Harris proposes new Medicare home care benefits

During an appearance on ABC's "The View" on Tuesday, Harris proposed a new plan to expand Medicare coverage for home healthcare aides for older adults. Under the plan, Medicare would cover in-home healthcare after a provider determines an enrollee needs help with daily tasks. Medicare would also create a sliding scale for beneficiary cost-sharing for long-term care services.

According to Harris, the plan is aimed at the "sandwich generation," or people who are taking care of their children as well as their aging parents.

"There are so many people in our country who are right in the middle. They're taking care of their kids and they're taking care of their aging parents, and it's just almost impossible to do it all, especially if they work," Harris said.

Currently, data from the U.S. Bureau of Labor Statistics shows that over 37 million people, or 14% of the adult population, provide some form of unpaid eldercare, with a majority (around 59%) being women.

Many Americans often struggle to find affordable home care for themselves or older adults since Medicare does not cover longer periods of home care. Home aides are typically only covered for a short time when patients are recovering from acute medical conditions, such as a stroke. According to KFF data, a professional live-in home health aide can cost more than $288,000 a year.

In addition to helping caretakers, Harris said the coverage expansion could improve the lives of older people. According to research from AARP, over two-thirds of adults over the age of 50 want to remain in their homes for the long term.

"It's about the dignity for that individual. It's about independence for that individual," Harris said.

In addition to home care, Harris has also endorsed adding coverage for vision and hearing to Medicare, a plan that was previously proposed by the Biden administration.

Commentary

According to Tricia Neuman, SVP and executive director of the Program on Medicare Policy at KFF, Harris' proposal is historic.

"It's been a long time – decades – since a presidential candidate put forward a Medicare proposal to help middle income families cope with the crushing cost of home care," Neuman said.

Similarly, David Grabowski, a health policy professor at Harvard University, said that expanding home health benefits "would be transformative from a care perspective." However, he noted that the cost of these benefits could be very high. "There will be a lot of sticker shock once this is costed out," he said.

In a recent report, the Brookings Institution estimated that a Medicare home care benefit could cost around $40 billion a year — but could be much higher depending on what is included. The Harris campaign has said that the plan would be paid for from savings through expanded Medicare drug price negotiations with drug manufacturers.

"The costs are a very major consideration," said Mark Warshawsky, a senior fellow at the American Enterprise Institute and the former vice chair 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."

There have also been concerns about how to expand access to care amid a shortage of home health workers.

"We know there's a sizable population of Medicare beneficiaries right now that can't receive care because agencies do not have the workforce, and they can't support that workforce because of a declining reimbursement model," said Joanne Cunningham, CEO of Partnership for Quality Home Healthcare.

Overall, there are "a lot of important policy questions that would dictate the parameters, the structure, who's eligible, what the cost is," Cunningham said. (Abelson/Sanger-Katz, New York Times, 10/8; Nova, CNBC, 10/8; McAuliff, Modern Healthcare, 10/8; Shivaram, NPR, 10/8; Goldman/Saric, Axios, 10/9)