Senate Democrats unveiled a policy roadmap Wednesday calling for increased access to affordable long-term care services, including a proposal to “establish a home care guarantee for people with Medicare.”
The plans are laid out at the high level in a “Dear Colleague” letter shared by Senate Finance Committee Ranking Member Ron Wyden, D-Ore., and cosigned by 16 other members of the minority party. It promises the exploration and development of various policy proposals that include investment in the long-term care workforce and an increase in nursing home oversight.
Also outlined is a broad effort around home care affordability and accessibility. The lawmakers said they want to better integrate home care as a part of the broader healthcare system, without waiting lists or “arbitrary poverty thresholds” to “guarantee middle-income families can access care without depleting their savings.”
To reach that goal, the Democrats said they intend to develop a policy that would see home care become Medicare’s first new benefit in two decades, since Medicare Part D was enacted in 2006.
“America is failing people who are aging and those with disabilities, who should have every opportunity to live at home and thrive in their communities,” the senators wrote in their letter. “Democrats want to ensure American families have affordable, high-quality care in the setting they choose with quality jobs and living wages for direct care workers.”
The letter does not outline any specifics behind the aspirational policies, only that Finance committee staff will begin tackling the issues and that more details will be released “in the coming weeks and months.”
Nor does the letter address how such policies could be funded, though it does outline the “five-alarm fire” financial burden of the status quo—over $288,000 per year on a 24/7 home health aide, over $120,000 per year on a private nursing home room and about $62,400 per year for full-time personal care services.
Medicare does not currently cover long-term care, outside of some short-term medical services, while state Medicaid programs are required to do so in a nursing home setting. States also have the option to provide at-home care to some beneficiaries.
The lawmakers’ letter and an accompanying flash report were replete with criticism of Republicans on broader healthcare funding—such as the One Big Beautiful Bill’s $1 trillion, decade-long Medicaid cuts—and in regard to the other long-term care priorities outlined in the missive.
On the lawmaker’s workforce aims, for instance, they derided Centers for Medicare and Medicaid Services (CMS) Administrator Mehmet Oz’s frequent suggestion that automation and other technologies will solve current and projected demand for long-term care workers. Rather, they said they will prioritize policies that improve workforce wages and incentivize recruitment, embrace legal immigrants as care workers and protect the livelihoods of family caregivers.
For nursing homes—where a prior Biden administration minimum staffing level requirement was shot down by the courts, the Trump administration and Congress—the senators said they intend to “align incentives to strengthen nursing home staffing standards so residents are safe and workers are supported.” They also plan to improve transparency and oversight of the facilities to improve care quality and to “ensure taxpayer dollars are spent on direct care and not siphoned off through profit-hiding shell games.”
The letter follows two similar policy outlines released by Senate Democrats hoping to gain a leg up on healthcare issues ahead of the coming midterm elections.
The first of these, released in February, addressed plans to tackle high-cost prescription drugs as an alternative to the president’s company-by-company dealmaking, which they described as “continued smoke and mirrors and broken promises to rein in Big Pharma.” The other, from March, broadly addressed healthcare costs and broadened access to affordable insurance coverage.