Medicare – TheNewsHub

Biden highlights drug price reductions with New Hampshire visit

Harsh — Tue, 22 Oct 2024 21:11:00 +0000

President Biden visits Democratic Party Headquarters in Manchester, NH

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Concord, New Hampshire – President Biden touted his administration’s progress in bringing down medication costs during a visit to New Hampshire on Tuesday alongside Sen. Bernie Sanders, as the president seeks to cement his policy legacy.

Mr. Biden said Americans pay the highest prices in the world for prescription drugs because of the high prices pharmaceutical companies charge. “It’s not capitalism. It’s exploitation when Big Pharma doesn’t play by the rules,” Mr. Biden said.

Mr. Biden spoke at Concord Community College, where he highlighted a new report by the Department of Health and Human Services that found nearly 1.5 million Medicare enrollees saved nearly $1 billion on prescription drugs in the first half of 2024. Even though it was an official White House event, the president needled former President Trump over the Republican nominee’s comment that he has “concepts” of a health care plan, the latest example of how murky the line between official and political events can be in a presidential election year.

“I’m trying to be a very good fellow,” Mr. Biden said. “I’m not letting my Irish get the best of me. But my predecessor, the distinguished former president, he wants to replace the Affordable Care Act with what he calls, this is what he refers to it as, a concept of a plan. I’ve heard that concept of a plan now for almost eight years. A concept of a plan — what the hell is a concept of a — he has no concept of anything! No plan!”

The savings are a result of the cap on out-of-pocket drug costs put in place by the Inflation Reduction Act, a signature piece of legislation the president signed into law in 2022. The law capped out-of-pocket drug costs for Medicare beneficiaries at $3,500 per year, and next year the cap will go down to $2,000 per year.

“Congress has talked a lot about this, but just never got much done. And partly it had to do with the fact that Pharma is such a big lobbyist,” Leighton Ku, a professor in the department of health policy and management at George Washington University, said in an interview with CBS News. “So the fact that the Biden administration could work with Congress to get even these marginal things done is impressive.”

The Biden administration had previously negotiated prices for 10 widely used prescription drugs after a back-and-forth between Medicare and drug manufacturers, and capped insulin at $35 per month for many patients.

On Monday, the White House also proposed a plan that, if put into effect, would require private insurers to cover over-the-counter birth control methods at no cost to patients.

In a statement released ahead of Tuesday’s event, Sanders praised the administration’s efforts to lower drug prices. “For the first time in history, Medicare is negotiating to lower the prices of some of the most expensive prescription drugs in America,” the Vermont senator said. “But, let’s be clear. Much more needs to be done. In my view, nobody in America should be paying more for prescription drugs than they do in Europe or Canada.”

Mr. Biden is also expected to make a stop at a campaign office while in the Granite State.

Kathryn Watson

contributed to this report.

Medicare drug plans are getting better next year. Some will also cost more.

Harsh — Mon, 21 Oct 2024 19:58:23 +0000

When Pam McClure learned she’d save nearly $4,000 on her prescription drugs next year, she said, “it sounded too good to be true.” She and her husband are both retired and live on a “very strict” budget in central North Dakota.

By the end of this year, she will have spent almost $6,000 for her medications, including a drug to control her diabetes.

McClure, 70, is one of about 3.2 million people with Medicare prescription drug insurance whose out-of-pocket medication costs will be capped at $2,000 in 2025 because of the Biden administration’s 2022 Inflation Reduction Act, according to an Avalere/AARP study.

“It’s wonderful — oh my gosh. We would actually be able to live,” McClure said. “I might be able to afford fresh fruit in the wintertime.”

The IRA, a climate and health care law that President Joe Biden and Vice President Kamala Harris promote on the campaign trail as one of their administration’s greatest accomplishments, radically redesigned Medicare’s drug benefit, called Part D, which serves about 53 million people 65 and older or with disabilities. The administration estimates that about 18.7 million people will save about $7.4 billion next year alone due to the cap on out-of-pocket spending and less publicized changes.

