Armin Grau

Prof. Dr. Armin Grau (born 18 March 1959 in Stuttgart) is a German specialist in neurology and a politician of Alliance 90/The Greens. He has been a member of the Bundestag since 2021, returned on the state list of Rhineland-Palatinate, and stands in the constituency of Ludwigshafen/Frankenthal. The Bundestag lists his occupation as physician (Arzt). He is married with five children and lives in Altrip, a municipality on the Rhine near Ludwigshafen.

Grau attended primary school and then the Wagenburg-Gymnasium in Stuttgart, where he passed the Abitur in 1977 and received a Scheffel Prize. From 1978 to 1983 he studied political science, German literature and history at the Ludwig Maximilian University of Munich, the University of Tübingen and the Free University of Berlin, taking a Magister Artium at the Free University. He studied medicine there in parallel from 1981, received his licence to practise in 1987 and a medical doctorate in 1989. From 1987 to 2003 he worked at the neurology department of Heidelberg University Hospital, including a period as a physician performing civilian service and a 1989–1990 research stay at the University of California, San Diego. He qualified as a neurologist in 1996, completed his habilitation in 1997 on infections as a risk factor for stroke, and has been an adjunct professor (außerplanmäßiger Professor) at Heidelberg University since 2004.

From 2003 until 2022 he was director of the department of neurology at the Klinikum Ludwigshafen, and from 2010 to 2014 he was also the hospital's medical director. His clinical and research work centred on stroke, including infections, inflammation, vaccination and socioeconomic factors. He initiated the statewide telestroke project TEMES in Rhineland-Palatinate in 2016, co-led the innovation-fund project on structured outpatient care after stroke (SANO) from 2018 to 2022, and sat on the board of the German Stroke Society from 2016 to 2021. In 2020 C. H. Beck published his popular book on neurology, Reine Nervensache.

Grau has been a member of the Greens since 1984. Before entering federal parliament he held local offices in Altrip and the Rhein-Pfalz district, including seats on the municipal council and the Verbandsgemeinderat Rheinauen and a period as spokesperson of the district party association. At the 2021 German federal election the Greens' candidate in Ludwigshafen/Frankenthal, then constituency 207, received 17,061 first votes (11.2 percent); Grau, who held fourth place on the state list, entered the 20th Bundestag. In the 20th electoral term the Bundestag biography records him as a member of the health committee and, from 2022, of the environment committee. In November 2024 the Green district associations of Ludwigshafen, Frankenthal and Rhein-Pfalz nominated him again for constituency 206, with 50 of 51 votes, and he said he would seek second place on the state list. At the 2025 German federal election the Green first-vote share in the constituency was 12,367 votes (7.7 percent), fourth behind the CDU, SPD and AfD, and the constituency seat was left vacant for lack of second-vote coverage. Grau returned through the Rhineland-Palatinate list. In the 21st Bundestag he is an ordinary member of the Committee on Labour and Social Affairs and a deputy member of the Committee on Health.

Early life and education

Schooling in Stuttgart

Armin Grau was born on 18 March 1959 in Stuttgart. A January 2018 announcement by Klinikum Ludwigshafen described him as 58, and the Rheinpfalz in April 2024 described him as 65, both consistent with that year. He has written that his grandfathers were a baker and an unskilled worker, and that his father was the first in the family to pass the Abitur. The biography published by the Bundestag records primary school from 1965 to 1968, without naming the school, and then the Wagenburg-Gymnasium in Stuttgart from 1968 to 1977, ending with the Allgemeine Hochschulreife, the general qualification for university. The school is a Gymnasium at Wagenburgstrasse 30.

The Wagenburg-Gymnasium in Stuttgart after its renovation.

That biography also lists him as a Scheffel Prize winner in 1977, the year of the Abitur. The prize, named for the poet Joseph Victor von Scheffel, has been awarded since 1928 by the Literarische Gesellschaft (Literary Society) in Karlsruhe for the best performance in German in the Abitur. It goes each year to pupils at participating Gymnasien in Baden-Württemberg and at further schools in other states, with support from the state's Ministry of Science, Research and the Arts.

Studies in the humanities and medicine

From 1978 to 1983 Grau studied political science, German studies and history in Munich, Tübingen and Berlin, at the Ludwig Maximilian University of Munich, the University of Tübingen and the Free University of Berlin, and took a Magister Artium at the Free University. In 1981, before that degree was finished, he began human medicine at the Free University and continued until 1987, when he passed the state examination. A note he wrote for Abgeordnetenwatch also places the medical course there. In 2024 he told the Rheinpfalz that, in the days after the Chernobyl disaster of 26 April 1986, he was caught in radioactive rain in Berlin while a medical student.

The Free University, founded in West Berlin in December 1948, had its own medical faculty. The Charité then belonged to the Humboldt University of Berlin, in the east of the city, and the Free University's teaching hospital was the Klinikum Steglitz, later the Benjamin Franklin campus. On 1 June 2003, after Grau had qualified, the two medical faculties were merged as Charité – Universitätsmedizin Berlin.

