How would Kamala Harris’Medicare-at-Home work?

Vice President Kamala Harris is proposing an expansion of Medicare to cover the costs of an in-home aide for many seniors, a direct pitch to the so-called “sandwich generation” of adults caring for aging parents in addition to their own children.
The plan, dubbed “Medicare at Home,” focuses on having Medicare cover costs of home care services and nurses as a way to help families avoid costs of nursing homes. Harris is pairing it with a plan she’s already announced that would expand the child care tax credit to up to $3,600, and $6,000 for parents with newborns.
Harris unveiled the plan during an Oct. 8 interview on “The View” talk show, where she talked about her own experience taking care of her mother while she had cancer.
She emphasized that her plan would be an expansion of Medicare, rather than Medicaid. This would enable it to coexist with private insurance. Medicaid also has certain stricter eligibility rules.
About a quarter of U.S. adults are part of the “sandwich generation” of those taking care of children and aging parents, according to census data. A Harris campaign official says its internal data shows this demographic of caregivers has a substantial number of undecided voters.
“In an election this close, proposals that speak to the financial security and health care needs of older Americans will resonate and can make a difference,” said Rich Fiesta, the executive director of the Alliance for Retired Americans, who has a PAC running anti-Trump advertisements.
A September poll conducted by the American Association of Retired Persons (AARP) poll showed that 78 percent of women who are over 50 years old and care for older family members say they’ve been struggling financially. Another AARP poll in Pennsylvania, a crucial battleground state, showed former president Donald Trump with an edge among voters 50 and over: 53 percent for Trump and 44 percent for Harris.
Except for the poorest seniors, for whom Medicaid can pick up the tab, most older adults have to rely on their own savings or family members for home care when they can no longer handle all of their daily needs but aren’t ready to move to a long-term care facility.
What is the price?
Adding Medicare coverage for home care could start at $40 billion annually, according to an estimate from a Brookings Institution study cited by the campaign.
However, the authors of the study caution that their figure is only a starting point for a “very conservatively designed universal program.” The ultimate price tag could be significantly higher, depending on how generous Congress is willing to be.
“It’s not saying it’s the program we should adopt, but just that you could make this work for dollars that are not crazy,” said Jonathan Gruber, chairman of the economics department at the Massachusetts Institute of Technology and a co-author of the estimate.
Gruber said the modeling also did not factor in major savings that the benefit could spur as ripple effects, like less money spent on nursing homes or family members who would be able to return to full-time jobs.
“We think we’re going to free potentially millions of informal care workers to go earn income in the labor market. And they’re going to pay taxes,” he said.
How to pay for it?
Harris said her expansion will be paid for mainly by expanding the Medicare Drug Price Negotiation Program, combined with a list of other reforms, like increasing the discounts that drugmakers would have to offer for brand-name prescriptions.
This is not the first time that Harris has pledged to expand the Inflation Reduction Act’s policies targeting prescription drug prices. Medicare is currently on track to save only $31 billion each year from the negotiation program and other drug price provisions, which would fall short of covering even the starting price tag for her proposal.
Harris has called on Congress to broaden the drug negotiation program, accelerating the pace of new price caps set by Medicare and making more drugs subject to the limits. More aggressive drug price negotiations could save hundreds of billions over the next decade, according to a Stanford University white paper cited by the campaign, assuming it’s able to survive an uphill battle on Capitol Hill.
Marc Cohen is the co-director of a center focused on long-term services and support backed by LeadingAge, the association of nonprofit providers of aging services. LeadingAge has called for adding home care to Medicare for years, as a fix to the “dangerously broken” system.
“At some point we will need to talk about a source, like Medicare itself, to pay for it. But I think that’s a very clever idea right now for getting this going. And then what you do is develop a constituency of political support, even for the young generation to say, ‘I want this to be available for my parents,’” said Cohen, a professor of gerontology at the University of Massachusetts Boston.