Vice President Kamala Harris has put forward a proposal to expand Medicare coverage, focusing on home health care, vision, and hearing services. Speaking on ABC’s The View on Tuesday, Harris discussed the challenges faced by the “sandwich generation,” adults juggling care for aging parents while raising children. Harris emphasized that the plan would help families balance these dual responsibilities, providing elderly individuals with dignity and independence.
Reflecting on her own experience caring for her mother, Shyamala Gopalan Harris, who died of cancer in 2009, Harris said, “It’s about dignity for that individual. It’s about independence for that individual.”
The proposal targets a major gap in Medicare coverage—home health services for longer-term care. Currently, Medicare only provides limited home care after acute medical events, such as strokes, for short durations. Millions of Americans who require extended home care must rely on Medicaid, which forces individuals to deplete their savings to qualify and often leaves them on lengthy waiting lists. According to David Grabowski, a health policy expert at Harvard, Medicaid covers home care for elderly and disabled Americans but faces severe limitations due to worker shortages and long waits.
The Harris campaign aims to fund this expansion through savings from Medicare drug price negotiations, which could reduce government spending on prescriptions for older adults. However, the total cost of the proposed benefits remains unclear. Grabowski notes that while the plan could transform care for many, “There will be a lot of sticker shock once this is costed out.”
In addition to home care, the proposal includes expanding Medicare to cover vision and hearing services—benefits frequently sought by older Americans but not currently included in Medicare. While some private Medicare Advantage plans offer these services, they are not available to all beneficiaries. Congress has previously rejected similar proposals.
Harris’s plan faces potential opposition in Congress, as similar efforts by the Biden administration were dropped from previous domestic policy bills during negotiations. The Biden administration’s plan, which would have cost $150 billion over a decade, was more modest, aiming to reduce Medicaid home care waiting lists. Harris’s broader proposal would extend coverage beyond Medicaid enrollees, providing care to a wider segment of the population.
Funding remains a significant hurdle for Harris’s proposal. The campaign suggests that the program would be financed through prescription drug negotiations under Medicare and new taxes on companies outsourcing jobs. However, expanding home care services under Medicare may come with additional costs to families, potentially using a sliding payment scale based on income.
A Brookings Institution study highlighted options for implementing a Medicare home-care benefit, estimating costs around $40 billion annually for a limited program. A more extensive initiative, like the one Harris proposes, would likely far exceed that estimate. The report also considered contributions from wealthier families and limits on paying family members for caregiving.
Mark J. Warshawsky, a senior fellow at the American Enterprise Institute, expressed concerns over the potential costs. He argued that Medicare, as a universal benefit, may not be the best vehicle for providing home care. “Many people can afford the care they need with the assets and income they already have,” Warshawsky said, calling the plan poorly targeted.
Efforts to expand long-term care coverage have struggled in the past. Democrats attempted to introduce a home care insurance plan under the Affordable Care Act, but it was deemed financially unfeasible. More recently, the Biden administration’s proposal to improve home care was removed from what became the Inflation Reduction Act.
Despite these challenges, the Harris campaign continues to advocate for expanded Medicare services, promoting it as a solution to relieve the financial and emotional burdens on families caring for aging relatives. Whether it can overcome the significant financial and political barriers remains to be seen.
Expanding home health care under Medicare is a popular idea among both parties. Former President Donald Trump’s 2024 campaign platform also includes provisions for at-home senior care, with promises to support unpaid family caregivers and address workforce shortages.
While expanding access to home care is appealing, the implementation may require a substantial increase in the workforce. “We cannot overstate that without staff, there is no care,” said Katie Smith Sloan, CEO of LeadingAge, an organization that supports aging individuals.
Judith Feder, a professor at Georgetown University, supports the move, arguing that it would relieve the burdens on families, both financial and physical. “This is what we need in national leadership,” she said, noting that long-term care has been neglected for too long.
Harris’s proposal, if successful, could represent a major shift in the U.S. approach to elder care, but only if it can navigate the political and financial challenges ahead.
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