Harris Proposes Medicare Expansion for Home-Based Long-Term Care: “It’s About Giving Folks’ Dignity”
Today on The View, Vice President Kamala Harris’ announced a proposal to expand Medicare to cover long-term care at home could be the most meaningful shift in our system in decades.
The fact that long-term care isn't already a part of Medicare tells you how backward our system has been for many years. Right now, if you’re a senior or someone with a disability who needs help with daily tasks like bathing or eating, you’re basically on your own. Medicare doesn’t cover this care unless you need skilled nursing, which means millions of Americans are forced to turn to Medicaid, a program for low-income people, or pay out of pocket—often to the tune of six figures annually. Medicaid’s long-term care benefits vary wildly by state, with waiting lists and eligibility traps that force families to "spend down" their life savings before they qualify.
This isn’t just a health care crisis. It’s a pocketbook crisis for millions of families—many of whom are already stretched thin. Harris’ proposal to expand Medicare to cover home care would lift an enormous burden off the “sandwich generation,” the people balancing caring for their aging parents while still raising their children. These are everyday Americans, caught between skyrocketing nursing home costs and limited caregiving options, often relying on unpaid family members to fill the gaps.
I know what this is like firsthand. When my mother could no longer live on her own after breaking her hip, she ultimately decided she would have to move into a nursing home. It was not possible for her to continue living in the home and neighborhood she loved. It was heartbreaking for all of us.
A Win for Seniors, People with Disabilities and Caregivers
Long-term care is one of the great blind spots in our health care system. Nearly 20% of seniors require assistance with daily activities, and that percentage is even higher among older seniors and people with disabilities, according to the National Library of Medicine. Without sufficient coverage for home care, we’ve defaulted to an institutional approach—nursing homes—which many people would rather avoid.
Harris’ proposal promises a new option: to stay at home and receive care in a familiar environment. For many seniors and individuals with disabilities, home-based care not only provides more dignity and independence but also delivers better health outcomes.
Let’s also not forget the caregivers themselves—often family members sacrificing their own careers, savings and health to care for their loved ones. This proposal could be a game-changer for them too, giving them physical relief and financial security. As Harris has noted, “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.”
A federal investment in home-based care would open new opportunities for these caregivers to pursue work outside the home and regain some control over their lives.
The Historical Context: What’s Different This Time
This isn’t the first time we’ve seen a proposal like this. You might remember that President Joe Biden had a similar idea as part of his Build Back Better plan, which included a substantial investment in home care. Unfortunately, that plan was gutted in Congress, leaving home care on the cutting room floor.
We have also seen many proposals to expand health coverage using private programs which leads to ballooning costs. For example, adding a private option for Medicare, known as Medicare Advantage (MA), now costs taxpayers an extra $140 billion a year because of corporate gaming.
But Harris is taking a different approach by tapping into Medicare, a program that Americans like and already covers 65 million Americans. Medicare, unlike Medicaid, doesn’t come with the same income restrictions or state-by-state patchwork of benefits. By shifting long-term care into Medicare, Harris is proposing a more universal solution, one that could provide peace of mind to millions of Americans regardless of their income level. By using Medicare, specifically traditional Medicare where this program will hopefully be housed, Harris is removing the possibility for Big Insurance to use the program for profits. Harris is also capitalizing on the simplicity of the Medicare program which operates using roughly half of the administrative costs of private insurance corporations.
Harris proposes to pay for this new benefit with money the federal government will save when it begins negotiating directly with pharmaceutical companies for lower drug prices next year. It’s a step that should’ve been taken years ago, and it represents a critical source of savings — savings that can be redirected to fund much-needed home care services. It’s a win-win for the American people: lower drug prices and better long-term care.
Political Challenges? Yes, But That’s To Be Expected
Of course, the road to making this proposal a reality won’t be easy. There will be opposition from some corners of the political spectrum, not to mention from the nursing home industry and big insurers. These industries have a financial interest in keeping things as they are, and they’ve proven time and again that they’re willing to fight tooth and nail to preserve their profits at the expense of Americans’ well-being.
But the American people are behind this. According to Data For Progress, an overwhelming majority — 88% — of voters support expanding Medicare to include long-term home care. It’s one of those rare health care proposals that appeals to Democrats, Republicans and Independents. That’s because it speaks to a fundamental human desire: to age with dignity, to receive care in a setting that feels like home, and to avoid financial ruin in the process.
Harris’ proposal is a step in that direction, and if enacted, it could reshape the way we think about long-term care for generations to come.
[Wendell Potter is a former health insurance executive who had a “crisis of conscience,” becoming disgusted with America’s broken healthcare system after years of helping the industry mislead Americans.
Wendell walked away from his job at Cigna, one of the country's largest health insurers, in 2008 and became a vocal critic of the insurance industry and a leading advocate of reform.
In June of 2009, Wendell shocked the nation in a very big way when he went public with what he knew about the healthcare system. In a riveting Congressional testimony, Wendell described how insurance company executives, in their quest to meet Wall Street’s profit expectations, routinely canceled the coverage of policyholders who got sick.
He went on to disclose a common but little-known practice that industry executives called “purging” behind closed doors. Under purging, insurance companies used big price increases to force small businesses with sick workers to drop their policies.
Potter also explained how insurance companies flouted regulations designed to protect consumers and how they intentionally made it nearly impossible for consumers to get the information they needed about their policies in a language they could understand. Wendell’s testimony became a key building block in the case for expanding healthcare under the Affordable Care Act.
Wendell went on to become a bestselling author. The New York Times called his first book, Deadly Spin, “a tour de force.” Pulitzer Prize-winning author and historian Doris Kearns Goodwin called his most recent book, Nation on the Take, “a stirring guide for how we can work together to reclaim our democracy and reunify our country.”
Wendell Potter is determined to change the course of healthcare in America. Through the Center for Health and Democracy, he continues his work of the last decade to fix our broken healthcare system for Americans and to shine a light on the underhanded practices of big corporations and other moneyed interests that frustrate the efforts of the richest country in the world from providing basic universal healthcare for all its citizens.]