The Bundestag biography dates the Approbation, the licence to practise medicine, to 1987. Under the Federal Medical Practitioners Act (Bundesärzteordnung) of Germany, that licence follows a university course in medicine and the medical examination (ärztliche Prüfung); the Act does not make a dissertation a condition of the licence. In 1989 he received the Dr. med. from the Free University.

Medical career

Heidelberg and research abroad

Grau’s biography on the website of the German Bundestag states that from 1987 to 2003 he worked in the department of neurology at University Hospital Heidelberg. In 1987–88 he was a physician doing civilian service (Zivildienst) rather than military service, and in 1989–90 he held a research stay at the University of California, San Diego on a stipend from Heidelberg University. The same account dates specialist recognition in neurology to 1996 and his habilitation—the postdoctoral qualification to teach in a German medical faculty—to 1997, on infections as a risk factor for stroke. It lists him from 2004 as an außerplanmäßiger Professor, an adjunct professor, at Heidelberg.

When Klinikum Ludwigshafen announced in January 2018 that he had become first chairman of the German Stroke Society, it described the Heidelberg years as ending in the post of senior attending physician (leitender Oberarzt) of the neurology clinic, the job he left for Ludwigshafen.

Klinikum Ludwigshafen

The Klinikum der Stadt Ludwigshafen am Rhein, a nonprofit company in municipal ownership since 1995, is a maximum-care hospital on Bremserstraße. It reports 18 clinics, four medical institutes and 1,010 beds, and is an academic teaching hospital of Johannes Gutenberg University Mainz and of the Medical Faculty Mannheim of Heidelberg University. A municipal hospital has stood on the site since 1892.

The parliamentary biography gives 2003–2022 as his term as director of the neurology clinic. The hospital records that he handed the directorship over in March 2022. The department, as the hospital now describes it, has 79 beds—three general wards, a 15-bed supraregional stroke unit and neurology-run beds on the medical intensive-care unit—and treats about 4,000 inpatients a year. The stroke unit is dated by the hospital to 1998, before Grau arrived, and was certified on 24 August 2010 under the procedure of the German Stroke Society, the German Stroke Aid and LGA InterCert. In 2018 the hospital credited the expansion of its stroke service, and of that unit, to his tenure as director.

From 1 June 2010 he was also Ärztlicher Direktor, medical director of the whole hospital. The supervisory board appointed him on the unanimous proposal of the chief physicians, in agreement with management, to succeed the pathologist Manfred Bohrer, whose term ended on 31 May 2010. The office runs for four years and is filled from among the clinic and institute directors. On 1 June 2014 Grau handed it to Matthias Bauer, director of the institute of laboratory medicine since 2006, and remained head of neurology.

After his election to the Bundestag in September 2021 he left the directorship. Simon Nagel, previously managing senior physician in neurology at Heidelberg, clinically responsible for its stroke unit and deputy head of vascular neurology, took up the Ludwigshafen post on 14 March 2022. The hospital thanked Grau for nearly twenty years as chief physician and for the medical-director term. Günter Layer, then medical director, said that under Grau neurology had become one of three main pillars of the hospital.

Stroke networks and professional bodies

On 1 April 2016 the Telestroke Network Rhineland-Palatinate (TemeS-RLP, also written TEMES) began work, with coordination for the first three years at Klinikum Ludwigshafen. Six supraregional stroke units—Katholisches Klinikum Koblenz-Montabaur, Klinikum Idar-Oberstein, Klinikum Ludwigshafen, Krankenhaus der Barmherzigen Brüder Trier, Universitätsmedizin Mainz and Westpfalz-Klinikum Kaiserslautern—rotate a 24-hour duty. The neurologist on duty joins the emergency department by videoconference, examines the patient with the local physician and receives the computed-tomography images, then advises on intravenous thrombolysis on site or transfer for mechanical thrombectomy. In the Ärzteblatt Rheinland-Pfalz in 2019, Matthias Maschke described the network as initiated by Grau in Ludwigshafen and accompanied and funded by the state. The network’s six-year account says the state largely paid for the build-up and that participating hospitals later financed it by flat contributions.

A first-year report by Frederick Palm, Grau and colleagues counted 1,568 teleconsultations: ischaemic stroke in 51.2 percent, intravenous thrombolysis in 12.5 percent of those patients and transfer for thrombectomy in 4.6 percent. Over six years the network reported more than 13,000 patients, a rise from 1,149 consultations in 2016 to about 2,400 a year, systemic thrombolysis in about 14 percent of ischaemic strokes, and transfer of almost 400 patients (5.5 percent) for a mechanical procedure. It estimated that about one in seven acute strokes in the state was then seen through the network.

The Deutsche Schlaganfall-Gesellschaft, founded in Frankfurt in 2001 to promote stroke research, training and political attention to the disease, lists Grau as first chairman for 2018–2019. The hospital reported that he had sat on the board since 2016 and took the chair on 1 January 2018 for two years, after an autumn election. His biography dates executive-board membership to 2016–2021; the society’s site still lists him as an extraordinary board member and notes his former chief post in Ludwigshafen.

