Kamala Harris Proposes Big Home Care Benefit For Medicare

Democratic presidential nominee Kamala Harris on Tuesday will propose a major new initiative: expanding Medicare to cover the cost of long-term care at home.

Such a plan could mean the option of staying at home, rather than in a nursing facility, for the millions of seniors and people with disabilities who need help with the daily tasks of life.

It could also mean physical and financial relief ― and new opportunities for school or work outside the home ― for the millions of working-age Americans who today provide so much of that care on their own without much in the way of outside assistance.

If the proposed legislation is enacted, such a program would represent a substantial boost in federal support for caregiving and, by any measure, one of the largest one-time increases in American history.

Harris will make her announcement during an appearance on “The View,” the nation’s top-rated daytime talk show, according to campaign officials who spoke with reporters on Monday.

During that interview, Harris will present the home care initiative as part of her efforts to address the needs of the “sandwich generation,” the working adults who have aging parents while still caring for children. Roughly a quarter of the American population falls into that category, according to Pew Research.

“The significance of access to home care is something that we hear about constantly,” Nicole Jorwic, chief of advocacy and campaigns at Caring Across Generations and a longtime advocate on disability issues, told HuffPost. “It’s an issue for the aging or disabled person themselves. It’s an issue for family caregivers. It’s an issue for the economy.”

Harris will pledge to finance the home care initiative fully, in part by tapping the savings from yet another reform she has proposed: expanding the federal government’s power to negotiate drug prices directly with manufacturers. The federal government acquired that power just two years ago, thanks to Democratic legislation that Harris supported.

The Harris campaign did not provide a detailed breakdown of how the new home care plan would work or what it would cost. But in just the last few weeks, two groups of analysts have published papers sketching out how such a proposal might look.

One of those papers, from the centrist Brookings Institution think tank, estimated new federal costs at about $40 billion a year.

“Home-based care is something almost everyone needs at some point, for themselves or a family member,” Larry Levitt, executive vice president at the nonpartisan health research organization KFF, told HuffPost. “A universal home care benefit through Medicare would have a lot of political appeal. There is, of course, the age-old question in health care about how to pay for it, especially with an aging population.”

Dollars alone don’t capture the scope of the proposal ― or the change it could mean for individual families.

Nearly 20% of seniors require some kind of help with bathing, eating and other daily life functions, according to the available research. The percentage is even higher for older seniors, plus there are non-elderly people who need these services because of disabilities.

But Medicare doesn’t cover this kind of long-term care, except in limited circumstances, nor does private insurance. And few families have the income or savings to pay out of pocket for these supports and services, which over the course of a year can easily generate bills into six figures.

That leaves Medicaid, currently the nation’s single largest payer of long-term services and, for millions of Americans, a true lifesaver. But Medicaid is available only to people with low incomes, which means that families cannot qualify until they have “spent down” whatever savings they have or figured out ways of transferring those savings to relatives. (An entire legal specialty exists purely to guide people through this process.)

And that’s not the only issue with Medicaid.

States manage the program, even though the federal government covers most of the cost, which means eligibility, benefits, management and reimbursement for long-term care vary enormously depending on where people live.

That’s especially true when it comes to home care. Many states cap enrollment, creating long waiting lists for services and forcing people into nursing homes (which Medicaid covers more uniformly) even when they would prefer to remain at home.

The alternative for many families is to provide care on their own, which is nice in some cases and terrible in others and somewhere in between for the rest.

As with child care, responsibility tends to fall disproportionately on women, extracting some combination of physical strain (home care can involve a lot of lifting, for example) and financial hardship (time caring for a relative is time not spent earning money outside the house).

That undoubtedly helps explain why the Harris campaign has decided to roll out this idea on “The View.” All the hosts are women, the audience skews female and conversation on the air blends the political and the personal ― as Harris has long done, especially when it comes to issues related to caregiving.

She has spoken frequently of what it was like taking care of her mother in her last years of life, following a cancer diagnosis, and has a long record of proposing initiatives to help families with the expense of caring for loved ones who need assistance.

That includes two proposals she’s already made in this campaign: one for a $6,000 tax credit for the parents of newborns and one for a program that would cap child care expenses at 7% of household income.

Campaign advisers said Harris planned to mention both on “The View.”

In one sense, the home care proposal represents yet another attempt to pick up on some of the unfinished business from Joe Biden’s presidency.

Democrats had hoped to create what would have been a new home care program as part of the legislation they were calling “Build Back Better” and that eventually became the Inflation Reduction Act, which Congress passed and Biden signed in 2022. But in order to secure the necessary votes, Democratic leaders had to jettison the home care proposal in order to satisfy a handful of legislators who thought it and some related proposals required too much new federal spending.

But the version Harris is putting forward now is different from the old one.

The previous proposal would have essentially taken the existing Medicaid program and made it bigger. Harris envisions Medicare taking on home care for its beneficiaries, which to many analysts and advocates for the elderly seems like an improvement, in part because Medicare is not limited to those in the most dire economic circumstances.

“The care that people need ― the long term-care ― is part of their overall health care needs,” Georgetown public policy professor Judith Feder, a co-author on one of the recently published papers sketching out a proposal, told HuffPost. “Nobody should have to be impoverished because they need health care or long-term care. It needs to be a true guarantee of security, not simply a last resort.”

Whether a home care program was part of Medicaid or Medicare, moving from Harris’ campaign pledge to actual policy would require answering all sorts of complicated questions and confronting all sorts of difficult trade-offs, over not just money but also issues like how to balance support for professional care workers and those who prefer to provide care on their own.

There would also be questions of whether and how to restructure Medicaid’s long-term care supports, how those would integrate with the new Medicare initiative and what that would all mean for the providers of care, who, undoubtedly, would have a thing or two to say about it.

But the potential complications go hand in hand with potential benefits, which include everything from additional savings to Medicare (because some studies suggest home care reduces hospital expenses) to shifting more care out of nursing homes and back to the home setting.

“Relative to other countries, we’re very nursing home focused, and we’re not really doing enough to keep people at home,” MIT economist Jonathan Gruber, a co-author of the Brookings paper, told HuffPost.

“I also just think it’s a valuable benefit to people that makes their lives better,” Gruber added, noting that research has shown home care can help reduce loneliness and improve overall health relative to nursing home care.

Whatever the policy details, there’s good reason to think the voters would welcome such a proposal. One week ago, the left-leaning public opinion firm Data for Progress released a poll on a hypothetical proposal “to expand Medicare to include coverage for long-term in-home care.”

The support was overwhelming, at 88% overall, and the numbers didn’t even vary much among self-identified Democrats, Republicans and independents.

“There isn’t a lot in the world of health policy that does this well with such a broad swath of the electorate,” Matthew Cortland, a senior resident fellow at the firm, told HuffPost.