With a month to go before the 2024 presidential election, this week Democratic nominee Kamala Harris proposed expanding Medicare benefits to include long-term care and in-home health services. Republican nominee Donald Trump has also said in-home care would be a priority for his administration.
Speaking Tuesday on ABC’s “The View,” Harris related her personal experience with caregiving and said the savings from Medicare negotiating lower drug prices could fund the initiative.
“I took care of my mother when she was sick. She was diagnosed with cancer and so it is a personal experience for me as well as something I care deeply about,” Harris said. “… It’s about dignity for that individual. It’s about independence for that individual. People are declining in skills to some extent but their dignity, their pride has not declined. They want to stay in their home. They don’t want to go somewhere else. Plus for the family to send them to a residential care facility, to hire somebody, is so expensive.”
Medicare, the largest health insurance program in the country, currently does not cover long-term care and limits in-home support to a few weeks. People who need these types of care must pay out of pocket, use private insurance or qualify for Medicaid.
Trump outlined his plans for Medicare in a statement posted Tuesday to his campaign website.
“President 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,” according to the statement.
For older voters in particular, Medicare and Social Security are important topics heading into November.
In this guide, we’ll break down where Harris and Trump stand on Medicare and Social Security. We also touch on some of President Joe Biden’s positions, since Harris’ campaign closely mirrors the president’s platform on certain policies. Here’s what you need to know.
Medicare, the federal health insurance program primarily for people ages 65 and older, faces its own set of challenges.
The program is projected to deplete its Hospital Insurance Trust Fund by 2036 unless action is taken to maintain solvency. Rising health care costs, an aging population and increased enrollment are the major factors contributing to Medicare’s financial strain.
Medicare was mentioned three times during the September presidential debate, all by Harris.
“My work that is about protecting Social Security and Medicare is based on long-standing work that I have done — protecting seniors from scams,” Harris said. It’s unclear if Harris was referring to work she did as a prosecutor, a senator or as vice president.
Later, Harris remarked on the Biden administration’s Medicare policy achievements.
“We have allowed for the first time Medicare to negotiate drug prices on behalf of you, the American people,” noted Harris, referring to legislation passed in August 2022 that gives the Secretary of Health and Human Services the power to negotiate prices for expensive drugs covered under Medicare.
She also took aim at Trump, adding: “Donald Trump said he was going to allow Medicare to negotiate drug prices. He never did. We did.”
In her one-paragraph policy summary on Medicare, Harris notes that she’ll “fight to ensure that Americans can count on getting the benefits they earned.”
As a Democratic candidate in the 2020 election cycle, Harris focused on the principles of a “Medicare For All” plan rather than describing how she planned to keep the program solvent for its more than 67 million current beneficiaries.
This time, Harris has been building on Biden’s notable Medicare policy changes and hitting many of the same talking points, such as cracking down on drug companies and high prices.
Related: How to manage health care costs in retirement
During his presidency, Biden enacted the most significant reforms to Medicare since prescription drug coverage was added to the program during the Bush administration in 2006.
One of his major legislative achievements, the Inflation Reduction Act, included measures to lower prescription drug costs for beneficiaries by allowing Medicare to negotiate prices directly with pharmaceutical companies — similar to the power employed by the Department of Veterans Affairs (VA) and other federal agencies. A 2020 report by the U.S. Government Accountability Office found that the VA paid an average of 54 percent less per unit on brand-name and generic prescription drugs than Medicare.
Giving Medicare this same negotiating power is expected to save billions of dollars for both the federal government and beneficiaries over the next decade. Harris specifically called for this kind of reform on the campaign trail five years ago.
The first wave of 10 newly negotiated drug prices — which take aim at the most expensive and most frequently used medications in the Medicare program — won’t go into effect until 2026. Price changes for additional drugs will be phased in over time.
But the Inflation Reduction Act went further. Starting in January 2025, all Part D prescription drug beneficiaries will have their annual out-of-pocket costs capped at $2,000. Harris referenced this cap during the debate, adding: “And when I am president, we will do that for all people.”
Finally, Biden called for directing savings from Inflation Reduction Act measures to Medicare’s Hospital Insurance Trust Fund to extend its solvency.
Trump promises to protect Medicare benefits but provides limited details on how he would achieve this.
Currently, Trump is proposing reversing increases made to Medicare Part B premiums during Biden’s administration, prioritizing at-home care, supporting caregivers through tax credits and “reduced red tape,” and “overturning disincentives that lead to care worker shortages,” according to a statement on his campaign website.
During his presidency, Trump did not implement significant reforms to address Medicare’s financial challenges.
His administration did propose various changes aimed at reducing health care costs for Medicare beneficiaries, such as efforts to increase price transparency, reduce prescription drug prices and lower the cost of insulin. But these initiatives had a limited impact on Medicare’s long-term funding issues.
Trump has made statements opposing any cuts to Medicare benefits, positioning himself as a defender of the program. He also suggested that waste, fraud and abuse within the system should be addressed to save money.
During his administration, Medicare Fee-For-Service improper payment rates declined modestly as the Centers for Medicare & Medicaid (CMS) led efforts to identify causes of improper payments and implement action plans.
