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Kamala Harris this week proposed to have Medicare cover in-home care for seniors and people with disabilities, in what would amount to a major expansion of the beloved federal health insurance program.
And while it doesn’t appear to have registered as such in the political conversation (more on that in a minute), her plan made an impression on a lot of everyday Americans who heard about it.
Mike Jennings is one of them.
Jennings is a web developer in northeast Kansas. About ten years ago, he, his sister and his mother became the primary caregivers for his grandmother, who was then in the early stages of Alzheimer’s disease. She wanted to live at home, and the rest of the family wanted that too, Jennings told me in a phone interview. But they couldn’t afford to hire in-home help, so they took on the responsibility of caring for her themselves ― trading shifts, juggling work and other responsibilities.
“We basically had to drop everything, it was all-hands-on-deck,” said Jennings, who was in his mid-30s at the time.
It was especially tough on his mother, Jennings said, because every time she dashed home from work to help with a care-related emergency, she felt like she was putting her job in jeopardy. And things only got worse as his grandmother’s condition deteriorated, requiring ever greater vigilance.
“She had gotten out of the house multiple times,” Jennings said. “One time she got out during a particularly bad storm, and we couldn’t find her, and it turned out she was sitting in a neighbor’s truck. She was injured. We had to take her to the hospital.”
Eventually the family found a memory care unit they could afford inside an assisted living facility, and they paid for it with a combination of his grandmother’s pension and a state program for which she had finally qualified. But things might have been different if a program like Harris’ Medicare proposal had existed at the time, Jennings said.
“It would have been a lot less stress, a lot less money, a lot less pain … and I think my grandmother would have been happier,” Jennings said. “Even if it’s not full-time, even if it’s part-time, it would have been such a weight lifted off our shoulders that I can’t even describe it.”
I know about Jennings because he quoted and responded to a post I made on social media, on the day of the announcement, describing Harris’ proposal and its purpose. And he was not the only one.
More than 2.5 million people viewed my item on X/Twitter, according to the site’s metrics. Dozens said they too had struggled trying to care for loved ones at home ― or, in many cases, were struggling now.
Here’s a sampling:
This would have saved my family SO much pain and so many sleepless nights. ― @jessleeesq
My dad spent the last three years of my grandma’s life taking care of her. In the process, any money she’d saved up and he’d saved up evaporated. This will legitimately change lives, both for the people receiving care and their loved ones. ― @VerboseDebose
BRAVO! I spent years caring for my mother without assistance, and then our only choice was a nursing home. ― @lkhwriter
I’m 71 and providing hours of daily care to my 68-year-old sister-in-law who incapable of caring for herself - she got ill after retirement. Her pension is too high for Medicaid and I can’t in good conscience take financial steps to make her eligible for it. If Medicare could help us it would be tremendous, as her income can’t cover her needs at all. And I am exhausted. ― @2DeCee
The reaction was unlike any I’ve ever gotten from what was, more or less, a news bulletin about a campaign proposal. And it shows just how big a need Harris is trying to address here — although that significance seems to have eluded some in the political class.
Which brings us to their reaction.
An Announcement And A Shrug
The Harris campaign had alerted reporters about the impending announcement the day before. That is standard practice in campaigns, and when the proposal became public at 5 a.m., a handful of outlets (including HuffPost) had stories ready to go.
But full articles on Harris’ proposal didn’t appear in The New York Times and the Washington Post for a few hours, and didn’t get much play on their homepages when they did. That proved emblematic. The home care proposal vanished from talk shows within a day, and so far it hasn’t drawn much coverage in the opinion pages.
All of this reflects judgments by editors and producers — and the campaign professionals who talk to them — that the proposal just isn’t that important. And from a reporter’s perspective, I get why.
This hasn’t been a hotly debated issue like, say, Obamacare has. It also feels a little pie-in-the-sky, since it’d likely require not just a Harris win but full Democratic control of Congress, which is not what polling models are predicting. The fact that Harris formally announced it on “The View,” ABC’s daytime talk show, probably made it feel less serious.
And that’s to say nothing of the ridiculously full news cycle, which includes not just the campaign but also two natural disasters and major conflict in the Middle East, to name just a few big stories. Everybody in politics is trying to do too much. Everybody has missed things. I certainly have.
Still, the relative lack of attention to Harris’ proposal is more than a little ironic given all the grief she has taken for not putting forward enough policy, or not outlining a vision, or not distinguishing herself from President Joe Biden. Now she’s doing all three and the response is … a collective shrug?
It doesn’t have to be that way.
The basic challenge with long-term care is that it’s extraordinarily expensive, with the costs of full-time care for one person easily surpassing $100,000 a year. Nine in 10 adults say it would be “impossible or very difficult” to pay such costs on their own, according to fall 2023 survey from the health research organization KFF. And it’s not like they have many places +to turn.
Medicare doesn’t currently cover long-term care except in limited circumstances, and decent private coverage is almost impossible to find. That leaves Medicaid, which varies by state and requires people to impoverish themselves or transfer assets before they can qualify. Even then, it has limits on home care, often forcing people into nursing homes when they’d rather stay home.
Harris’ solution is to make in-home care a regular Medicare benefit, available to all enrollees. Her campaign didn’t provide a ton of detail — another reason, I suspect, the political world didn’t pay a lot of attention. But the official release cited an independent study that sketched out what such a program could look like and estimated it would require about $40 billion a year in new federal spending.
That works out to a ten-year figure approaching half a trillion dollars, after taking inflation into account. It would arguably represent the largest expansion of the welfare state since the Affordable Care Act, and the single biggest investment in caregiving in modern history.
Harris has suggested offsetting much of the cost with savings from another campaign proposal, one designed to reduce Medicare spending by extracting lower drug prices from manufacturers. Whether that would provide enough money and whether the fiscal tradeoffs are worthwhile are just some of the many questions Harris would have to answer if she were elected and able to pursue the proposal.
But whatever its very real pros and cons, the Harris plan represents one of the first serious, high-profile efforts to address a need that’s likely to touch most families eventually, one way or another. That alone makes it worthy of more attention than it’s gotten so far.
Just look at reaction on social media. Or listen to people like Mike Jennings.