In a presidential campaign cycle unusually light on health care proposals, Vice President Kamala Harris on Tuesday unveiled an ambitious — and expensive — Medicare strategy that would introduce a new category of coverage for home health care.
The proposal would involve Medicare paying for home health aides to assist older Americans with daily tasks such as eating and using the bathroom. It amounted to a last-minute bet by the Harris campaign that major domestic policy reforms could break through to undecided voters.
It was also a sign of Medicare’s growing power in American life. Enrollment has steadily risen over the past decade, with nearly 70 million people in the program, many of them in private Medicare Advantage plans. That has made the program a rich target for presidential candidates seeking to appeal to older voters and the family members who look after them, often in difficult economic circumstances.
The Harris campaign cited a University of Michigan poll from August showing that more than a quarter of people 50 years and older help care for at least one family member or friend with a health problem.
Ms. Harris introduced the idea in two mass-media venues likely to reach people who would be affected by the policy: ABC’s “The View” and on the satellite radio show hosted by Howard Stern. A spokesman for the Harris campaign noted the reach of the vice president’s announcement: Though the audience for both shows is in the millions, women make up a significant portion of “The View” audience, while men account for a majority of Mr. Stern’s listeners.
Ms. Harris’s proposal came as more Americans have become familiar with the painstaking, life-altering work of tending to their older relatives. The number of Americans who will need home care is expected to continue growing substantially, with the first baby boomers entering retirement by the thousands every day.
“Back when Medicare started, people didn’t live much longer than 65,” said Juliette Cubanski, a Medicare expert at KFF, a nonprofit health policy research group. “Life expectancy is now 70s and 80s and living into 90s. We’re finding a greater need for longer term services and supports.”
Ms. Harris’s appearance with Mr. Stern underscored that point.
“I have an old mother, 97 years old,” Mr. Stern told her at one point. “The cost is, people don’t know this yet — if they’re not taking care of somebody elderly, it will bankrupt you.”
“Or your parent will not get the care they need, or you’re going to have to leave your job,” Ms. Harris said.
The proposal, coming less than a month before the election, was in part a recognition of the extraordinary nature of Ms. Harris’s not yet three-month-old campaign. She is still working through a policy agenda with her advisers.
“She’s responding in part to a demand on the part of many voters that they want to know more,” said Tom Daschle, the former Senate Democratic leader from South Dakota, referring to recent polling of undecided voters. “It’s about what you could do most with in government.”
Medicare has featured heavily in recent months in the Harris campaign and Biden administration. Ms. Harris has called for expanding and accelerating a new drug price negotiation program for beneficiaries. The Biden administration recently averted a potential political disaster, staving off higher prescription drug premiums in Medicare that would have otherwise been brought on by other health care reforms.
Federal officials used subsidies for insurers to offset those costs, drawing fierce criticism from Republican lawmakers, who accused the Biden administration of deploying financial tricks to keep premiums low.
Running for re-election in 2020, President Trump devised his own last-minute Medicare agenda, seeking to distribute $200 drug discount cards to millions of people in the program, a controversial plan that eventually fizzled.
With her home health care proposal, Ms. Harris highlighted what her campaign said was an effort by the Trump campaign to target Medicare for cuts — part of a broader effort to rein in safety net spending. Republicans have long called for reforms to Medicare to limit its budget trajectory.
The issue flared up in March, when Mr. Trump appeared to suggest he was open to slashing programs such as Medicare. His campaign quickly downplayed the comments, and Mr. Trump has repeatedly claimed he would not seek cuts from the program.
Home care featured in the Republican Party’s convention platform this year, and a spokeswoman for Mr. Trump said this week that he “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.”
The proposal Ms. Harris made on Tuesday in part mimics offerings in Medicaid, the joint federal-state program that insures poor Americans. Medicaid covers home care, but wait times for those services can be long and some recipients are forced to spend their savings to qualify.
Campaign officials said that Ms. Harris’s home health proposal was influenced by her experience caring for her mother, Shyamala Gopalan Harris, when she was dying from cancer. “Cooking meals for her, taking her to her appointments. Trying to make her comfortable, figuring out which clothes were soft enough that they wouldn’t irritate her. Telling her stories to try and make her laugh,” Ms. Harris said in a recent speech in Pittsburgh.
Under the plan, Medicare recipients would be assessed by health providers on their capacity to take care of themselves, and health aides would be designated by the program.
Health policy experts said that even if Medicare were to cover the service, there might not be enough workers to tend to Americans in the program. Low wages have contributed to shortages in the home health care industry. Aides, who can cost roughly $30 an hour, can be more expensive than assisted-living care.
Any proposal Ms. Harris would make as president would have to clear a potentially divided Congress, and be financed. The Harris campaign said that savings from the Biden administration’s new program negotiating drug prices in Medicare would help pay for it.
“This is part of the challenge of changing Medicare — that it requires congressional action, especially when we’re talking about a new benefit that could cost tens of billions of dollars over time,” Ms. Cubanski, the Medicare expert, said.
A recent Brookings Institution paper, which the Harris campaign cited on Tuesday, said that a home health program targeting lower-middle-class Americans would cost around $40 billion annually. If the new offering was more sweeping, the costs could go up substantially.
Some conservative health policy experts warned that the proposal could amount to a financial calamity. Ge Bai, a health policy expert at the Johns Hopkins Carey Business School, pointed to Medicare’s enormous spending on prescription drugs as one example of the policy’s potential for skyrocketing costs over time.
“The numbers don’t add up,” she said. Medicare officials could potentially have to take other significant steps to offset the new program, she added.
“It’s not a coincidence that Democrats chose Medicare reform in their very precious legislative window,” she said, referring to when Mr. Biden signed the Inflation Reduction Act into law, which authorized the Medicare drug price negotiations. “It’s not just about the program itself. It’s about laying out a platform for them to win the election.”
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