Harris Wants Medicare to Shut Down Home Care When Trump Rolls Back Obamacare | Washington Monthly
When asked if health care is on the ballot in November, most voters immediately say yes, and they feel strongly about the issue. Either they are for reproductive health rights and pro-choice abortion and voted for Kamala Harris, or they are against both and voted for Donald Trump.
Most people don’t know or don’t know that Harris also proposed the most important expansion of Medicare since he added the prescription drug benefit in 2003. His plan would be more popular if people many know about it. Nor do they realize that a second Trump presidency, especially if Republicans also win control of Congress, will cause millions of people to lose their health insurance or see their benefits drastically reduced.
In early October, Vice President Harris, surrounded by ABC troops The Viewannounced plans to increase the home care benefit to Medicare. It will provide funding for home aides to help with the daily activities of elderly and disabled families struggling to live in nursing homes. Most of that care is provided by unpaid relatives unless the beneficiary qualifies for Medicaid, which requires exhausting the person’s assets first.
Speaking about her struggles to support her mother as she was dying of cancer, Harris pledged to help the sandwich generation who find themselves caring for young children and an aging parent. “Giving that support to your family members means losing everything you can afford to be able to continue Medicaid or retirement,” Harris told cheering supporters at a recent rally. “That means cutting a very important part of your income just so you can give the people in your life the dignity and support they deserve.”
Recent surveys show 75 percent of US adults support the long-term care assistance program, which European countries and Japan offer with a mandatory purchase requirement. long-term care insurance, tax-funded programs, or a combination of the two. As with health insurance, the US is the only industrialized country without a long-term care program. However, among Americans, “two-thirds support a government-run long-term insurance program, government money for low-income people to get long-term care.” long in their family, or Social Security wage credit for caring for a loved one. ,” a 2022 Associated Press-NORC Center for Public Affairs Research report on long-term care found.
The need for such a program is great. About 50 million Americans, or 20 percent of all households—up from 15 percent a decade ago—provide unpaid care for loved ones who stay at home while they are away. need help with basic activities of daily living such as dressing, bathing, toileting and feeding. That number will grow exponentially over the next two decades as the Baby Boomer generation moves into its final years. The number of people who can benefit includes not only the elderly disabled by ‘dementia’ and other diseases but also young family members with severe mental and physical disabilities.
The stress of working on what is essentially a second job—caring for someone at home, 65 percent of childbearing work falls to women—can take a toll on a caregiver’s life. They lose contact with friends. They are emotionally exhausted. Often they also end up neglecting their health. About a third of caregivers skip routine physical or dental care because they work in caregiving jobs, according to a 2018 study by AP-NORC. About 40 percent have physical or mental health problems.
A comprehensive home care program will cost more. Providing in-house subsidies to help caregivers will cost Medicare an estimated $40 billion a year, according to a recent Brookings analysis. Released just three weeks before Harris announced his plan, its authors include Jonathan Gruber, a key drafter of the Affordable Care Act, and Wendell Primus, who served for many years as the chief policy officer of the health care to Representative Nancy Pelosi, former Speaker of the. The house.
Their plan called for a free means-testing program for low-income earners, including a pay increase for high-income earners. Without Medicaid, the home health aide industry relies on wealthy families paying out-of-pocket when they hire their loved ones for home health care.
Although the benefits could be paid for through general taxation, an Urban Institute report issued six years ago sought to fund the long-term care program through an additional Medicare income tax, which currently which is set at 2.9 percent of income divided equally between employees and employers. . The premium would not start until the workers were 40 years old.
On the campaign trail, Harris said he would pay for the program with savings from the lower drug price negotiations, one of the biggest health achievements of the Biden-Harris administration in years. the first four in office. However, the Congressional Budget Office estimates that drug price negotiations over the next decade will save about $100 billion, which is only a quarter of what the Brookings authors estimate that the benefit of Home care will cost more than ten years.
Yet CBO’s bean-counting approach fails to consider the financial benefits from home care. Studies of pilot programs from the Centers for Medicare and Medicaid Services that provide caregivers with home assistance show that they reduce emergency visits, hospitalizations and nursing home admissions. Employers are benefited by workers with increased productivity who are very tired and no longer need time to take care of the people they love. Federal funds benefit from the Medicare takeover of the Medicaid home care program, which frees up resources for other federal programs or tax relief.
Recognizing the potential popularity of the home health program, Republicans have updated their 2024 party platform to include a short section promising to “protect seniors’ care at home.” However, their proposed solutions, which are to “return resources to elder care at home, overcome negative attitudes that cause a shortage of care workers, and support unpaid family caregivers through tax bills and reduced tape,” ignoring the basics.
None of the Medicare home benefits were disenrolled. The shortage of care workers is a result of woefully low wages, which Republicans have helped by refusing to raise the federal minimum wage or Medicaid rates in the states they control. And the tax breaks are often useless for low-income people who pay little or no federal income tax. They will go mostly to the rich since the modest taxes paid by people in the bottom half of the income distribution are much lower than the cost of a home health care aide.
Meanwhile, the Republican platform and Trump have been deliberately silent on the biggest health care issue facing millions of Americans next year: the end of expanded subsidies for insurance plans. of individual and family health care sold through the Obamacare exchanges. In the past three years, they helped bring the default rate down to about 8 percent—the lowest in United States history.
If Trump returns to office, those subsidies will be on the chopping block next year to help pay for his 2017 tax overhaul, which targeted the wealthy and big businesses. Experts say that without those additional Obamacare subsidies, millions will stop buying insurance because it is no longer affordable—something that happened during Trump’s first term when the free rate went up.
Trump also never mentioned the plans of Project 2025 planners, who are likely to fill key positions in his health care agencies, to return to the rules that undermine the value of health insurance. . They include the sale of short-term insurance plans that leave consumers with large bills when they get sick and do not meet current regulatory standards such as free preventive services and guaranteed coverage (no discrimination for pre-existing medical conditions); the ongoing process of converting Medicaid into block grants, which will result in substantial cuts to services in many states; and completely turning Medicare over to the private insurance industry, which already enrolls more than half of its beneficiaries at a higher cost to taxpayers than the cost of those left in the traditional program.
When Harris says, “We’re not going back,” he’s not kidding. His health care plans keep the benefits provided by Obamacare and build on them with his new home care benefit. Trump — and those who hope to ride in his clothes — plan to roll back the gains made under the Affordable Care Act and return to a time when one in six Americans had uncovered and tens of millions were left in the lurch. that left them in medical debt.
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