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.