Since 1999, hospital stroke care in the state has been followed by a quality programme administered through SQMed in Mainz, whose specialist committees review results and advise the steering group. The August 2019 Ärzteblatt Rheinland-Pfalz identified Grau as deputy chair of SQMed’s stroke committee, under Martin Eicke of Idar-Oberstein. The parliamentary biography describes membership, at times as chair, of the state’s acute-stroke quality committee until 2021.

From July 2018 to June 2022 the Innovation Fund of the Federal Joint Committee funded, with about 5.8 million euros, SANO (“Structured ambulatory aftercare after stroke”), a cross-sector programme linking general practitioners, a stroke coordinator, a trained stroke nurse and therapists. The fund named Grau, at the Ludwigshafen neurology clinic, as project lead, with consortium partners at Würzburg University Hospital and the Westphalian University of Applied Sciences; his biography calls the role a co-leadership. A 2013 masthead of the American Heart Association journal Stroke listed him, with George Howard, as section editor for population studies. The biography also records fellowships of the American Heart Association (FAHA) and the European Stroke Organisation (FESO).

Stroke research and publications

Risk factors and clinical studies

Grau's research, begun at the neurological clinic of Heidelberg University and continued from Ludwigshafen, examined infection, inflammation and social conditions as contributors to stroke. His 1997 habilitation was on infections as a risk factor for stroke. A 1995 case-control study of 197 patients with acute cerebrovascular ischaemia and 197 matched population controls found infection in the preceding week in 38 patients and 10 controls (odds ratio 4.5, 95% CI 2.1–9.7); the association remained after adjustment for vascular risk factors (odds ratio 4.6), and febrile respiratory infections were the main contributors. A 1998 study of 166 patients and 166 hospital controls again found recent bacterial or viral infection to be a risk factor after age adjustment (odds ratio 2.9, 95% CI 1.31–6.4), although coagulation and inflammatory markers did not differ between infected and uninfected patients.

Later work turned to chronic infection. In 303 patients seen within seven days of ischaemic stroke or transient ischaemic attack, severe periodontitis (mean clinical attachment loss greater than 6 mm) carried a 4.3-fold risk of cerebral ischaemia compared with mild or no periodontitis after adjustment for vascular, socioeconomic and lifestyle factors (95% CI 1.85–10.2); the association was present in men and in people under 60, whereas caries was not associated. In 370 patients with stroke or transient ischaemic attack and 370 population controls, influenza vaccination in the previous campaign was less common among patients (19.2% versus 31.4%) and remained associated with lower odds after adjustment (odds ratio 0.46, 95% CI 0.28–0.77); other recent vaccinations were not, and the authors noted that residual confounding could not be excluded. A 2010 review treated acute, especially respiratory, infection as a short-acting trigger, described single chronic infections as inconsistently associated with stroke, and regarded the aggregate burden of past infection as the more consistent finding.

In the population-based Ludwigshafen Stroke Study, low socioeconomic scores in childhood (odds ratio 1.77, 95% CI 1.20–2.60) and adulthood (1.74, 95% CI 1.16–2.60) remained associated with ischaemic stroke in 470 patients and 809 controls after adjustment for other life stages and risk factors. Upward mobility from the father's occupation to the subject's vocational education was associated with lower risk after further adjustment (odds ratio 0.67, 95% CI 0.45–0.99), whereas a shift into a more disadvantaged tertile between adolescence and adulthood was associated with higher odds (2.93, 95% CI 1.21–7.13). Seropositivity to five microbial agents did not consistently explain the childhood association, and the adult socioeconomic association ceased to be significant once dental-care factors were included.

From 2018 to 2022 Grau co-led the Innovation Fund project on structured ambulatory aftercare (SANO) and was a senior author, with Peter U. Heuschmann, of its main report. In this open-label cluster-randomised trial, 15 of 30 regions used a one-year cross-sector aftercare network and 15 usual care; 1,203 of 1,396 enrolled intervention patients and 1,283 of 1,395 control patients were analysed. The primary composite of recurrent stroke, myocardial infarction or death within 12 months occurred in 64 of 1,203 patients (5.3%) and 80 of 1,283 (6.2%) and was not significantly different (adjusted odds ratio 0.95, 95% CI 0.54–1.67). The consortium evaluation found differences on some secondary targets: among smokers, about half the intervention group and 26% of the control group had stopped within a year (adjusted odds ratio 2.82, 95% CI 1.58–5.04), LDL-cholesterol goals were met by 67% versus 61% (adjusted odds ratio 1.65, 95% CI 1.22–2.22), and statin use was 93% versus 86%, whereas blood pressure below 140/90 mm Hg did not differ (73% versus 70%). All-cause death favoured the intervention before adjustment (hazard ratio 0.41, 95% CI 0.20–0.86) but not after (adjusted hazard ratio 0.59, 95% CI 0.26–1.34). A correction stated that the summary had transposed the death counts, which were 12 (1.0%) of 1,203 intervention patients and 31 (2.4%) of 1,283 control patients; the composite result was unchanged. Serious adverse events were recorded more often under the intervention (266 of 1,151) than under usual care (106 of 1,152). The published interpretation was that vascular events at one year did not differ despite effects on some risk factors.