The annual enrollment period for Medicare beneficiaries to renew or switch drug coverage or to choose a Medicare Advantage plan began Oct. 15 and runs through Dec. 7. Medicare Advantage is the commercial alternative to traditional government-run Medicare and covers medical care and often prescription drugs. Medicare’s stand-alone drug plans, which cover medicines typically taken at home, are also administered by private insurance companies.

“We always encourage beneficiaries to really look at the plans and choose the best option for them,” Chiquita Brooks-LaSure, who heads the Centers for Medicare & Medicaid Services, told KFF Health News. “And this year in particular it’s important to do that because the benefit has changed so much.”

Improvements to Medicare drug coverage required by the IRA are the most sweeping changes since Congress added the benefit in 2003, but most voters don’t know about them, KFF surveys have found. And some beneficiaries may be surprised by a downside: premium increases for some plans.

CMS said Sept. 27 that nationwide the average Medicare drug plan premium fell about $1.63 a month — about 4% — from last year. “People enrolled in a Medicare Part D plan will continue to see stable premiums and will have ample choices of affordable Part D plans,” CMS said in a statement.

However, an analysis by KFF, a health information nonprofit that includes KFF Health News, found that “many insurers are increasing premiums” and that large insurers including UnitedHealthcare and Aetna also reduced the number of plans they offer.

Many Part D insurers’ initial 2025 premium proposals were even higher. To cushion the price shock, the Biden administration created what it calls a demonstration program to pay insurers $15 extra a month per beneficiary if they agreed to limit premium increases to no more than $35.

“In the absence of this demonstration, premium increases would certainly have been larger,” Juliette Cubanski, deputy director of the Program on Medicare Policy at KFF, wrote in her Oct. 3 analysis.

Nearly every Part D insurer agreed to the arrangement. Republicans have criticized it, questioning CMS’ authority to make the extra payments and calling them a political ploy in an election year. CMS officials say the government has taken similar measures when implementing other Medicare changes, including under President George W. Bush, a Republican.

In California, for example, Wellcare’s popular Value Script plan went from 40 cents a month to $17.40. The Value Script plan in New York went from $3.70 a month to $38.70, a more than tenfold hike — and precisely a $35 increase.

Cubanski identified eight plans in California that raised their premiums exactly $35 a month. KFF Health News found that premiums went up for at least 70% of drug plans offered in California, Texas, and New York and for about half of plans in Florida and Pennsylvania — the five states with the most Medicare beneficiaries.

Spokespeople for Wellcare and its parent company, Centene Corp., did not respond to requests for comment. In a statement this month, Centene’s senior vice president of clinical and specialty services, Sarah Baiocchi, said Wellcare would offer the Value Script plan with no premium in 43 states.

In addition to the $2,000 drug spending limit, the IRA caps Medicare copayments for most insulin products at no more than $35 a month and allows Medicare to negotiate prices of some of the most expensive drugs directly with pharmaceutical companies.

It will also eliminate one of the drug benefit’s most frustrating features, a gap known as the “donut hole,” which suspends coverage just as people face growing drug costs, forcing them to pay the plan’s full price for drugs out-of-pocket until they reach a spending threshold that changes from year to year.

The law also expands eligibility for “extra help” subsidies for about 17 million low-income people in Medicare drug plans and increases the amount of the subsidy. Drug companies will be required to chip in to help pay for it.

Starting Jan. 1, the redesigned drug benefit will operate more like other private insurance policies. Coverage begins after patients pay a deductible, which will be no more than $590 next year. Some plans offer a smaller or no deductible, or exclude certain drugs, usually inexpensive generics, from the deductible.

After beneficiaries spend $2,000 on deductibles and copayments, the rest of their Part D drugs are free.

That’s because the IRA raises the share of the bill picked up by insurers and pharmaceutical companies. The law also attempts to tamp down future drug price hikes by limiting increases to the consumer price inflation rate, which was 3.4% in 2023. If prices rise faster than inflation, drugmakers have to pay Medicare the difference.

“Before the redesign, Part D incentivized drug price increases,” said Gina Upchurch, a pharmacist and the executive director of Senior PharmAssist, a Durham, North Carolina, nonprofit that counsels Medicare beneficiaries. “The way it is designed now places more financial obligations on the plans and manufacturers, pressuring them to help control prices.”

