Winter Came, but Health Reform Didn’t:

Abstract Germany’s “traffic light” coalition (2021–2025) announced ambitious health policy reforms but produced a mixed record of incremental adjustments and stalled initiatives. We ask why some projects advanced while others failed during times of severe problem pressure. Drawing on actor-centered institutionalism (ACI), we analyze how problem types and actor constellations interacted across three central subfields of German health policy: statutory health insurance, digitalization, and hospital policy. Using interpretive process tracing based on publicly available parliamentary documents, we reconstruct decision-making processes and veto interactions on selected reform initiatives. Policy outcomes are conceptualized as legislative formulation, that is, the formal adoption of reform bills rather than implementation effects. The article refines ACI by linking coordination and distribution problems to crisis-driven reform attempts and differentiated veto capacities in a fragmented institutional setting. We develop three hypotheses on joint versus separated bargaining, actor constellation, and compensation or exclusion of veto players. Our analysis suggests that the success of reform does not depend primarily on the urgency of the problem but rather on the interplay between the nature of the problem, the constellation of actors, and coordination that is either facilitated or blocked by institutional factors. Practically, the findings offer diagnostic value for policy advisors and strategic actors seeking to anticipate reform outcomes in complex policy systems.