INSPiRE-TMS, coordinated from the Charité, tested a support programme after non-disabling stroke or transient ischaemic attack; Grau was a co-author. Among 1,030 patients assigned to the programme and 1,042 to conventional care, recruited at seven German hospitals and one Danish centre, stroke, acute coronary syndrome or vascular death occurred in 15.8% and 16.8% after a mean 3.6 years (hazard ratio 0.92, 95% CI 0.75–1.14). At one year more support-group patients met targets for blood pressure (52% versus 42%), LDL cholesterol (62% versus 54%), physical activity (33% versus 19%) and smoking cessation (51% versus 34%).

Teaching and popular science

Since 2004 Grau has held the title of außerplanmäßiger Professor at Heidelberg University. The medical faculty's repository lists him as supervisor of nine dissertation abstracts from 2014 to 2025, on the Ludwigshafen stroke registry, periodontal markers, mortality after stroke and, in 2025, variation in incident ischaemic stroke in relation to air-pollution measurements.

On 16 March 2020 C. H. Beck published Reine Nervensache: Wie das Nervensystem unser Leben bestimmt (ISBN 978-3-406-75092-2), 238 pages with illustrations by Iris Zerger. Using patient narratives, it explains ordinary autonomic reactions and disorders including tension headache, migraine, stroke—in a chapter titled "Wen der Schlag trifft"—epilepsy, multiple sclerosis, dementia and Parkinson's disease. Publisher-reproduced notices in Bild der Wissenschaft, MDR Wissen and the Mannheimer Morgen called it accessible to readers without medical training.

Local politics

Joining the Greens

Grau has written that, during studies in political science, German and history at the Ludwig Maximilian University of Munich, the University of Tübingen and the Free University of Berlin, he was active in university groups of the Young Socialists in the SPD. He states that in 1983 he attached himself to the Greens in Berlin, then the Alternative Liste, seeking answers to environmental destruction and a link between environmental and social policy, and that he entered the party in 1984. The Bundestag biography, based on members’ own information, records membership of Alliance 90/The Greens from 1984 and does not mention the Jusos or 1983.

On 2 June 2008 fifteen people founded a Green branch in a back room of the Gaststätte Rheintal in Altrip. The Bundestag biography calls this a renewed founding and lists Grau as spokesperson until 2020; the Rhineland-Palatinate Greens’ profile ends that role in 2018, while Die Rheinpfalz still described him as Altrip spokesperson in July 2017. His account for the branch’s tenth year cites a motorway-bridge debate, a planned Rhine polder, a new hard-coal unit at Mannheim-Neckarau and transport toward Mannheim that the founders thought inadequate; the first board was Peter Hook, Grau and treasurer Wolfgang Renner.

Offices in Altrip and Rhein-Pfalz

At the election of 7 June 2009, when Altrip stood outside any Verbandsgemeinde, the Greens took 15.8 percent of the weighted vote and four of 24 seats; turnout was 53.5 percent. The CDU won eight seats, the SPD seven, voter groups four and the DVU one. The branch names Toni Krüger as faction chair and Grau as deputy, with Susann Grimm and Simon Kobel. In 2014 the Greens again took four seats, with 18.4 percent, against eight for the SPD, seven for the CDU and five for voter groups. The biography places him on the Altrip council from 2009 to 2019 and as faction spokesperson in 2018–2019.

A Rhineland-Palatinate law of 22 November 2013 formed, on 1 July 2014, a Verbandsgemeinde from Altrip, Neuhofen and the old Verbandsgemeinde Waldsee (Waldsee and Otterstadt). It kept the name Waldsee until 1 January 2016, when the Landtag’s decision for Rheinauen took effect; administration is in Waldsee, and the treasury and municipal utilities are in Altrip, in the Rhein-Pfalz-Kreis on the left bank of the Rhine. In May 2014 the Greens won four of 36 seats on the new council, with 11.3 percent.

Grau was Green spokesperson on the Verbandsgemeinderat Rheinauen from 2019 to 2021. In November 2021, after entering the Bundestag, he resigned, saying meetings in Waldsee could not be combined with Berlin; Peter Aures became faction chair and the Altrip architect Tobias Hook took the seat. The biography also lists him as spokesperson of the Rhein-Pfalz district association from 2015 to 2021, on the extended state executive from 2018 to 2021, and on the speakers’ council of the federal working group on labour, social affairs and health. The state party profile runs the district post and the working-group role to 2022 and calls him speaker of that group, not only a member of its council. Re-elected unanimously with Sara-Jane Potraffke of Lambsheim in Großniedesheim on 29 November 2019, he said he was “actually not the right person” for the post, his health policy being at Land and federal level rather than in the district.

In July 2017 he joined Christian von Staden, state chair of the Allgemeiner Deutscher Fahrrad-Club, on a ride through Altrip to map hazards for children cycling to school in Mannheim via the ferry, notably the Rheinstraße and a path on Rheingönheimer Straße that ends at a 50 km/h stretch.