Another provision of the law allows beneficiaries to pay for drugs on an installment plan, instead of having to pay a hefty bill over a short period of time. Insurers are supposed to do the math and send policyholders a monthly bill, which will be adjusted if drugs are added or dropped.

Along with big changes brought by the IRA, Medicare beneficiaries should prepare for the inevitable surprises that come when insurers revise their plans for a new year. In addition to raising premiums, insurers can drop covered drugs and eliminate pharmacies, doctors, or other services from the provider networks beneficiaries must use.

Missing the opportunity to switch plans means coverage will renew automatically, even if it costs more or no longer covers needed drugs or preferred pharmacies. Most beneficiaries are locked into Medicare drug and Advantage plans for the year unless CMS gives them a “special enrollment period.”

“We do have a system that is run through private health plans,” CMS chief Brooks-LaSure said. But she noted that beneficiaries “have the ability to change their plans.”

But many don’t take the time to compare dozens of plans that can cover different drugs at different prices from different pharmacies — even when the effort could save them money. In 2021, only 18% of Medicare Advantage drug plan enrollees and 31% of stand-alone drug plan members checked their plan’s benefits and costs against competitors’, KFF researchers found.

For free, unbiased help selecting drug coverage, contact the State Health Insurance Assistance Program at shiphelp.org or 1-877-839-2675.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Drug costs, abortion, Obamacare: How Trump and Harris could change U.S. health care

Harsh — Sat, 19 Oct 2024 12:00:01 +0000

President Donald Trump talks to the press outside the White House, July 19, 2019, left, and Democratic presidential nominee and U.S. Vice President Kamala Harris speaks to mark the one-year anniversary of the Oct. 7 Hamas attacks on Israel, at the vice president’s residence at the U.S. Naval Observatory in Washington, Oct. 7, 2024.

Getty Images (L) | Reuters (R)

Prescription drug costs. Abortion rights. The future of Obamacare.

The fast-approaching presidential election between Vice President Kamala Harris and former President Donald Trump could lead to a huge range of outcomes for patients on those issues and others in the sprawling U.S. health system.

Both candidates are pledging to make care more affordable in the U.S., an outlier in the developed world due to its higher health-care spending, worse patient outcomes and barriers to access. But the candidates appear to have different approaches to doing so if elected.

The candidates have not yet released detailed proposals on health policy, which ranks slightly lower than other issues at the top of voters’ minds, such as the economy. But each candidate’s track record provides a glimpse of what drug costs, health care and reproductive rights could look like over the next several years.

“A Trump administration will try to slash federal health spending to pay for tax cuts and reduce the role of the federal government in health,” Drew Altman, CEO and president of health policy research organization KFF, told CNBC. He said a Harris administration “will build on existing programs, increasing federal spending to make health care more affordable for people.”

It wouldn’t be easy for either administration to make sweeping changes: The U.S. has a complicated and entrenched health-care system of doctors, insurers, drug manufacturers and other middlemen, which costs the nation more than $4 trillion a year. Any overhaul of the U.S. health-care system would also depend on which party controls Congress, and on the policies state lawmakers pass.

Despite spending more on health care than any other high-income country, the U.S. has the lowest life expectancy at birth, the highest rate of people with multiple chronic diseases and the highest maternal and infant death rate among those nations, according to a 2023 report published by The Commonwealth Fund, an independent research group.

Around half of American adults say it is difficult to afford health care, which can drive some patients into debt or lead them to put off necessary care, according to a May poll conducted by KFF.

Here’s how Harris and Trump differ in their approaches to key health-care issues.

nearly three times higher than those in other countries, according to the nonprofit research firm RAND.

About 1 in 5 adults say they have not filled a prescription in the last year because of the cost, while roughly 1 in 10 say they have cut pills in half or skipped doses, according to the March KFF survey.

Activists protest the price of prescription drug costs in front of the U.S. Department of Health and Human Services building in Washington, D.C., on Oct. 6, 2022.

