Republican health policy advisers are starting to push back against Democrats’ plans to create a new long-term care benefit in Medicare health insurance coverage for seniors.Long-term care, especially home- and community-based programs, for seniors and people with disabilities, is going to be the subject of ideological battle as candidates on both sides of the aisle start to think about their healthcare messaging for the 2028 presidential election season.Senate Democrats, led by Sen. Ron Wyden (D-OR), began laying the groundwork in May to incorporate home healthcare coverage as part of an agenda to prepare for the party winning both chambers of Congress and the White House in 2028. In particular, Democrats are hoping to include in a new healthcare bill “a home care guarantee for people with Medicare,” the federal health insurance program for seniors over 65.
Bobby Jindal, former GOP governor of Louisiana and health policy expert, told the Washington Examiner that lawmakers should focus on developing workable strategies to address an aging population instead of creating a new entitlement program for long-term elder care.“Of course the Democrat response is going to simply be let’s just add new benefits and not worry about how to pay for them,” Jindal said. “I think a more thoughtful approach would be to re-examine what should be a Medicaid responsibility, what should be a Medicare responsibility, what should be your private sector responsibility, and what is possible with new technologies.”Jindal, who now serves as chair of the Healthy America program at the Trump-aligned America First Policy Institute, said it is too early to definitively say what the Republican platform on the problem will look like in the 2028 election, but he says he sees it as a critical issue in the coming years.By 2030, all 73 million baby boomers will be 65, a trend demographers at the Census Bureau refer to as a “gray tsunami.” The Alzheimer’s Association estimates that nearly 7 in 10 people turning 65 will need long-term care at the end of their lives due to dementia-related diseases.According to the long-term care services resource company CareScout, the annual cost for an in-home health aide was roughly $78,000 annually in 2024. A private room in a skilled nursing home facility was on average $128,000 per year. The division between Medicare and Medicaid, the joint federal-state insurance program for low-income people, creates a complicated and fragmented system for paying for long-term care, with most costs for home health or nursing facilities being covered directly by patients and their families.Medicare only covers short-term, limited residential care and a limited amount of skilled at-home nursing care. Medicaid, by contrast, covers the majority of long-term residential home-based care for people below a certain income threshold. Brian Blase, president of the free-market Paragon Health Institute, told the Washington Examiner coming up with a policy solution for long-term care benefits is going to be even more important not only as baby boomers age but also as families have fewer children.“I think the role of the family is appropriate to take care of your elder relatives,” Blase said. “It’s an important family responsibility [but to] the extent that families are smaller, that does add pressure to the public sector.”New benefit but old playbook from Democrats
