, running from 2025 to 2027. Adeslas got off first. DKV has now done the same.

With that panorama, the ball is in Asisa's court. The company has not said no, but it has not said yes either, and one detail explains its doubts: if it goes alone, it will not just take the 500,000 civil servants and family members it would get in a normal split; it would also take on the more than one million left by the other two. Economically, it means moving from one contract to a single-provider operation with the entire mutual scheme inside. And the sector's accounts have been in the red for years.

Some in the debate argue that when a government body does not want to tender something, it commissions a study or lets the process die on its own. The difference is that here what is dying is a system covering 1.5 million people, and the one deciding is a third party whose numbers do not add up.

What happens if the Muface tender is left without bidders?

That Muface will still be obliged to provide coverage until mid-September, a window the government can use to negotiate a new agreement. In that scenario, questions arise over whether the seniority of Muface members and their families will be preserved.

Politically, the government's partners are openly opposed to the system. Sumar and Podemos oppose Muface, and the former discreetly celebrates that the tender may go unawarded: it would fit a core point of their program, which involves ending this public-private partnership and pushing public employees into the general health system. It is not a comfortable position for Hacienda (the finance ministry), which would have to bear the cost of that transfer just when it is failing to unlock its own accounts.

Who pays for Muface and how much it costs to return 1.5 million patients to the public system

The system is sustained by an unusual mix: private clients' premiums contribute 18.5% and the State subsidizes the remaining 80%. That design attracts criticism: its detractors describe it as a privilege not extended to the rest of the population and paid for with everyone's taxes.

The calculation of the transfer has numbers on the table. According to an estimate circulating in the debate, the cost of the failed agreement over the next three years is 1,492 million euros annually. Spread among the one million users who would actually move to the public system — the remaining 30% are already in it — this comes out to about 1,492 euros per person per year, compared with the 2,000 euros that the public health system spends on average on each patient. According to that calculation, the State loses money with the change.

Other participants play down the impact: 1.5 million people spread across Spain are less than 5% of total users, and the blow will be felt above all where there are more civil servants. Madrid, Catalonia and Andalusia would have to reorganize their health budgets, and in the Community of Madrid containment measures are already prepared to absorb incoming Muface members.

Insurers that don't want 70-year-old Muface members

This is the arithmetic the companies don't advertise. A good part of the group is not profitable individually: they are people in their 60s, 70s and 80s with a medical history behind them. According to some Muface members, when they have asked about continuing as private clients outside Muface, the answer they get is always the same: a prior medical questionnaire and custom terms. In practice, for many that amounts to being unable to take out health insurance for the rest of their lives.

There is a second effect that only appears when you scratch the surface. Muface members pay 35% of the price of medicines, a payment that disappears in the public system after retirement. If Muface is wound up, that cost changes hands and amount. With the group's majority age bracket — precisely the segment that consumes the most prescriptions — the adjustment is not exactly small.

Óscar López, Montero and the two-week window

The political knot lies between Hacienda and Función Pública (the public administration ministry). Minister María Jesús Montero has not offered Óscar López any budget alternative to back public employees, according to the version circulating in the dispute. López has a narrow window — around two weeks — to extract from Hacienda a budget that satisfies Asisa, and he is doing so in a context in which the government has failed to unlock the public accounts, with Junts and Podemos pressing from opposite sides.

Montero's silence, Sumar's discreet celebration and the fact that the three insurers have been losing money for years paint a scenario where no one wants to be the one to break the pact. If Asisa says no, the fallout falls on Función Pública. If it says yes, it signs a contract that is loss-making on paper and with a million new Muface members on top.

There remains the option that all this ends in a third agreement signed at the last minute and with the insurers presented as saviors of the system. It would be, however, the first time in this whole mess that anyone comes out ahead with something other than time.