Anna Moneymaker | Getty Images

Many of Trump’s efforts to rein in drug prices have either been temporary or not immediately effective, according to some health policy experts. On the campaign trail, the former president has also provided few specifics about his plans for lowering those costs.

Some of Harris’ proposals are not fully fleshed out, but if elected she can build on the Biden administration’s efforts to save patients more money, experts said.

Harris plans to expand certain provisions of President Joe Biden’s Inflation Reduction Act, part of which aims to lower health-care costs for seniors enrolled in Medicare. In 2022, she cast the tie-breaking Senate vote to pass the legislation.

Harris’ campaign says she intends to extend two provisions to all Americans, not just older adults in Medicare: a $35 limit on monthly insulin costs and a $2,000 annual cap on out-of-pocket drug spending.

She also plans to expand and speed up the pace of Medicare drug price negotiations with manufacturers to cover more expensive drugs. The landmark policy, passed as part of the IRA, has faced fierce opposition from the pharmaceutical industry, as some companies have challenged its constitutionality in court.

Trump has not indicated what he intends to do about IRA provisions.

Many Republicans have been vocal critics of the drug pricing negotiations, claiming they harm innovation and will lead to fewer cures, according to Dr. Mariana Socal, a health policy professor at the Johns Hopkins Bloomberg School of Public Health. Trump made a similar argument in 2020 when he opposed a separate Democratic bill that would allow Medicare to negotiate drug prices.

Still, Socal said a Trump administration wouldn’t have much flexibility to dismantle or scale back the law without change from Congress.

Some of Trump’s efforts to lower drug prices during his presidency “didn’t really come into fruition,” Socal added.

In 2020, he signed an executive order to ensure Medicare didn’t pay more than the lowest price that select other developed countries pay for drugs. But the Biden administration ultimately rescinded that policy following a court order that blocked it.

The Trump campaign this month said the former president would not try to renew the plan if reelected.

Also in 2020, Trump issued a rule setting up a path to import prescription drugs from Canada, where medication prices are 44% of those in the U.S. But it took years for the measure to gain momentum. The Biden administration only in January approved Florida’s plan to import some prescription treatments from Canada.

Trump also set a $35-per-month cap on some insulin products for seniors through a temporary program that Medicare prescription drug plans, also known as Part D plans, could choose to join. The program was in effect from 2021 to 2023, and less than half of all Part D plans opted to participate each year, according to KFF.

But that measure was much more limited than the Biden administration’s insulin price cap, which requires all Part D plans to charge no more than $35 per month for all covered insulin products. It also limits cost-sharing for insulin covered by Medicare Part B plans.

Both administrations would likely continue to scrutinize pharmacy benefit managers, the drug supply chain middlemen who negotiate rebates with manufacturers on behalf of insurance plans, according to Dr. Stephen Patrick, chair of the health policy and management department at Emory University.

Lawmakers and the Biden administration have recently ramped up pressure on PBMs, accusing them of raking in profits while inflating prescription medication prices and harming U.S. patients and pharmacies.

she would not back the program as president.

But Harris has supported the Affordable Care Act, also known as Obamacare, since she was a senator, consistently voting against bills to repeal the plan and reasserting her commitment to strengthen it during the presidential debate on Sept. 10.

The ACA was designed to extend health coverage to millions of uninsured Americans and implement reforms to the insurance market. The law expanded Medicaid eligibility, mandated that Americans purchase or otherwise obtain health insurance, and prohibited insurance companies from denying coverage due to preexisting conditions, among other provisions.

The IRA extended enhanced subsidies that made ACA health plans more affordable for millions of households through 2025 — a provision Harris plans to make permanent if elected, her campaign said.

Harris may also work with Congress to try to extend Medicaid coverage in the 10 states that haven’t expanded it under the ACA, some experts said. Medicaid provides coverage for 81 million people, or more than 1 in 5 Americans, according to KFF.

The program is the largest source of federal funding to states. It covers low-income patients and families, as well as those with complex and costly needs, such as people with disabilities and individuals experiencing homelessness.

But if Republicans control even one branch of Congress, boosting Medicaid coverage will “be much tougher, if not impossible to do,” KFF’s Altman said.