The Struktur- und Genehmigungsdirektion Süd is seeking approval for a retention basin on the districts of Waldsee, Altrip and Neuhofen; a public hearing was held in November 2024, and the anonymised record was published in July 2025. Die Rheinpfalz described about 327 hectares south of Altrip, to be flooded in an extreme Rhine event for cities including Speyer, Mannheim and Worms, and reported local opposition. SWR reported about 300 objections. Grau said in April 2024 that the polder dispute had kept him on local flood policy for more than fifteen years. He lists membership of the Bürgerinitiative Hochwasser- und Naturschutz, an Altrip group that in 2023 renamed itself for the Verbandsgemeinde Rheinauen.

In April 2024, in an exchange that also involved SPD parliamentarian Christian Schreider and CDU district chair Torbjörn Kartes, he addressed legacy debt in municipalities such as Ludwigshafen: a federal offer to cover at most half if the Land took the rest, which he said Rhineland-Palatinate had already taken up, provided a constitutional change stopped the debt being rebuilt. The biography also lists the Marburger Bund, the union IG BCE, BUND and the transport club VCD.

Bundestag elections

2021 election

Armin Grau, a physician from Altrip, was the direct candidate of Alliance 90/The Greens in constituency 207, Ludwigshafen/Frankenthal, at the Bundestag election of 26 September 2021. In May a joint meeting of the Green associations of Ludwigshafen, Frankenthal and the Rhein-Pfalz district nominated him; on the digital ballot he received 53 votes to two for Immanuel Pustlauck of Frankenthal, with a postal ballot still required to confirm the result. On 30 July the constituency election committee admitted 13 candidates, among them Torbjörn Kartes of the Christian Democratic Union (CDU), Christian Schreider of the Social Democratic Party (SPD), Stefan Scheil of the Alternative for Germany (AfD), Michael Goldschmidt of the Free Democratic Party (FDP), Grau for the Greens, Liborio Ciccarello of Die Linke and Hans Arndt of the Free Voters.

The same month a state delegate assembly placed Grau fourth on the Green list in Rhineland-Palatinate, behind Tabea Rößner, Tobias Lindner and Corinna Rüffer. That ranking still had to be confirmed by postal vote. He held fourth place at the election.

Of 210,969 eligible voters, 154,911 cast ballots, a turnout of 73.4 percent, and 152,789 first votes were valid. Schreider won the constituency seat with 50,108 votes (32.8 percent). Kartes, who had held the seat, received 38,193 (25.0 percent). Scheil took 17,740 (11.6 percent). The Green total, cast for Grau, was 17,061 (11.2 percent), ahead of Goldschmidt with 13,688 (9.0 percent), Arndt with 7,411 (4.9 percent) and Ciccarello with 4,648 (3.0 percent). On second votes the Greens received 18,128 (11.8 percent), behind the SPD on 45,895 (29.9 percent), the CDU on 33,726 (22.0 percent) and the FDP on 18,421 (12.0 percent), and level in share with the AfD on 18,075 (11.8 percent). Grau did not win the constituency. He entered the Bundestag through the Rhineland-Palatinate Green list and has been a member since 2021.

2025 election

The election of the 21st Bundestag was set for 23 February 2025 by an order of the Federal President of 27 December 2024, which revoked the order of 23 August 2024. The constituency kept the name Ludwigshafen/Frankenthal but was renumbered 206.

Map of the Rhineland-Palatinate Bundestag constituencies, including Ludwigshafen/Frankenthal, published by the state returning officer.

At a meeting on 30 October 2024 the Green associations in Ludwigshafen, Frankenthal and the Rhein-Pfalz district nominated Grau again for constituency 206, by 50 votes to none with one abstention. He said he would seek second place on the state list. The federal returning officer later recorded his election at list place 2.

It was the first Bundestag election under the 2023 electoral reform. A party candidate now gains a constituency seat only with the most first votes and with second-vote coverage (Zweitstimmendeckung): in each state, that party's constituency winners are ranked by first-vote share and seats are filled in that order, so further constituencies stay empty. Second votes allocate the 630 seats. Overhang and compensatory seats were abolished. The previous Bundestag had reached 736 members; the statutory size is 630, while the number of constituencies remains 299.

Turnout in constituency 206 was 79.2 percent: 163,099 of 205,998 eligible voters, with 161,031 valid first votes. Sertac Bilgin (CDU) led with 43,627 votes (27.1 percent), ahead of Schreider with 42,213 (26.2 percent) and Scheil with 37,117 (23.0 percent). Grau received 12,367 (7.7 percent). Jonas Leibig (Die Linke) took 7,794 (4.8 percent), Eric von Nagel (FDP) 5,737 (3.6 percent), Jan Alexander Mohammad of the Bündnis Sahra Wagenknecht 5,445 (3.4 percent) and Hans Arndt (Free Voters) 4,621 (2.9 percent). On second votes the CDU led with 44,479 (27.5 percent), followed by the AfD with 37,871 (23.4 percent), the SPD with 31,398 (19.4 percent) and the Greens with 14,379 (8.9 percent).

