By the time you read this, it’s possible this year’s presidential election will be over. Regardless of the outcome, there has recently been a remarkable proposal regarding homecare that should not go unnoticed. We can either hold Kamala Harris to her campaign promise, or advocate for Donald Trump to follow suit.
The Affordable Care Act, passed in 2010, protected people with disabilities by making it illegal for insurers to deny coverage or impose waiting periods for applicants with preexisting conditions. Republicans tried to repeal it well over a hundred times by attaching repeal amendments to bills which had to pass. They always said they’d substitute a better plan, but not once in the past 14 years have they produced a bill. As far as I can tell, after reviewing the Trump campaign materials, long term care is unaddressed. (He still supports repeal of the Affordable Care Act.)
Kamala Harris, however, has proposed a change to the Medicare program that would dramatically improve the health and quality of the lives of millions with disabilities and seniors needing homecare services to reside in the community and stay out of nursing homes.
The federal Medicaid program currently pays for personal care for people with disabilities and seniors. The states can opt in or out of Medicaid’s homecare program. They are required to pay a participatory share and the nature and extent of services provided depends on the level of state participation. Medicaid requires recipients to be poor and retaining income is difficult. Work incentive programs have not solved this problem.
The Harris proposal would have Medicare cover homecare for seniors and Medicare-eligible people with disabilities. Income would not be an issue. This would be paid for by negotiating Medicare drug prices and stopping fraud and abuse.
The concept, extremely attractive to seniors, allows them to age in place with, at least partial Medicare coverage. On the TV show “The View,” Harris described the “sandwich generation”—people, mostly women, who care for their parents and children. These caregivers also hold jobs outside the home, which Harris said is untenable for families. She proposed Medicare-sponsored personal care assistance. She also proposed adding vision and hearing care to the Medicare benefits package.
Medicare recipients who are not poor enough to qualify for Medicaid but are in need of homecare services pay privately, out of their own pockets. If they need enough care they are eventually impoverished and end up on Medicaid.
Currently, there is a vast shortage of personal care workers for multiple reasons, including low pay and the fact that Medicaid requires workers to have a Social Security number. The vast majority of care workers are employed by companies that contract with local governments.
Where could all the new homecare workers necessary for Harris’s proposal to be successful come from? The Medicare homecare proposal could be enhanced by comprehensive immigration reform. Undocumented workers are currently employed as personal care assistants, mostly by those who self-pay in untaxed cash.
Creating a migrant worker program in the homecare field, with a path to citizenship, enhanced training, and opportunity for advancement would afford seniors and those with disabilities in need of homecare the ability to stay out of nursing facilities and will make the difficult work of personal care assistance more attractive to the labor force—a win for all.
Opinions expressed are solely those of the writer(s) and do not necessarily reflect the opinions of Able News at The Viscardi Center and/or The Viscardi Center.