Vice President Kamala Harris outlined a new proposal for home health care on “The View” on Tuesday, describing a Medicare expansion plan that she said would help what is called the “sandwich generation” to take care of aging parents.
That constituency includes many adults who find themselves straddling the responsibility of rearing their children at the same time that their parents need more assistance to stay at home.
“There are so many people who are right in the middle,” said Ms. Harris on the ABC talk show.
She recalled caring for her mother, Shyamala Gopalan Harris, before she died of cancer in 2009. “It’s about dignity for that individual. It’s about independence for that individual,” she said.
Home health services that last more than a few months represent “the biggest gap in Medicare,” said David Grabowski, a health policy professor at Harvard who studies long-term care. Medicaid, the federal-state program for the poor, covers home care for elderly and disabled Americans who need it, but people are forced to spend all their savings to qualify and often face long waiting periods.
The Harris campaign said that the plan would be paid for with savings from the expansion of Medicare price negotiations with drug manufacturers, which is expected to lower government spending for older people’s prescriptions. But it is not clear how much the additional benefits under the Harris plan would cost.
“This would be transformative from a care perspective,” Mr. Grabowski said, but he added that the price could be very high. “There will be a lot of sticker shock once this is costed out.”
In a fact sheet published on Tuesday, the Harris campaign also endorsed expanding Medicare to cover vision and hearing benefits — proposals that have been floated before but rejected by Congress. Medicare, the federal insurance program for older Americans, does not cover such services, which many older people use. Some private Medicare Advantage plans offer it as an optional benefit.
Former President Donald J. Trump’s campaign said he previously supported the idea of covering home care in the Republican Party’s 2024 platform, where it appears in a sentence about “care at home for the elderly.”
“President Trump will take care of our seniors by shifting resources back to at-home senior care, overturning disincentives that lead to care-worker shortages, and supporting unpaid family caregivers through tax credits and reduced red tape,” said Karoline Leavitt, a campaign spokeswoman, in an email.
Millions of Americans struggle to find affordable home care for themselves or their loved ones as they age. Medicare does not cover longer periods of home care, typically paying for a home aide only when a patient is recovering from an acute medical condition, like a stroke, and only for a short time, often just a few months.
While Medicaid will pay for a home aide if someone has a low income and limited assets, there are long waiting lists. In many areas of the country, there is a severe shortage of workers because of low wages and better, less stressful jobs in other industries. Home health aides assist patients with basic daily tasks like dressing, eating and using the bathroom.
Most people have no choice but to rely on a family member to care for them because they cannot afford the cost of professional aides, which can surpass the expense of an assisted-living center. Agencies can charge some $30 an hour, according to Genworth, an insurance company for long-term care. Others end up spending their assets and moving to a nursing home, which Medicaid covers.
The number of Americans expected to need home care is expected to grow in the coming years. The first baby boomers have been entering retirement by the thousands every day, and they will begin turning 85 in 2031. While not everyone who reaches an advanced age requires long-term care, a substantial share of the very elderly need such help because of physical disability or dementia.
Expanding access is likely to require many more workers to provide the care.
“We cannot overstate that without staff, there is no care,” said Katie Smith Sloan, chief executive of LeadingAge, an association of nonprofit nursing homes and organizations that assist aging people.
Judith Feder, a professor of public policy at Georgetown University who published a recent paper on a possible Medicare home-care benefit, said such a policy would relieve financial and physical burdens on family members.
“It is what we need in national leadership to address a need among the population that has been disregarded for much too long,” she said.
The program could cost hundreds of billions of dollars or more, and it might face a difficult time in Congress. According to the Harris campaign, the program would be financed through aggressive negotiations over prescription drugs under Medicare and through other policies, including taxes on companies that shift jobs overseas.
Both expanded home health care and Medicare prescription-drug negotiations are popular ideas.
The Biden administration also wanted to create Medicare benefits for hearing and vision and offer more assistance for long-term care at home as part of its big domestic policy bill. But the efforts were axed from the bill during congressional negotiations when Democrats still controlled both the House and Senate. The Biden approach to home health care, estimated to cost $150 billion over a decade, was more modest. It would have provided additional funding to state Medicaid programs to reduce waiting lists for home care. The Harris proposal would be much broader because it would not be limited to Americans enrolled in Medicaid, who must be poor to qualify.
A Medicare benefit would be broader, though that does not mean it would be free to everyone.
The Harris campaign fact sheet said that the program would require payments from families on a sliding scale according to income.
A recent paper from the Brookings Institution sketched out possible options for a Medicare home-care benefit, including higher contributions from wealthier families and restrictions on paying family members to provide the care. Its plan, with a benefit targeted at lower-middle-class Americans, was estimated to cost around $40 billion a year, and the campaign fact sheet cited that number. A more generous program could far exceed that estimate.
“The costs are a very major consideration,” said Mark J. Warshawsky, a senior fellow at the American Enterprise Institute and the former vice chairman of an Obama-era commission on long-term care. “Medicare, because it is a universal benefit, is not the right way to provide it, because many people can afford the care they have with the assets they have, the income they have and their supports from family. It’s very poorly targeted.”
Previous federal efforts to address long-term care at home have foundered. Democrats tried to create an insurance plan that would. include longer coverage for home care for as part of the Affordable Care Act, but it was not considered to be financially feasible. The Biden plan was scrapped during negotiations over what became the Inflation Reduction Act.