In 2023, Trump criticized Republicans who considered cutting Medicare to offset federal spending, arguing such cuts were unnecessary.
Social Security, established in 1935, is a cornerstone of the American social safety net, providing financial support to retirees, disabled individuals and others.
However, the program faces significant challenges. The Social Security Trust Fund is projected to be depleted by 2035, which could result in reduced benefits if action isn’t taken.
The looming insolvency is driven by demographic shifts, including an aging population and lower birth rates, which have resulted in fewer workers supporting more retirees.
“Addressing those financial challenges will require the political will in both parties to raise revenues for Social Security,” says Christian Weller, a senior economist and professor of public policy at the University of Massachusetts, Boston.
Calculator: Estimate your amount of Social Security benefits
The Harris campaign published a set of policy priorities online in September, providing a glimpse into where the vice president stands on key issues but few details.
Harris noted that she’d strengthen Social Security “for the long haul by making millionaires and billionaires pay their fair share in taxes.” She’s likely referring to extending the Social Security payroll tax to higher incomes. Currently, these payroll taxes aren’t applied to wages above $168,600 in 2024.
Harris said very little about Social Security during her 2020 run in the Democratic primary.
But in February 2019, then-Senator Harris co-sponsored the Social Security Expansion Act, legislation introduced by fellow senator Bernie Sanders. The bill proposed extending the Social Security payroll tax to incomes over $250,000 a year. At the time, the amount of income subject to payroll taxes was capped at $132,900.
Biden has consistently pledged not to cut Social Security benefits before and during his presidency. During his 2020 presidential campaign and his time in office, he has emphasized his commitment to protecting and strengthening the program.
Biden proposed raising taxes on wealthy Americans to ensure the program’s solvency. Specifically, he suggested subjecting earnings over $400,000 to Social Security payroll taxes.
However, Biden’s promises to raise taxes on the wealthy haven’t come to fruition. Similarly, he didn’t implement significant changes to Social Security during his presidency.
Trump has taken a more ambiguous stance on Social Security. During his presidency and recent campaign, he said he would protect Social Security benefits. However, he hasn’t offered details on how he would ensure the program’s long-term solvency without cutting benefits, raising taxes or changing the retirement age.
Trump’s approach often hinges on the belief that a stronger economy would naturally bolster Social Security. He argues that economic growth and job creation would boost payroll tax revenues, thereby supporting the program.
Still, many experts say economic growth alone won’t be a panacea for Social Security.
“Faster economic growth can certainly help Social Security’s finances,” says Weller. “But it can only translate into better Social Security finances if it also goes along with strong wage growth.”
At various points, Trump has made statements suggesting he might be open to cutting Social Security benefits. However, he has walked back many of those comments, emphasizing his commitment to protecting benefits. More recently, he’s talked about eliminating federal taxes on Social Security income, which could speed up insolvency.
Earlier in his career, Trump referred to Social Security as a “Ponzi scheme” and advocated for its privatization. However, he abandoned this stance during his first presidential campaign, along with his earlier support for raising the retirement age to 70. Currently, the retirement age for individuals born in 1960 or later is 67.
“I can’t think of any benefit cut less popular than an increase in the retirement age,” says Weller.
Older Americans are a solid voting bloc in presidential elections, and savvy politicians know those votes can influence the outcome of a competitive race.
According to the U.S. Census Bureau, people ages 65 and older made up 25.7 percent of the voting population in the 2020 presidential election. Meanwhile, people ages 18–29 made up just 16.5 percent of the voting population. The report found that younger voters were underrepresented compared to the general population, while older Americans were overrepresented.
In short, seniors turn out to vote.
Experts say this causes many candidates to concentrate on issues central to older Americans — like Social Security benefits, Medicare and prescription drug costs — during election years. Proposals to alter these programs are widely unpopular with voters.
“People contribute to Social Security all of their careers in expectation of getting benefits in the future,” says Weller.
He adds: “Messing with Social Security’s benefits is rightfully seen as breaking a promise.”
Social Security’s tax rate and benefits are set by law. So to tweak them, Congress must first change the law, and the president then needs to sign it.
“While a president does not have legislative power, he has a lot of influence to introduce and push for large-scale changes,” says Weller.
Social Security is treated separately from the rest of the federal budget for accounting purposes since it’s a mandatory program, says Weller. The Social Security Board of Trustees only administers the program — it doesn’t have any legislative power over Social Security.
Members of Congress from both sides of the aisle have proposed reforms to Social Security over the last decade, from lowering (or raising) the retirement age to tweaking how the program is funded.
Despite numerous bills introduced in the House and Senate, none of the measures have been signed into law.
“The two sides are too far apart on their proposals and there’s no urgent need to act since Social Security can still pay full benefits for the next decade,” says Weller.
Medicare and Social Security are important safety nets for millions of Americans. Trump and Harris are likely to continue facing questions on the future of both programs, though voters should remember that candidate promises don’t always translate to concrete action after Election Day.
While voters should pay attention to both candidates’ positions, they should also remember that Congress — not the president — holds the ultimate power to reform Medicare and Social Security.