Democrats face a difficult path to retaining their slim Senate majority, while Republicans are trying to cling to narrow control of the House.

Vice President Kamala Harris greets guests after speaking at an event celebrating the 13th anniversary of the Affordable Care Act in the East Room of the White House in Washington, D.C., March 23, 2023.

Nathan Posner | Anadolu | Getty Images

Meanwhile, Trump led multiple failed crusades to repeal the ACA during his first term. In a campaign video in April, Trump said he was not running on terminating the law and would rather make it “much, much better and far less money,” though he has provided no specific plans. Many Republicans have abandoned their promises to repeal the law after it grew more popular in recent years.

During the Sept. 10 debate, Trump reiterated his belief that the ACA was “lousy health care.” But he did not offer a replacement for the law when asked, saying only that he has “concepts of a plan.”

KFF noted that Trump’s previous replacement proposals would have made the ACA less expensive for the federal government but raise out-of-pocket premiums for patients, lead to more uninsured Americans and increase risks for states.

A Trump administration would likely have major implications for Medicaid, Altman said.

Notably, Trump has said he would not cut spending for Medicare and Social Security. But that makes Medicaid, which costs the federal government more than $600 billion a year, a target for severe cuts, Altman noted.

He said Trump could make fundamental changes to the program to curtail enrollment, such as lifetime limits on how many years people can get Medicaid coverage.

A rally against Medicaid cuts in front of the U.S. Capitol on June 6, 2017.

Bill Clark | CQ-Roll Call, Inc. | Getty Images

Trump could also revisit some of his earlier attempts to reduce spending on Medicaid. As president, he approved eligibility restrictions such as work requirements, and proposed changing the way the federal government gives money to states for Medicaid into a “block grant” program.

That refers to the government providing states with a fixed amount of money to administer and provide Medicaid services in exchange for more flexibility and less oversight.

The Biden administration withdrew some of those restrictions and encouraged waivers that would expand Medicaid coverage and reduce health disparities, which Harris would likely pursue if elected, experts said.

A Democratic House or Senate would likely block any of Trump’s sweeping changes to Medicaid, according to Altman.

“My theory is that if the Democrats hold even one house in Congress, all of that will fail,” he said. “There’ll be a big debate, but it will fail. Medicaid is too big.”

a late August poll by The New York Times and Siena College.

This is the first presidential election held since the Supreme Court overturned Roe v. Wade, the landmark ruling that established the constitutional right to abortion in the U.S. in 1973.

Abortion access in the U.S. has been in a state of flux in the roughly two years since the court’s decision, which has given conservative governors and legislatures the power to limit the procedure in their states. As of last year, more than 25 million women ages 15 to 44 lived in states where there are more restrictions on abortion than before the court’s ruling in 2022, PBS reported.

Vice President Kamala Harris speaks about Florida’s new 6-week abortion ban during an event at the Prime Osborn Convention Center in Jacksonville, Florida, May 1, 2024.

Joe Raedle | Getty Images

The future of abortion rights could look starkly different depending on which candidate holds office, according to Stacey Lee, professor of health law and ethics at the Johns Hopkins Carey Business School. That leaves the reproductive well-being of many women, especially lower-income people and people of color, hanging in the balance.

Harris has long been a staunch advocate of abortion access and has seized the opportunity to highlight what some health policy experts and voters consider the extreme and often inconsistent views of Trump and the broader Republican Party.

She has blamed Trump, who appointed three members of the Supreme Court’s conservative majority, for the reversal of Roe v. Wade, and urged Congress to pass a national law codifying abortion rights. Democrats have not had enough votes in Congress to pass such protections under Biden.

Last month, Harris also said she supports eliminating the filibuster in the U.S. Senate to restore federal abortion protections as they existed under Roe v. Wade. The filibuster rule requires a 60-vote threshold for most legislation to pass, which makes it difficult for lawmakers to approve bills in a closely divided Senate.

Harris has also “been a firm proponent” of defending the availability of the abortion pill mifepristone, Lee said. Anti-abortion physicians squared off with the Food and Drug Administration in 2023 in an unprecedented legal battle over the agency’s more than two-decade-old approval of the medication.