The official result left the constituency vacant for insufficient second-vote coverage. In Rhineland-Palatinate the CDU first-vote winners in Trier (Dominik Sienkiewicz, 30.8 percent), Mainz (Ursula Groden-Kranich, 27.3 percent) and Ludwigshafen/Frankenthal (Bilgin, 27.1 percent) did not receive constituency seats. Grau did not win the first-vote count. He returned through list place 2 of the Rhineland-Palatinate Greens; the Bundestag records that election via the state list together with his constituency candidacy in 206. On the state list the Greens also seated Misbah Khan (place 1), Corinna Rüffer (place 3) and Julian Joswig (place 4).

Twentieth Bundestag

Health committee

In the 20th electoral term of the Bundestag (2021–2025), Armin Grau was a full member of the Health Committee for Alliance 90/The Greens. He sat for the Ludwigshafen/Frankenthal constituency on the Rhineland-Palatinate list. Abgeordnetenwatch lists him as the Greens’ Obmann on that committee for the term. The Rheinpfalz reported in March 2024 that he was taking the post for six months, and with it the deputy health spokesperson’s role, while Saskia Weishaupt was on maternity leave. On his Abgeordnetenwatch profile he described his brief as hospitals and outpatient care.

The main hospital bill of the traffic-light coalition was the Hospital Care Improvement Act (Krankenhausversorgungsverbesserungsgesetz, KHVVG), from the ministry of Karl Lauterbach. The Federal Ministry of Health described it as moving hospitals off payment almost entirely by diagnosis-related group case fees toward a standby payment for sites the states assigned to service groups, if they met uniform rules on staff, equipment and related specialties. There were to be 65 groups at first. State planning would remain, with exceptions and higher supplements for rural hospitals needed for access, and cross-sector “Level 1i” sites mixing local inpatient, outpatient and nursing care. A transformation fund of up to €50 billion over ten years would pay for restructuring; states could assign groups until the end of 2026, with payment shifting in 2027–28 and the change finished in 2029.

The plenary referred the bill on 27 June 2024. The committee report of 16 October 2024 (paper 20/13407) names Grau as a rapporteur with Christos Pantazis of the Social Democratic Party of Germany, Stephan Pilsinger of the CDU/CSU, Andrew Ullmann of the Free Democratic Party and opposition rapporteurs. Deutsches Ärzteblatt called him the Greens’ hospital-policy rapporteur.

In the second and third reading on 17 October 2024 he said case-only payment had rewarded volume and lucrative procedures, and that earlier governments had left a financial, staffing and conceptual crisis. He called service groups on the North Rhine-Westphalia model, plus a standby budget, a paradigm shift: 60 per cent of revenue would be paid that way and would not follow case numbers so long as patient numbers stayed within 20 per cent. Cross-sector sites, on flat daily rates rather than case fees, were his answer for basic and, where admission was open, specialist outpatient care in rural areas; “safeguarding hospitals” would keep exceptions, higher supplements and a base grant. He cited committee changes—faster standby payments, a private-insurance share, midwife-led delivery rooms, and no penalty when paediatric wards discharged children earlier—and said the bill put sustainability into hospital finance, with 5 to 6 per cent of climate-damaging emissions coming from health care. He called the reform “a huge step forward” and asked the Bundesrat not to block it.

CDU/CSU spokesman Tino Sorge said an impact analysis had been withheld and that standby pay still tracked past volumes. Janosch Dahmen said the coalition had tabled more than 50 amendments. Grau answered that the states would set the effects by assigning service groups and planned cases, and that a simulation had waited on the transparency law, which the Bundesrat had delayed. The roll-call passed the bill by 373 votes to 285, with one abstention; Grau voted yes. The Bundesrat cleared it on 22 November 2024.

Environment and other assignments

Grau began the term as a substitute on the Committee on the Environment, Nature Conservation, Nuclear Safety and Consumer Protection. In September 2022 the Rheinpfalz reported that he had become a full member in place of Stefan Wenzel, who had been appointed a state secretary in the Federal Ministry for Economic Affairs and Climate Action. He said his subjects would be chemicals and mining law, tying environment to health and social justice, and pointed to earlier local work on water and floods. In April 2024, after Jan-Niclas Gesenhues became a parliamentary state secretary, Grau said he had also become rapporteur for water: drinking water, municipal supply and wastewater, the National Water Strategy and flood protection, including the planned polder at Altrip.

A May 2023 taz interview presented him as the Greens’ rapporteur for chemicals and health policy. He said per- and polyfluoroalkyl substances (PFAS) could not be wholly avoided, cited harm to hormones, fertility, the thyroid and cancer risk, and called regulation overdue. On 18 January 2024, debating a CDU/CSU motion to keep PFAS where they supported production, he said single-substance bans had been replaced by substitutes of unknown risk.

During the 2022 gas shortage he rejected CDU and CSU calls to reconsider fracking. He told the Rheinpfalz that new wells would take years to affect supply, and that fracturing shale, clay, marl or coal seams stayed banned because the pressurised mix of water, chemicals and sand could threaten groundwater and cause earthquakes.

