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

Democrats have long sought a new home health and long-term care benefits program.

In 2010, Democrats enacted, as part of Obamacare, the Community Living Assistance Services and Supports, or CLASS, Act with the intention of creating a national, voluntary long-term services insurance program financed by individual premium contributions. But by 2013, the program was abandoned because it was not fiscally sustainable and was repealed.

Former President Joe Biden pledged to include $400 billion for in-home and community-based services, or HCBS, as part of the 2021 Build Back Better bill. But the funding was eventually cut from the Senate-passed version of the bill.

On the 2024 campaign trail, then-Vice President Kamala Harris also pitched to the public to add at-home long-term care benefits to Medicare, appealing to the so-called sandwich generation that takes care of both young children and elderly parents.

Wyden’s call to Democrats this summer, in the form of a Dear Colleague letter, was more of a request to brainstorm a home health Medicare benefit than a concrete policy proposal. Staff for the Senate Finance Committee, of which Wyden is the leading Democrat, told reporters at the time that the goal of the letter was mainly to spark dialogue among senators rather than committing to a specific dollar figure for any new benefits. 

But the projected cost of any new benefit would be critical, considering the financial strain Medicare is already under.

The nonpartisan Congressional Budget Office estimated earlier this year that Medicare spending is projected to double over the next decade, reaching $2 trillion and accounting for 4% of projected gross domestic product by 2036.

Last year, the Medicare Trustees projected the trust fund for Medicare Part A would be insolvent by 2033, three years earlier than previously projected.

Blase said that any new Medicare benefit ought to be at net-zero cost to the budget.

“Congress needs to, if they’re going to add a new benefit, there needs to be some trade-off because the program is on a totally unsustainable financial trajectory,” he said.

GOP solution: Tackling abuse and fraud

Conservative policy advisers see the fix to the problems of long-term care policy as an extension of the GOP’s broader goal of targeting waste, fraud, and abuse in federal entitlement programs. 

Blase said one of the primary ways to improve the state of long-term care would be to tighten eligibility requirements for Medicaid coverage of home health and nursing home care, which would in turn create an opportunity for a more robust long-term care insurance market to fill the void.

Medicaid rules require that recipients “spend down” the majority of their assets and have a limited take-home income in order to qualify for long-term care coverage.

But Medicaid planners and elder law attorneys frequently advise clients on how to avoid losing their nest eggs before obtaining Medicaid to cover long-term care costs through legal loopholes. Through financial maneuvers such as irrevocable trusts and spousal asset transfers, wealthy individuals and families can often access Medicaid benefits to pay for long-term care.

“Our main recommendation is to limit Medicaid to the truly poor with limited assets, and that people need to, if they have assets, put them towards their long-term care expenses rather than relying on the government,” Blase said. 

Along similar lines, Jindal and former House Speaker Newt Gingrich co-authored an opinion piece in Fox News Digital last month arguing that identifying fraudulent billing by providers is essential to building on the home health and long-term care programs already funded by taxpayer dollars. 

The White House Fraud Task Force, led by Vice President JD Vance, has reportedly identified nearly $230 billion in fraud and abuse since March. Much of this fraud has been through improper billing of high-risk services such as community-based care and home care for seniors and people with disabilities, as well as hospice centers. 

In addition to using artificial intelligence to identify billing irregularities, Jindal said, the Centers for Medicare and Medicaid Services could, in theory, leverage new technologies to verify home health companies are sending aides to real patients in a way that does not jeopardize legitimate providers.

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“Whether through a smartphone type device, or GPS device, there are devices, there are technologies that can help to automate some of this compliance,” Jindal said.

Jindal said program integrity measures, rather than just creating a new benefits program, are “about protecting vulnerable seniors who deserve high-quality services provided by honest providers.”