MOVING CARE TO THE HOME — Vice President Kamala Harris has an ambitious plan to overhaul the way the nation cares for older Americans by allowing Medicare to offer home care benefits, Ben reports with POLITICO’s Robert King. Currently, Medicare covers home nursing care and home health aides in only limited circumstances, and Medicaid coverage is a patchwork across states. Many older Americans say they prefer receiving care at home than in institutional settings like nursing homes and hospitals. Harris’ proposal comes amid a broader push to bring more care into the home, sometimes using technology like telehealth and remote monitoring. The issue has bipartisan support in Congress and has been pitched as a way to reduce rampant health care spending. But making that plan a reality has roadblocks, including Congress and cost. Some questions remain, including: 1. How much will it cost? Experts say the proposal could save money by curbing unnecessary and pricey hospitalizations, and Harris’ proposed pay-fors could offset the costs. But there’s significant uncertainty. “There are just so many unknowns,” said Rachel Prusynski, assistant professor in the department of rehabilitation medicine at UW Medicine. The Harris campaign pointed to a proposal from a left-leaning think tank estimating a similar proposal would cost $400 billion over a decade. Marc Goldwein, senior vice president for the nonpartisan Committee for a Responsible Federal Budget, an advocacy group that supports “fiscal responsibility,” called that estimate “plausible.” Harris said the “large majority” of costs would be paid for by expanding Medicare drug price negotiations, boosting discounts pharma companies provide for some drugs in Medicare and requiring pharmacy benefit managers, which negotiate drug prices on behalf of insurers, to reveal more about their business practices. In 2019, the Congressional Budget Office estimated that expanding drug price negotiation to include more than twice the currently eligible medications could save more than $450 billion over a decade. But Harris has other ambitions that will cost money. “Is this enough also to cover these costs and cover the entire rest of their agenda?” Goldwein asked. “The answer appears to be no.” 2. What would it include? The benefit would aim to cover older adults’ everyday vital services like bathing and eating; current home health coverage in Medicare isn’t intended for longer-term care. Some of the uncertainty surrounding the cost stems from the lack of details about the benefit structure, said Rachel Prusynski, assistant professor in the department of rehabilitation medicine at UW Medicine. The campaign said doctors or nurses would evaluate Medicare enrollees. Medicare would designate aides, such as “qualified home health aides, personal care attendants, or direct care workers.” 3. Who’s eligible? If passed by Congress and signed into law, the new benefit would be available to everyone on Medicare. However, it’s unclear whether beneficiaries’ income would affect cost-sharing amounts. “You can make this thing as expensive or inexpensive as you need it to be,” said Sherry Glied, a Brookings fellow and dean of New York University’s Robert F. Wagner School of Public Service. WELCOME TO THURSDAY PULSE. We’re thinking of all our readers and their loved ones in areas impacted by Hurricanes Helene and Milton. Send your tips, scoops and feedback to ccirruzzo@politico.com and bleonard@politico.com and follow along @ChelseaCirruzzo and @_BenLeonard_.
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