In June, the Supreme Court unanimously dismissed the challenge to mifepristone and sided with the Biden administration, meaning the commonly used medication could remain widely available. The administration’s FDA also revised restrictions on medication abortion, allowing certain certified retail pharmacies to dispense the pills.

Meanwhile, Trump vaguely suggested in August that he would not rule out directing the FDA to revoke access to mifepristone. Just days later, his running mate, Sen. JD Vance, of Ohio, attempted to walk back those remarks.

Trump’s comments appear to be a shift from his stance in June, when the former president said during a CNN debate that he “will not block” access to mifepristone.

During his time in office, Trump introduced several anti-abortion measures. That includes a “gag rule” that would have made clinics, such as Planned Parenthood, ineligible for federal health funds if they provided abortions or referrals for them.

Vance this month also said a future Trump administration would defund Planned Parenthood.

But Trump has also waffled over the last few years on abortion policy, appearing to soften his stance on the issue to appeal to more moderate and independent voters.

He takes credit for Roe v. Wade’s demise since he reshaped the court, and his latest stance is that abortion policy should be set by the states. Earlier this year, however, Trump lamented that certain state laws go “too far.”

During a radio interview in March, Trump said he would consider a national ban on abortions around 15 weeks of pregnancy.

But earlier this month, he said he would not support a federal abortion ban, writing in a post on X he would veto one. He added that he supports exceptions in cases of rape and incest and to save the life of a pregnant woman.

“It is difficult to find consistency within his policies, but that lack of consistency should amplify that perhaps anything is possible in terms of a more restrictive stance to abortion and reproductive rights,” Lee said.

President Donald Trump arrives to speak at the 47th annual anti-abortion “March for Life” in Washington, D.C., Jan. 24, 2020.

Nicholas Kamm | Afp | Getty Images

Meanwhile, both Harris and Trump have recently expressed their support for in vitro fertilization, a type of fertility treatment performed outside of the body in a lab. It accounts for roughly 2% of births in the U.S. but is extremely costly for many low- and middle-income people who need the technology to start families.

It became a campaign issue after the Alabama Supreme Court ruled in February that frozen embryos created during the IVF process could be considered children, which threatened the availability of those services in the state.

Trump has called for the government or private insurers to pay for IVF treatment. Harris has said she would defend the right to both IVF and contraception, but has not specified how she would do so.

What is Harris' "Medicare at Home" plan and how would it work?

Harsh — Wed, 09 Oct 2024 01:46:52 +0000

Vice President Kamala Harris is proposing an expansion of Medicare to cover the costs of an in-home aide for many seniors, a direct pitch to the “sandwich generation” of adults caring for aging parents in addition to their own children.

The plan, dubbed “Medicare at Home,” focuses on having Medicare cover costs of home care services and nurses as a way for families to help avoid costs of nursing homes. Harris is pairing it with a plan she’s already announced that would expand the child care tax credit to up to $3,600, and $6,000 for parents with newborns.

Harris unveiled the plan in a Tuesday interview on “The View” talk show, where she talked about her own experience taking care of her mother while she had cancer.

She emphasized that her plan would be an expansion of Medicare, rather than Medicaid. This would enable it to coexist with private insurance. Medicaid also has certain stricter eligibility rules.

About a quarter of U.S. adults are part of the sandwich generation of those taking care of children and aging parents, according to census data. A Harris campaign official says its internal data shows this demographic of caregivers has a substantial number of undecided voters.

“In an election this close, proposals that speak to the financial security and health care needs of older Americans will resonate and can make a difference,” said Rich Fiesta, the executive director of the Alliance for Retired Americans, who has a PAC running anti-Trump advertisements.

A September AARP poll showed that 78% of women who are over 50 years old and care for older family members say they’ve been struggling financially. Another AARP poll in Pennsylvania, a crucial battleground state, showed former president Donald Trump with an edge among voters 50 and over: 53% for Trump and 44% for Harris.

Except for the poorest seniors, for whom Medicaid can pick up the tab, most older adults have to rely on their own savings or family members for home care when they can no longer handle all of their daily needs but aren’t ready to move to a long-term care facility.

