The Democratic presidential nominee, Vice President Kamala Harris, on Tuesday announced a proposal on long-term care under Medicare focused on the “sandwich generation,” which refers to Americans who are caring for their children while also caring for aging parents. (Photo by Getty Images)

Vice President Kamala Harris unveiled a plan Tuesday that would strengthen Medicare coverage to include long-term care for seniors in their homes, tackling one of the biggest challenges in U.S. health care.

The Democratic presidential nominee revealed the proposal while on “The View” — one of several high-profile media appearances this week as she and the GOP presidential nominee, former President Donald Trump, sprint to the November finish line.

“There are so many people in our country who are right in the middle: They’re taking care of their kids and they’re taking care of their aging parents, and it’s just almost impossible to do it all, especially if they work,” Harris said during the live interview. “We’re finding that so many are then having to leave their job, which means losing a source of income, not to mention the emotional stress.”

Harris is focusing on the “sandwich generation,” which refers to Americans who are caring for their children while also caring for aging parents.

Under the plan, Medicare — the nation’s health insurance program for people 65 and older and some under 65 with certain disabilities or conditions — would cover an at-home health benefit for those enrolled in the program, as well as hearing and vision benefits, according to her campaign in a Tuesday fact sheet.

Medicare for the most part now does not cover long-term care services like home health aides.

The benefits would be funded by “expanding Medicare drug price negotiations, increasing the discounts drug manufacturers cover for certain brand-name drugs in Medicare, and addressing Medicare fraud,” per her campaign.

Harris also plans to “crack down on pharmaceutical benefit managers (PBMs) to increase transparency, disclose more information on costs, and regulate other practices that raise prices,” according to her campaign, which said she will also “implement international tax reform.”

The campaign did not cite a price tag but noted similar plans have been estimated to cost $40 billion annually, “before considering ​​savings from avoiding hospitalizations and more expensive institutional care, or the additional revenues that would generate from more unpaid family caregivers going back to work if they need to.”

The proposal comes along with the nominee’s sweeping economic plan, part of which involves cutting taxes for more than 100 million Americans, including $6,000 in tax relief for new parents in the first year of their child’s life.

Trump responds

In response to the proposal, the Trump campaign said the former president “will always fight for America’s senior citizens — who have been left behind by Kamala Harris,” per a Tuesday news release.

The campaign also cited Medicare Advantage policies extended by the Centers for Medicare and Medicaid Services in Trump’s first term.

The campaign reiterated the 2024 GOP platform’s chapter on protecting seniors, saying Trump will “prioritize home care benefits by shifting resources back to at-home senior care, overturning disincentives that lead to care worker shortages, and supporting unpaid family caregivers through tax credits and reduced red tape.”

Harris and Howard Stern

While appearing live on “The Howard Stern Show” on Tuesday shortly after “The View,” Harris dubbed Trump an “unserious man,” saying the consequences of him serving another term are “brutally serious.”

She also again criticized Trump for nominating three of the five members to the U.S. Supreme Court who voted to overturn Roe v. Wade in June 2022 — a reversal that ended nearly half a century of the constitutional right to abortion.

“And it’s not about abortion, you have basically now a system that says you as an individual do not have the right to make a decision about your own body. The government has the right to make that decision for you,” she said.

Harris, who said she would appoint a Republican to her Cabinet if elected, was asked whether she would choose former Wyoming Rep. Liz Cheney.

Cheney was the vice chair of the U.S. House Jan. 6 committee tasked with investigating the 2021 attack on the U.S. Capitol.

Harris did not disclose a preference, but said Cheney is “smart,” “remarkable” and a “dedicated public servant.”

Cheney is among some prominent Republicans to endorse Harris. She campaigned with the veep in Ripon, Wisconsin — the birthplace of the Republican Party — just last week.

Trump talks with Ben Shapiro

Meanwhile, Trump said Harris is “grossly incompetent” during an interview that aired Tuesday on “The Ben Shapiro Show.”

“Biden was incompetent, she is equally incompetent and in a certain way, she’s more incompetent,” Trump told Shapiro, a conservative political commentator and co-founder of The Daily Wire, referring to President Joe Biden.

Trump also criticized Harris’ Monday interview on CBS News’ “60 Minutes,” saying the veep “answers questions like a child.”

“She’s answering questions in the most basic way and getting killed over it,” Trump added.

Look ahead for Harris, Trump campaigns

Harris was also set to also appear on CBS’ “The Late Show with Stephen Colbert” on Tuesday night. She will also appear at a Univision town hall in Las Vegas, Nevada, that airs Thursday.

Trump was slated to participate in a roundtable with Latino leaders and a Univision town hall on Tuesday in Miami, but both events were postponed due to Hurricane Milton.

Trump is set to give remarks Wednesday in Scranton, Pennsylvania. Later that day, he will continue campaigning in the Keystone State with a rally in Reading.

GET THE MORNING HEADLINES.

