The Democratic presidential nominee, Vice-President Kamala Harris, announced a plan to provide long-term, at-home care services through Medicare, the public health insurance program for Americans older than 65.
If approved, the program would represent a major expansion of Medicare, which currently only covers at-home care under narrow circumstances. Harris made the announcement on ABC’s The View, a day-time talkshow popular with older women.
“Taking care of a parent – that means trying to cook what they want to eat, what they can eat,” said Harris. “It means picking out clothes for them, that’s soft enough that it doesn’t irritate their skin. It means trying to think of something funny to make them laugh or smile,” she said.
“We’re talking about declining skills” of older people, “but their dignity, their pride, has not declined,” Harris added.
The announcement is part of the Harris campaign’s effort to focus on the “sandwich generation” – or the more than 105 million Americans who care for parents, children or both, it said.
Today, Medicare typically covers at-home care only in “post-acute” settings, such as when a person is recovering from a surgery.
Instead Medicaid, the public health insurance program for the low-income and disabled, is the largest single payer of what the government calls “long-term support services” – everything from nursing homes to the home health aides on which Harris focused. Medicaid spent $207bn on long-term support services in 2021, or roughly 44% of all such spending nationally, according to the Congressional Budget Office (CBO).
Harris said the cost of the program would be paid for with expanded Medicare prescription drug negotiations and limiting payments to pharmacy benefit managers – the middle men in the US’s drug supply system.
Medicare completed its first negotiations with drug makers this year. The CBO estimates prescription drug negotiations will save the government $98.5bn over a decade. Harris did not outline the cost of an at-home care support program in her appearance. Her campaign said at-home care costs roughly $3,000 less per month than nursing home care.
However, Harris did mention that the proposal was made through Medicare to avoid a phenomenon many in the sandwich generation will recognize – the Medicaid “spend down”. Families forced to “spend down” their loved ones’ assets must pay for a certain amount of healthcare before Medicaid begins contributing to costs.
People who receive long-term support services are among the government’s most expensive beneficiaries. Although they comprise 6% of all people enrolled in Medicaid, they account for 34% of federal and state Medicaid spending, according to an analysis by the Kaiser Family Foundation.
