The future of Medicare, America’s sweeping health insurance program for older adults, continues to come up on the campaign trail from both Vice President Kamala Harris and former President Donald Trump during this final stretch leading up to the 2024 presidential election.

This year’s voting comes at a time when the 67.5 million Americans enrolled in Medicare plans are starting to see significant changes, largely resulting from the Inflation Reduction Act that Vice President Kamala Harris cast a tie-breaking vote for in 2022. 

Harris has touted the law’s more generous prescription spending benefits for seniors, which Biden administration officials say have not resulted in feared premium spikes or cutbacks for most drug plans.

Some of that “stabilization” is the result of billions poured into premium-lowering efforts, which Republicans have voiced frustration over as an “election year stunt.” Premiums for Medicare Part B are also continuing to grow, up to an estimated $185 monthly in 2025.

The act has also offered some respite for lawmakers grappling with the program’s long-running insolvency crisis, as spending is still outpacing the taxes that fund it. Medicare’s trust fund now has until 2036 before it is set to run out, thanks in large part to savings from the law and an economic rebound following the COVID-19 pandemic.

Harris wants to expand Medicare benefits

Harris has made her proposal to expand Medicare’s coverage for home health care aides a common part of her stump speech in recent weeks. The plan also calls for adding coverage for hearing and vision benefits to Medicare.

Expanding the new benefits could be paid for by a separate Harris proposal to expand the Medicare Drug Price Negotiation Program, which was created by the Inflation Reduction Act.

The price caps program under its current design will be too small to cover the expanded benefits Harris wants. But the campaign has pointed to estimates suggesting that billions more could be recouped by a more aggressive approach to its price caps and other drug cost reforms, if Congress signs off.

Former President Donald Trump’s campaign responded to the Harris announcement by pointing to their own promises in the Republican platform this year, including “shifting resources back to at-home care.” 

They also cited changes Medicare made during the COVID-19 pandemic under Trump, like expanding access to telehealth providers.

Trump wants to block Medicare age increases

A frequent applause line at Trump’s rallies is his pledge to block any increases to the eligibility age for Medicare coverage, which is currently set at 65 years old, and to eliminate income taxes on Social Security benefits.

“I will fight for and protect Social Security and Medicare. There will be no cuts, and we won’t be raising the age, like they’re going to end up doing,” Trump told supporters at a Pennsylvania rally on Oct. 9. 

Those promises could add to the steep challenges facing Congress, as it navigates the thorny solutions to Medicare insolvency. Though the deadline for Medicare running out of money has been pushed back, officials have warned Congress that delaying action now to shore up the fund will force even more painful changes down the road.

While Trump has painted his pledge as a broadside against his Democratic rival, the retirement age issue was actually a point of division within his own party during the GOP primary. House Democrats have also railed against some of their GOP colleagues over a plan that suggested “modest adjustments to the retirement age” down the road.

Harris accuses Trump of backing cuts to Medicare

Democrats have accused Trump of backing cuts to Medicare for years, despite his repeated vows not to cut the program’s funding.

The Harris campaign has revived attacks from Trump’s first term, which claimed his proposed budgets were cutting “Medicare support for hospitals and other providers under the guise of eliminating wasteful spending.”

“Now Donald Trump has a different approach. He tried to cut Medicare and Social Security every year he was president,” Harris said on Oct. 29, in remarks near the White House that the campaign billed as her closing argument.

At the time, Trump White House officials defended the savings as good government reforms and said Medicare’s funding would still grow under the budget. The changes largely echoed recommendations by a nonpartisan advisory commission to improve the program, and outside budget watchdogs agreed it would not directly impact beneficiaries.

Harris has also claimed that her Republican opponent would cut Medicare and overturn provisions the Inflation Reduction Act added, like the Medicare Drug Price Negotiation Program. As evidence, she cites proposals in the Heritage Foundation’s “Project 2025” platform, written by Trump allies, despite his own disavowal of the document.

Trump accuses Harris of “bankrupting” the program

On the trail, Trump most often brings up Medicare when accusing Harris of “bankrupting” the program. He frames the attack the same way he did against President Biden earlier this year, before Mr. Biden dropped out, claiming a surge of migrants was “destroying” Medicare.

“They’re allowing millions of these people to go into Social Security, Medicare. They’re going to destroy it,” Trump said on Oct. 29, in remarks from his Mar-a-Lago resort in Florida.

Under current law, undocumented immigrants are not eligible for Medicare. Only some “lawfully present immigrants” can get premium-free Medicare, typically only after those seniors have paid payroll taxes in enough years.

A more nuanced version of Trump’s attack, published by his campaign, points to Harris’ support for an “earned pathway to citizenship” for immigrants. The Trump campaign claims this could “make millions of low-wage migrants into US citizens” and threaten the survival of the program.

This echoes a similar claim that has come up in Washington for years. A failed immigration reform effort in 2013 that sought to carve out a “pathway to citizenship” was projected to result in higher Medicare spending to cover the additional people, though it was also projected to bring in more tax revenue that could outweigh the increased expenses.

The Harris campaign has promised to solve Medicare’s funding shortfall “by making corporations and the wealthiest Americans pay their fair share in taxes.”