The archived biography also lists him as a deputy on the Committee for Labour and Social Affairs and on the Subcommittee on Global Health. It also records outside pay: he remained chief physician at Klinikum der Stadt Ludwigshafen am Rhein gGmbH until March 2022, at €4,322.55 gross a month, plus €3,270.91 gross for 2021, €6,838.00 for 2022 and a 2023 back payment of €2,338.06 for 2022.

Twenty-first Bundestag

Labour and social affairs

At the 2025 German federal election on 23 February, Alliance 90/The Greens took 11.6 percent of second votes and 85 of 630 seats in the 21st Bundestag, 33 fewer than in 2021. Grau again stood in constituency 206, Ludwigshafen/Frankenthal. The Green ticket received 12,367 first votes (7.7 percent) and 14,379 second votes (8.9 percent); the seat was left unfilled for lack of second-vote coverage, and the Bundestag lists him as returned on the Rhineland-Palatinate state list. The state party gives that list place as number two. The new Bundestag met on 25 March 2025. Olaf Scholz’s term then ended and he continued only as caretaker chancellor until 6 May, when Friedrich Merz was elected on a second ballot, with 325 of 618 votes, on a joint nomination of the CDU/CSU and the Social Democratic Party of Germany, which held 208 and 120 seats. The Greens, a partner in the outgoing traffic-light coalition, sat in opposition.

From the opening of the term the Bundestag biography records Grau as an ordinary member of the Committee on Labour and Social Affairs. The committee was constituted on 21 May 2025 with 42 full members, six of them Greens: Timon Dzienus, Grau, Ricarda Lang, Lisa Paus, Sylvia Rietenberg and Corinna Rüffer. The Green parliamentary group lists him as its spokesperson for labour and social affairs. Die Rheinpfalz reported on 8 July 2025 that the group had elected him the previous Monday to lead its working group on labour and social affairs and to be spokesperson for labour and social policy, quoting a Green statement in his name in favour of a poverty-proof minimum wage, more collective agreements, citizen’s benefit with training, and a “guarantee pension” with the pension level kept above 48 percent. The Rhineland-Palatinate Greens say their Bundestag state group has four members — Misbah Khan, Grau, Rüffer and Julian Joswig — and that Grau has been its deputy chair since 2025, with Khan as chair.

On 5 December 2025 he spoke on the government’s bill to stabilise the pension level and to equalise child-raising periods (printed paper 21/1929). He called a guarantee only until 2031 too short, asked for a permanent stabilisation, and said average pensions were already about €1,150, and about €200 lower for women. The bill passed. The plenary protocol’s final tally is 318 yes, 224 no and 53 abstentions; the published roll call gives 318 yes, 225 no and 53 abstentions, with 34 members not voting, and records Grau’s vote as no. That account says the result reached the chancellor’s majority of 316. On 12 November 2025 he asked an oral question about dropping mandatory safety officers in firms with up to 50 employees, citing accident figures that almost 40 percent of reportable accidents fall in that size class. He is the first signatory of the Green motion “Work longer in good health and improve the reduced-earning-capacity pension” (21/3844), which links longer working lives to prevention and rehabilitation and calls for bringing otherwise uninsured self-employed people, members of parliament and newly appointed civil servants into statutory pension insurance.

Deputy assignments

The biography, whose structured data were last modified on 29 September 2026, lists only one deputy seat: the Committee on Health, from 25 March 2025. On 7 May 2025 Die Rheinpfalz reported that his Berlin office had said he would also be a deputy on the Committee on the Environment, Climate Action, Nature Conservation and Nuclear Safety, and quoted him as wanting to continue on hospital policy. Minutes show that seat only briefly. The lists for 24 June and 2 July 2025 name him among the Green deputies. On 8 July 2025 the chair recorded that he was leaving as a deputy and that Julia Verlinden was entering in his place; that sitting’s list names Verlinden, not Grau. The member page omits any environment seat. The state party’s Bundestag page still calls him a deputy on a committee titled “Environment, Nature Conservation, Nuclear Safety and Consumer Protection”, the previous term’s name, so the party page and the parliament’s record disagree.

As health deputy he led criticism of the Hospital Reform Adjustment Act (21/2512). In the first reading on 12 November 2025 he called hospital policy a zigzag: €4 billion in “immediate transformation funds”, then €1.8 billion withdrawn by deleting a most-favoured-treatment clause. He said the previous term’s reform — standby budgets rather than pure case-based payment, concentration of specialised care, and reachable basic care, including in rural areas — was being delayed and diluted by dropping uniform accessibility rules, removing the infectiology service group and loosening minimum volumes for cancer surgery. On 6 March 2026 the Bundestag passed the bill, as amended in committee, with the coalition in favour and the opposition against. Grau said the changes did considerable damage, postponed the standby payment and turned quality rules into what he called a leaky Swiss cheese. A Green motion on the same print, 21/4535, failed, with the Greens in favour, the CDU/CSU, SPD and AfD against and the Left abstaining. The recommendation to reject the Green motion on children’s health (21/2721) passed with the CDU/CSU, SPD and AfD against the Greens.

