Jacquelyn Martin/AP Photo
Vice President Kamala Harris chats with the hosts during a commercial break at The View, October 8, 2024, in New York. The Democratic presidential nominee used her appearance to announce her campaign’s proposed home health care benefit.
The Harris campaign’s proposal to add a long-term home-based care benefit to Medicare, announced Tuesday on the daytime talk show The View, has been described as a lifeline for the “sandwich” generation, who are struggling with caring for children and elderly parents simultaneously. But it also could provide a counterweight to a blitz that the Trump campaign has mounted in states with large elderly populations like Pennsylvania.
Throughout the campaign, Kamala Harris has maintained slight leads on Donald Trump among seniors, which if it held would make her the first Democrat to win the 65-and-older category since Al Gore in 2000. But Trump has a plan to fight back, which has been put into practically every mailbox in Pennsylvania, among other states.
The seemingly untargeted mailer campaign features Social Security and Medicare, the social insurance programs for the elderly. “We will fight for and protect Social Security and Medicare benefits with no cuts, including to the retirement age,” the mailer reads, echoing part of Trump’s “Agenda 47” platform. This neglects that Trump put cuts to Social Security and Medicare into his proposed budget every year of his presidency. As recently as this year, he told CNBC that there was “a lot you can do in terms of entitlements, in terms of cutting.”
But recognizing his loosening grip on senior voters, Trump has loudly reversed himself on Social Security and Medicare cuts, while also floating a plan to eliminate income taxes on Social Security benefits, something that would drastically diminish the ability for the government to pay full benefits over time.
The mailer, paid for by the “Republican Federal Committee of Pennsylvania,” an arm of the state Republican Party that has spent over $10 million this cycle, also attacks Harris for “destroying Social Security and Medicare,” albeit with specifics that do not correspond to any policy directly harming the programs. The mailer criticizes Harris for spending bills that “drove inflation through the roof, causing Medicare premiums to rise and Social Security benefits to go down in value.” It cites a 2022 increase in Medicare Part B premiums of 14.5 percent, without mentioning that premiums decreased the next year. The increase was based on possible increased Medicare spending on an Alzheimer’s drug called Aduhelm that didn’t materialize.
In addition, the mailer cites an anti-immigration group article claiming that Harris’s “amnesty plan for illegal immigrants would cost Social Security over $1.3 trillion.” The article is from February 2021, and whatever amnesty plan it was discussing at that time didn’t pass. Undocumented immigrants, meanwhile, help prop up Social Security and Medicare by paying into the system ($32 billion in 2023) without being eligible for benefits.
Despite the misleading nature of the attacks, the mailers have flown well below the radar. They have been blanketed across Pennsylvania, a state with one of the larger elderly populations in the country. Meanwhile, an AARP poll of Pennsylvania from last month, while showing Harris on top by two points, had her losing seniors in the state by seven, a reversal from Joe Biden’s one-point lead among seniors in the state.
Advocates for seniors have complained in recent weeks that the Harris campaign hasn’t given them any material with which to fight back on the appeal to seniors. That ends with the new proposal, which not only adds a long-term care benefit in Medicare, but includes new benefits for hearing and vision coverage. That adopts a policy that has been advanced by Sen. Bernie Sanders (I-VT), but without the most expensive element of it, dental coverage. The hearing benefit in Medicare in particular will likely be even cheaper than current estimates because of the new rules allowing over-the-counter hearing aids.
The “Medicare at Home” plan, according to a Harris campaign fact sheet, is designed to allow seniors and people with disabilities to receive assistance at home, rather than be put into costly nursing homes. It could also reduce hospitalizations, like from falls at home seniors suffer without help. (Hearing and vision coverage, which could limit other maladies that spring from untreated hearing and vision problems, could also reduce the need for some medical treatment.)
A version of the in-home support services concept was introduced in the 2021-2022 Build Back Better proposal; it never got through the Senate. But there is a major difference in this version. The Build Back Better plan sat on top of the existing way people draw this coverage, through Medicaid. But that is only available for low-income people, who are forced to spend down assets or savings to qualify. Medicaid is also a federal-state partnership that varies widely depending on where in the country you live. In many states, there are long waiting lists for in-home support services.
But Harris’s plan takes in-home support out of Medicaid entirely, making it a benefit through Medicare. No longer would it serve only the poor, or force people to become poor to access it.
After medical evaluations, doctors could prescribe home health assistance from qualified care aides certified by the Medicare program. The Harris proposal states there would be a sliding scale of cost-sharing for higher-income seniors, with full coverage at lower incomes. On the workforce side, the proposal promises to “draw upon best practices across Medicare plans as well as the private sector” to train eligible care aides, while promising better wages.
There are two recent research papers, one from Georgetown University and another from the Brookings Institution, that this plan relies upon. The Brookings plan was co-authored by Wendell Primus, former House Speaker Nancy Pelosi’s top health care policy official.
One danger of a program like this is that traditional Medicare has been rapidly losing market share to private Medicare Advantage programs, which promise low premiums but can underdeliver on benefits while gouging the federal government with overbilling. If the new home care benefit doesn’t contain an out-of-pocket cap to protect seniors in traditional Medicare, premiums are likely to rise and beneficiaries are likely to flee to Medicare Advantage, which has proven more expensive for the government to maintain.
The Harris campaign says Medicare at Home, estimated to cost $400 billion over a decade, would be paid for by expanding existing Medicare drug price negotiations. The initial concept of drug price negotiation, as scored by the Congressional Budget Office, would have saved $450 billion over that decade, so theoretically it would work, but that’s before you come into contact with Congress and the pharmaceutical lobby, who fought hard to successfully limit the program in Build Back Better.
In addition to expanding drug price negotiations, the Harris campaign calls for “cracking down” on pharmacy benefit managers (PBMs), middlemen who use information advantages to raise prices on drugs. That fits with the Federal Trade Commission’s recent lawsuit against PBMs for jacking up the price of insulin.
The Harris proposal concedes that prescription drug reform may not be able to pay for all of the Medicare at Home benefit and the vision and hearing coverage addition. It refers vaguely to “international tax reform” to make up the difference. But one revenue source from the Medicare program is not covered: reforming Medicare Advantage to limit overbilling. That could lead to a significant pot of money.
In the fact sheet, Harris’s campaign also bashes Trump for calling for cuts to or privatization of Medicare and Medicaid in the past, including through the repeal of the Affordable Care Act, which has a number of Medicare-related provisions. But having something tangible like a home care proposal could provide ballast for the campaign to appeal to seniors, which Trump has been attempting for some time.