SUBSCRIBE

Reading Time: 4 minutes

Gov. Tony Evers earlier this month announced a plan to spend $258 million in pandemic relief to increase Medicaid reimbursements to long-term care providers — a proposal previously halted by the Legislature’s Republican budget-writing committee.

The Democrat’s move kept long-term care, among other issues affecting families, in the middle of his tug of war with the Republican-controlled Legislature over spending authority. While a July Wisconsin Supreme Court ruling gave more leeway to the Evers administration, the outcome of a Tuesday vote on two constitutional amendment questions could shift some power back to the Legislature.

A yes vote on both questions would restrict the governor’s ability to allocate emergency federal funds without legislative approval.

Those votes and the outcome of any squabbling over Evers’ plan to boost compensation for long-term care providers will shape the spending power of each branch of government.

Evers’ Medicaid reimbursement increase is among few — if not the only — active statewide efforts to rescue long-term care providers as they endure challenges that threaten their service to elderly residents and people with disabilities.

As the proportion of Wisconsin’s senior population has grown in recent years, so has a crisis in the industry that cares for them. Low state reimbursement rates through Medicaid, the joint state and federal aid program to help low-income residents afford care, have depressed provider revenue and worker pay. That has fueled workforce shortages and facility closures that severely limit options for seniors and disabled adults who can’t afford to privately pay for care. 

Assisted living facilities on average pay caregivers between $17 and $20 an hour. State reimbursements assume caregivers make just $13 an hour, Mike Pochowski, president and CEO of the Wisconsin Assisted Living Association, said earlier this year. 

The increase would come from a pool of pandemic relief aid that the federal government sent to the state health department specifically for assisted living and home-based care industries.

The Wisconsin Department of Health Services earlier this year sought to increase Medicaid payments to providers. But doing so first required review from the Republican-controlled Joint Committee on Finance. 

That additional legislative oversight resulted from an effort by former Republican Gov. Scott Walker and allies to erode gubernatorial power during a lame-duck session in late 2018 before Evers succeeded him.

Walker signed a series of laws that increased the oversight authority of several legislative committees. That included giving the finance committee veto power over administration proposals to significantly increase Medicaid reimbursements.

The finance committee refused to schedule a hearing on the latest proposal after a member anonymously objected in April, blocking it from implementation. Committee leaders say they worry about the annual $103 million general revenue cost of maintaining higher Medicaid reimbursement rates once pandemic relief runs out.

Finance committee co-chair Rep. Mark Born, R-Beaver Dam, told Wisconsin Watch and WPR that the Legislature already made substantial investments in long-term care in the three most recent state budgets.

Committing the amount of money requested by the health department halfway through a budget cycle is “exceptionally rare,” Born said in a statement.

As the proposal sat, the Wisconsin Supreme Court ruled the finance committee could not legally block spending on conservation projects initiated by the governor’s administration.

The ruling may have emboldened Evers to move ahead on the reimbursement increase despite the finance committee’s inaction.

“Unfortunately, Republican lawmakers had objected to that plan and subsequently failed to take further action,” Evers communications director Britt Cudaback wrote in a statement to WPR and Wisconsin Watch. “Thus, the governor directed DHS to do it anyway using federal funds already allocated to the department.”

Tuesday’s constitutional amendment vote could affect those dynamics.

Although vague language in the proposed amendment creates ambiguity over the full scope of the potential, a yes vote would certainly grant the Legislature more authority over spending previously held by the executive branch, said Philip Rocco, an associate professor of political science at Marquette University. 

One possible outcome: Governors and the departments they oversee could no longer make decisions about federal emergency dollars, such as boosting compensation to care providers, without the Legislature’s oversight.

While the amendments are most clearly aimed at power over undesignated and unanticipated federal dollars, they could impact other types of funding, said Bryna Godar, a staff attorney at University of Wisconsin Law School’s State Democracy Research Initiative.

Split party control between the Legislature and governorship means Wisconsin residents can expect continued legal fights over the scope of the Legislature’s power regardless of Tuesday’s election outcome, Rocco said. 

Asked for his reaction to the administration’s move, Joint Finance Committee Co-chair Sen. Howard Marklein, R-Spring Green, wrote in an email to WPR and Wisconsin Watch: “We have had a productive dialogue with DHS on this topic and I had hoped that we would come to an agreement. I look forward to continuing the discussion during the budget process next session.”

The federal pandemic funds that Evers allocated for the rate hike last through March 2025. The Legislature will control any future changes through the next two-year budgeting process that culminates in July 2025.

Evers’ plans to increase reimbursement rates beginning in October 2024 make political sense, Rocco said.

“It is a lot harder to repeal something than it is to stop it from being enacted in the first place.”

Nearly two-thirds of assisted living providers would see reimbursement rate increases of about 40% while three in four supportive home care providers would see increases of about 16% — raises that many providers say they can’t afford to lose.

Long-term care caught up in Wisconsin government’s battle over spending power is a post from Wisconsin Watch, a non-profit investigative news site covering Wisconsin since 2009. Please consider making a contribution to support our journalism.