Policy positions and public debate

Health system and hospitals

As a health-committee member for Alliance 90/The Greens, Grau worked on the Hospital Care Improvement Act, passed by the Bundestag on 17 October 2024 and the Bundesrat on 22 November 2024. Under Karl Lauterbach, the Federal Ministry of Health said a retention payment would fund much of the cost of needed hospitals largely independent of cases, but only for state-assigned service groups meeting national quality rules. After the Bundesrat confirmed the next coalition’s adjustment act in March 2026, Grau said the reform was being “finally slowed down.” He accused Nina Warken of yielding to the states on a six-year exception for assigning service groups without full quality criteria and on weaker concentration of cancer surgery. In the October 2025 cabinet text Warken called the original law impractical and said more time for the states kept its aims; SPD spokesperson Christos Pantazis said delaying retention payments avoided dilution. Bavaria wanted longer exceptions, Baden-Württemberg’s Green minister Manne Lucha said planning rights were still too tight, and Hesse said rural care was not secured.

In June 2026 he told taz that doctor staffing still varied sharply, that more doctors on the books were not more full-time posts. A KPMG test found the Medical Association’s staffing tool not ready for compulsory use; Grau called the study weak and said ministers would neither share the data nor design a replacement. In October 2026 the government refused any named system, citing less bureaucracy and a general duty in §137k of Social Code Book V; the Medical Association said that would not protect quality.

He has called higher co-payments—a few euros per surgery visit, or hospital charges raised from ten to twenty euros a day—“always socially unjust,” and said their advocates often blocked reform while premiums bought what he termed mediocre benefits. A coalition draft reported by taz would raise drug co-payments, cut dentures and narrow free spouse cover, and levy sugary drinks from 2028 for about €450 million a year. In June 2026 Grau co-sponsored a Green motion for a tiered manufacturer levy along a unanimous finance-commission line, cited as about €450 million a year and €20–170 million in later health-insurance savings. Through Janosch Dahmen the group said contributors and employers would bear about 40 percent of the adjustment, against 21 percent on the commission’s numbers, and claimed tax funding of non-insurance tasks and higher levies on spirits, tobacco and nicotine could cut contributions two points from 2027. He asked the government to look at statutory benefits, including bone-density scans and coronary CT, sold as individual services. State secretary Tino Sorge saw no proof of widespread abuse but said supervisors would be consulted; Grau thought the cases isolated, yet worth clarifying.

Pensions, wages and social security

Grau, the Greens’ labour spokesperson, has opposed cutting the pension level after the 2031 end of the coalition safeguard. In November 2025 he backed Chancellor Friedrich Merz against the Young Union: an abrupt cut would deepen old-age poverty, German pensions were “by no means high,” and they should follow wages. In June 2026 he rejected Johannes Winkel’s smaller rise, proposed to fund student grants and parental allowance. Average pensions of about €1,150 were not enough, a lower replacement rate had left them behind wages, and tax gaps on large inheritances and cryptocurrencies should finance both pensions and those benefits.

His January 2026 motion, first read on 24 April, said statutory pensions could absorb demography without steep contributions through women’s employment, jobs for disabled people, immigration into shortage occupations, and cover for uninsured self-employed people, parliamentarians and new civil servants. It favoured voluntary longer work, not a higher retirement age, rejected an “active pension” tax break, and put prevention and rehabilitation ahead of pension. The abatement-free “pension at 63” should end in its present form, with some of the saving used to reduce disability-pension deductions; an “overload-protection pension” would cover people who could not work but failed the disability test, a gap also noted, the motion said, by the commission on a reliable generational contract. Almost half of disability claims were refused. In May 2026 he called government social policy “more than meagre,” said basic income support overused sanctions, wanted the minimum wage at €15, about 60 percent of median pay, and objected to fewer safety delegates.

For a guarantee pension after 30 insurance years, set above basic security, he cited social-assistance spending of €20.2 billion in 2024, up 14.8 percent, more than half of it old-age and disability basic security. He rejected an Institute of the German Economy description of pensions as a “cost driver,” and said parliamentarians and new civil servants should share the cost.

Environment and regional issues

In May 2024 Grau, then flood rapporteur, called for a federal flood law that term, with common monitoring and federal help for towns. The Rhine dyke near Altrip, where he lives, still needed strengthening. In May 2023 he told taz that PFAS should face a European group restriction, with long transitions only where no substitute existed. Against FDP fears for industry he said delay would harm health and, later, the economy. He wanted BASF’s Ludwigshafen jobs—he put them at 35,000—kept only with “trustworthy” chemicals, and said a local hotspot required groundwater protection without a broad cleanup technology yet.

In April 2024, on the anniversary of Chernobyl, he called the exit from nuclear power right: dangerous even in routine use, he said, citing higher childhood leukaemia near German plants, while renewables had kept supply secure near the former Biblis and Philippsburg sites. For Frankenthal’s hospital he told Rheinpfalz in September 2026 that a regional-clinic role depended partly on ambulance times and that Rhineland-Palatinate must account for it. In March 2025 he backed Ludwigshafen treasurer Andreas Schwarz (SPD) on federal help with legacy debt, saying a constitutional draft had lain in the finance ministry since early 2025 because Christian Lindner and the CDU/CSU had shown no interest, and that tax revenue should then shift toward the municipalities.