Healthcare affordability has become a central issue in the 2026 midterm election season, ranking higher on voters’ minds than other concerns like inflation, unemployment, and the war in Iran.

But Wyden’s initiative looks beyond this fall in an attempt to cobble together a unified front so the party is ready to enact major healthcare reforms should they win a governing trifecta in the 2028 presidential election cycle.

In February, Wyden and Democratic colleagues sent a strategy letter on how the party should organize legislation to lower the costs of prescription drugs. In March, another cohort of senators published a letter on private health insurance market reforms for the party to pursue.

The most recent letter outlines in broad strokes the goals of improving the long-term care workforce by increasing wages, improving the quality of care in nursing homes, and improving accessibility to long-term, home-based care services.

Among those goals is the creation of “a home care guarantee for people with Medicare,” but the letter lacks details on how this would be executed or how much it would cost.

Democrat Finance Committee staff told reporters ahead of the announcement that the home health letter, as well as the prior letters, are meant effectively as early brainstorming rather than concrete policy proposals.

“We want to ensure the Senate is prepared to act on these issues when Democrats have another opportunity to enact the bold, meaningful change the American people demand and deserve,” the senators wrote.

Millions require supportive care

Millions of Americans require supportive care services, most of which are out-of-pocket expenses for families.

Roughly 1.3 million lived in certified nursing facilities in 2025, according to the health think tank KFF. Those numbers are only expected to rise as baby boomers reach retirement age. The Alzheimer’s Association estimates that nearly 7 in 10 people turning 65 will need long-term care due to Alzheimer’s and dementia-related diseases.

On top of this, about 25 million Americans, including more than 7 million children, live with a disability that requires supportive services to remain in their communities, according to the Census Bureau.

According to CareScout, a service that helps families find long-term care resources, 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.

Medicare, the federal health insurance program for seniors, only covers short-term, limited residential care, such as a rehabilitation center following major surgery, and a limited amount of skilled at-home nursing care.

Medicaid, the joint federal-state insurance program for low-income people, covers long-term residential and home-based care. In practice, accessing this benefit requires patients and their families to, as investment advisers call it, “spend down” their assets before becoming eligible for Medicaid benefits.

Wyden and his colleagues described this system as requiring people to “impoverish themselves to meet strict eligibility limits” and “leaving hundreds of thousands of people who need these services to language on waiting lists every year.”

“In the richest country in the world, the sticker prices for long-term care devastate families, and the responsibility often falls on the family caregivers who are stretched thin on time and resources,” the senators wrote.

The cohort of senators also point to the GOP’s $1 trillion reduction in Medicaid spending over the next decade, passed in the Republican budget bill last year, as having taken “a sledgehammer to this already broken system.”

“These historic cuts to Medicaid will force states to cut services that support seniors and people with disabilities living at home, and making care provided in nursing homes less safe,” the Democrats wrote.

Democrats have tried this before

Democrats tried to advance expansive home-based care benefits the last time they had a governing trifecta in 2021, but ultimately failed to enact the sweeping changes some hoped they would achieve. 

Former President Joe Biden pledged to include a $400 billion investment in home-based and community services as part of his Build Back Better reconciliation bill package in 2021.

But that funding eventually was cut from the Senate-passed version of the bill. Instead, only $150 billion was passed in an effort to help reduce waitlist times for in-home care services and improve pay for home health workers.

On the 2024 campaign trail, then-Vice President Kamala Harris also made a pitch to the public to add at-home long-term care benefits to the Medicare program.

Harris announced the plan during her October appearance on The View in an attempt to reach stay-at-home caregivers watching daytime television. The appeal targeted the so-called sandwich generation, a demographic taking care of both young children and elderly parents.

At the time, the left-leaning polling firm Data for Progress found that 55% of all likely voters strongly supported and 33% somewhat supported Harris’s proposal of expanding Medicare coverage for long-term in-home care services. That included 86% of Republicans who at least somewhat supported adding a home health Medicare benefit.

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Harris’s plan intended to recoup the cost of expanding home health and community services by using savings from the Medicare drug price negotiation, a core feature of the 2022 Inflation Reduction Act that allows the federal government to negotiate with drug companies for the most expensive drugs for the program.

Senate Finance Committee Democratic staff told reporters ahead of Wyden’s announcement that the ranking member’s letter is mainly to spark dialogue between senators rather than committing to specific dollar figures for any new benefits.