Hello Fellow Netizens!
With less than a week until the Presidential Elections, Docnetizen will focus on the health policy issues receiving the most attention from candidates, aiming to educate and inform you about why they matter. This article will focus exclusively on a policy proposal from the Harris-Walz campaign regarding Medicare expansion for at-home medical services. Without further ado, let’s jump in to the topic!
The Current Landscape of Aging at Home
Aging at home is a popular concept among many Americans, especially elderly individuals who may require assistance with their day-to-day activities. A 2021 survey conducted by AARP (formerly the American Association of Retired Persons) found that 77 percent of adults aged 50 and older wish to remain in their homes long-term, a trend that has remained consistent for over a decade. The Centers for Disease Control and Prevention (CDC) also provides additional statistics that should be considered for older adults:
- 9.4% of noninstitutionalized persons age 65 and older had difficulty with self care
- 23.5% of noninstitutionalized persons age 65 and older reported having “fair or poor” health
- 89.7% of home health agency patients are age 65 and older
- Obesity affects at least 40 percent of individuals age 65–74, and a third of individuals older than 75 years old
- Hypertension affects at more than half of individuals age 65–74, and more than 80 percent of individuals older than 75 years old
Given these statistics, we can agree that as we age, our healthcare needs become more complex and can affect how we live if we choose to age at home. For individuals who require additional support, home health aides play a vital role in assisting with activities of daily living (ADLs), such as feeding oneself, and instrumental activities of daily living (IADLs), such as doing laundry or cooking. The cost of home health aides varies widely by region and depends on the local cost of living. ConsumerAffairs provides a chart outlining the average hourly rates for home health aides by state, which you can explore if you’re curious. In my state of Virginia, the average hourly cost is around $23. With a 40-hour workweek, this translates to an annual expense for agencies of approximately $47,840 per aide, excluding holidays and time off. In comparison, the average rate is $17 per hour in Louisiana and $33 per hour in Minnesota, highlighting how affordability for aging at home depends heavily on where you live.
Medicare provides coverage for some home healthcare services, but only under specific circumstances. According to Medicare.gov, Medicare Part A and/or Part B can cover expenses if a patient:
- Requires only part-time or intermittent skilled services, which may include physical therapy or assistance from health aides
- Is ‘homebound,’ meaning they have difficulty leaving their home without help (such as using a cane, wheelchair, walker, or crutches; special transportation; or assistance from another person) due to an illness or injury, or their condition makes it inadvisable to do so.
If these conditions are not met, it becomes extremely difficult to qualify for coverage. For example:
- The requirement for part-time or intermittent services may not suit elderly patients with complex conditions that demand near-constant monitoring.
- Family members or home health agencies not certified by Medicare do not qualify as providers of ‘skilled services.’ This is significant, as a 2015 AARP survey found that nearly one in five adults (19%) were providing unpaid care to someone with health or functional needs.
- Medicare does not cover certain services, such as meal delivery, homemaker services (like food shopping and cleaning), or custodial or personal care (e.g., help with bathing, dressing, or using the bathroom) if these are the only services needed.
Policy Proposals
The Harris-Walz campaign published a policy proposal earlier this month tackling this very issue. Their outline targets specific items of concern that we discussed previously:
Medicare enrollees will be independently evaluated by physicians or nurses as to whether seniors are unable to independently perform activities of daily living like bathing, eating, and going to the bathroom and/or face serious cognitive impairment. Aides will be designated by Medicare and can include any qualified home health aides, personal care attendants, or direct care workers recognized by their state
This is a reversal of one of the limitations Medicare imposed for what services it was able to cover.
[The Harris-Walz] initiative will provide care workers access to better wages, improve quality of care for seniors and those with disabilities, and treat our seniors with the dignity they deserve
This is supposedly to help improve the shortage of health care aides in certain parts of the country; this is a pattern affecting nearly all sectors of the medical field.
While not directly related to home healthcare, the Harris-Walz campaign is also proposing extended coverage for hearing and vision services, which are not currently covered by traditional Medicare. This would be a significant step, given the variability in coverage for both services through private insurance or certain Medicare Advantage plans. KFF notes in an article that ‘…difficulty with hearing and vision is relatively common among Medicare beneficiaries, with close to half (44%, or 25.9 million) of beneficiaries reporting difficulty hearing and more than one-third (35%, or 20.2 million beneficiaries) reporting difficulty seeing in 2019.’ One can easily see the potential benefits expanded coverage like this would offer older individuals who prefer to age at home, especially in preventing injuries from falls.
This all sounds great, right? But how can we afford it?
Money and Cost
The Harris-Walz campaign estimates that their proposal would cost taxpayers around $40 billion per year, based on an analysis by the Brookings Institution. Their plan to reduce the impact of this significant expense includes:
…[Expanding] Medicare drug negotiations, increasing the discounts drug manufacturers cover for certain brand-name drugs in Medicare, and cracking down on pharmaceutical benefit managers (PBMs) to increase transparency, disclose more information on costs, and regulate other practices that raise prices
These measures were outlined in the Inflation Reduction Act, signed into law by President Biden in 2022. However, there has been pushback on this strategy for generating savings. An article from Forbes pointed out that for fiscal year 2023-2024, the Congressional Budget Office (CBO) attributed only $226 million in estimated savings to a bill regulating PBMs. Additionally, federal intervention in drug pricing has produced unintended consequences, potentially leading to increased spending. The CBO estimated that certain drug-pricing provisions in the Inflation Reduction Act required temporary subsidies totaling $5 billion to offset significant premium increases for Part D beneficiaries.
Alternatively, Stanford University highlighted long-term federal savings from aggressive drug-pricing laws. For example, the Elijah E. Cummings Lower Drug Costs Now Act was projected by the CBO to reduce federal spending for Medicare by about $456 billion over a 10-year period.
…[Implementing] international tax reform so that we stop encouraging companies to shift jobs and profits overseas
This is a somewhat broad statement; however, it can be assumed that it reflects the Harris-Walz campaign’s strategy to increase investments in domestic healthcare companies, aiming to lower costs for those who wish to age at home.
We should remind ourselves that none of this is possible without acts of Congress, which will depend heavily on the outcome of the election. If Republicans maintain control of the House of Representatives and regain the Senate, a Harris presidency would face significant challenges in implementing any Medicare reforms as ambitious as those the campaign has proposed.
This is where you, fellow Netizens, come in. Whether you want to see policy changes like these will depend significantly on your vote. With Election Day fast approaching, I encourage you to do your research, vote for your candidates, and inspire others to vote as well!
Stay safe and until next time, fellow Netizens!
Featured Image: Photo by Andrea Piacquadio: https://www.pexels.com/photo/joyful-adult-daughter-greeting-happy-surprised-senior-mother-in-garden-3768131/
Disclaimer: This article reflects the author’s own opinions and statements. They do not reflect the opinions or stances of any organization affiliated with the author
