Oct 24, 2024
In her efforts to win over sandwich generation voters, Vice President Kamala Harris has given them some serious food for thought: a Medicare expansion plan that she contends will help adults raising young children also care for their aging parents.
The presidential candidate revealed her “Medicare at Home” proposal during an early October episode of ABC’s “The View” stating that it would relieve the stress felt by the roughly 1-in-4 American adults who provide intergenerational care.
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“It’s just almost impossible to do it all, especially if they work,” Harris said. “We’re finding so many of them having to leave their jobs, which means losing a source of income, not to mention [enduring] the emotional stress.”
Under the Harris plan, Medicare would be required to cover the costs of long-term care offered in a family’s domestic setting; it would also add vision and hearing benefits for seniors. While clear numbers haven’t emerged, Medicare at Home would also provide coverage “for those of modest incomes with a sliding scale,” where seniors with higher incomes would participate in a cost-sharing arrangement, according to the Harris campaign.
Based on a nurse or physician evaluation, seniors would also qualify for visits from Medicare-designated caregivers that “can include any qualified home health aides, personal care attendants, or direct care workers recognized by their state.”
Figuring out the facts
Historic? Yes, according to health care leaders such as Tricia Neuman, senior vice president and executive director for the Program on Medicare Policy at KFF.
“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 told CNBC after Harris made her announcement.
Neuman may be among the most qualified to assess the potential impact. Three days after “The View” episode, she co-authored a piece where KFF estimated that 14.7 million Medicare beneficiaries would potentially be eligible for the new home care benefit.
The “why” behind Harris’ plan also stems from a 2022 Pew Research Center study cited by her team. The survey of nearly 9,700 adults found that 23% had a parent 65 or older while raising at least one child younger than 18 or providing financial support to an adult child. Her goal is to provide the financial help they need, which would in turn ease the caretaking pressures coming at them from all sides.
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Harris cited “a personal experience” that informs her political agenda: She cared for her ailing mother Shyamala Gopalan Harris, who died of cancer in 2009. Harris said she learned “It’s about dignity for that individual, it’s about independence for that individual.”
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Sound research, unrealistic odds
The research behind the Harris plan traces back to a study on the “daily living limitations” of older U.S. adults published in November 2023 in the medical journal Epidemiologia. Based on a sample of more than 30,000 adults 50 and older spanning 12 years, it found that in 2018, approximately 9.4% had difficulty dressing; 7% had trouble bathing; and just below 7% experienced problems getting in and out of bed.
Analyzing the cost of long-term services and support, a five-author team writing for the Brookings Institution (which cites the above study) concluded that “most Americans do not have enough income or savings” to cover them. Their analysis suggested that there are “fiscally feasible ways to add a home care benefit to the Medicare program.” The cost of a home health aide averages $33 an hour, according to Genworth.
Yet even supporters of Medicare at Home struggle to reconcile the vision with the numbers. Though acknowledging the idea was “positively delightful,” health care expert Neal K. Shah, writing in MedCity News, maintained that the costs were simply too great. Brookings estimates those at $40 billion annually.
Finding the funding and getting the care details right would lead to “well-meaning bureaucrats trying to micromanage one of the most personal and complex aspects of health care,” Shah predicted.
At the very least, Harris as a well-meaning politician would find Medicare at Home competing for attention with countless issues she’s addressed on the campaign trail: from immigration to gun control to the economy to Russia’s war on Ukraine. And considering there’s a strong chance Democrats will lose their Senate majority and Republicans will keep control of the House, even if the election goes her way, a President Harris may have almost no opportunity to see her ambitious plans enacted. Such a scenario would leave those plans ailing at best.
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Lou Carlozo is a freelance contributor to Moneywise.