“We increasingly encounter families that want to qualify for Medicaid today that aren’t considered the lowest income, but for whom providing and paying for long-term care is making them low income,” said Kevin Prindiville, executive director of the group Justice in Aging.

Democrats have accused Trump of supporting cuts to Medicare’s budget during his term in the White House, a charge that the Republican candidate has denied.

While he floated the idea in a March CNBC interview, saying, “There is a lot you can do in terms of entitlements in terms of cutting,” he then suggested that these cuts would affect “the theft and the bad management of entitlements.”

He has since said he won’t “cut one penny” from Social Security or Medicare, and the Republican Party platform has similar language.

How much would “Medicare at home” cost?

Adding Medicare coverage for home care could start at $40 billion annually, according to an estimate from a Brookings Institution study cited by the campaign.

However, the authors of the study caution that their figure is only a starting point for a “very conservatively designed universal program.” The ultimate price tag could be significantly higher, depending on how generous Congress is willing to be.

“It’s not saying it’s the program we should adopt, but just that you could make this work for dollars that are not crazy,” said Jonathan Gruber, chairman of the economics department at the Massachusetts Institute of Technology and a co-author of the estimate.

Gruber said the modeling also did not factor in major savings that the benefit could spur as ripple effects, like less money spent on nursing homes or family members who would be able to return to full-time jobs.

“We think we’re going to free potentially millions of informal care workers to go earn income in the labor market. And they’re going to pay taxes,” he said.

How would Harris pay for Medicare at home?

Harris said her expansion will be paid for mainly by expanding the Medicare Drug Price Negotiation Program, combined with a list of other reforms, like increasing the discounts that drugmakers would have to offer for brand-name prescriptions.

This is not the first time that Harris has pledged to expand the Inflation Reduction Act’s policies targeting prescription drug prices. Medicare is currently on track to save only $31 billion each year from the negotiation program and other drug price provisions, which would fall short of covering even the starting price tag for her proposal.

Harris has called on Congress to broaden the drug negotiation program, accelerating the pace of new price caps set by Medicare and making more drugs subject to the limits. More aggressive drug price negotiations could save hundreds of billions over the next decade, according to a Stanford University white paper cited by the campaign, assuming it’s able to survive an uphill battle on Capitol Hill.

Marc Cohen is the co-director of a center focused on long-term services and support backed by LeadingAge, the association of nonprofit providers of aging services. LeadingAge has called for adding home care to Medicare for years, as a fix to the “dangerously broken” system.

“At some point we will need to talk about a source, like Medicare itself, to pay for it. But I think that’s a very clever idea right now for getting this going. And then what you do is develop a constituency of political support, even for the young generation to say, ‘I want this to be available for my parents,'” Cohen, a professor of gerontology at the University of Massachusetts Boston, said.

Who would be covered by Harris’ Medicare at Home” proposal?

All Medicare enrollees deemed to be “unable to independently perform activities of daily living like bathing, eating and going to the bathroom” would be eligible after being screened by physicians or nurses, according to the campaign’s proposal. People with “serious cognitive impairment” would also be covered.

Not everyone would get all their costs paid for by Medicare. Seniors with higher incomes would have to pay a larger share of the cost out of their own pockets.

The details of that coverage are a big factor that could also impact the cost of the plan, affecting how many Americans end up taking advantage of the proposed benefit.

Only home care aides “designated by Medicare” would be covered under the proposal, which would include “any qualified home health aides, personal care attendants, or direct care workers recognized by their state.”

The campaign did not address whether family members would be able to be paid with cash for taking care of an older relative, as a previous bill by House Democrats had proposed.

Prindiville said that was among the things they were hoping for in the details of the proposal, as lawmakers try to “strike the right balance” to make home care more affordable.

“When families want to provide that care, let’s pay them for it so that economically it makes sense,” said Prindiville.

Alexander Tin

Alexander Tin is a digital reporter for CBS News based in the Washington, D.C. bureau. He covers the Biden administration’s public health agencies, including the federal response to infectious disease outbreaks like COVID-19.