Family Care: Good Policy, Good Politics

Originally published in The American Prospect on October 22, 2020.

In late July, then-presumptive Democratic presidential nominee Joe Biden gave a speech announcing the third and final plank of his economic recovery plan: a ten-year, $775 billion investment in care work.

If elected, Biden promised, he would bail out struggling child care centers, invest in building more facilities, and raise the pay and benefits of all caregivers, including those who care for seniors. Biden also pledged to expand universal preschool, and give low- and middle-income families tax credits for child care.

“We are trapped in a caregiving crisis within an economic crisis within a health care crisis,” Biden said at the July campaign event in New Castle, Delaware. Emphasizing his experience raising his son as a single father, Biden touted his proposed investments in care work as “a fresh, bold way to build up a critical part of our labor force and help us recover faster and stronger.”

Aspects of Biden’s care work plan overlap with child care legislation backed by Democrats in Congress, as well as parts of the child care proposal Sen. Elizabeth Warren (D-MA) ran on during her presidential campaign. In 2016, Hillary Clinton championed new investments in child care in her run for the White House.

Biden’s proposals don’t go as far as Bernie Sanders’s plan to make child care free and universal. Marie Newman, who is likely headed to Congress in January after ousting Rep. Dan Lipinski (D-IL) in a primary in March, also made universal child care a key plank of her campaign. Mondaire Jones, who won an open seat in New York’s Westchester County, foregrounded universal child care as well.

Biden’s ideas also don’t amount to so-called universal family care—the policy idea unveiled in 2019 by Caring Across Generations, which would provide child care, paid leave, assistance for people with disabilities, and elder care, all through a new social-insurance program. But his rhetoric has gotten a lot closer to that idea. That Biden has decided to make caregiving a key facet of his run against Donald Trump reflects the growing recognition among mainstream politicians that these caregiving issues are not just crucial economic issues, but also winning political ones.

Jess Morales Rocketto, the executive director of Care in Action, which leads political advocacy for the country’s 2.5 million domestic workers, described Biden’s care work plan as a win for activists, despite falling short of universal family care, which is their ultimate goal.

“It’s a very significant step and reflects what we’ve been saying, which is that care is the future of how we keep people safe,” she said. “This is a real opportunity for us to help show people that universal family care is more than just a message frame or rhetoric, but a real and serious policy plan.”

THE NEED FOR affordable child care and elder care isn’t new, so many may wonder why it’s taken so long for politicians to get to this point.

Vicki Shabo, a senior fellow at the think tank New America, points to three reasons the U.S. has moved at such a sluggish pace when it comes to care work.

The first, she says, is a perception problem. Unlike the rest of the developed world, which has robust public investments in care infrastructure, the U.S. has left care work as something to figure out privately outside of government. As a result, child care and elder care have been dismissed within public policy as “individual issues that people need to navigate on their own,” Shabo says.

The next hurdle involves the anti-regulatory stance of businesses and the Republicans who cater to them. Powerful corporations and conservatives have foregrounded the idea that workers and employers should be sorting out these types of family issues individually, free from rules dictated by government.

The last reason, Shabo says, is that for a very long time politicians in the U.S. treated care work as a “woman’s issue,” as somehow less important than other economic policies legislators prioritize.

That last point is starting to change. While child care and elder care still are largely women-led issues in Congress, some male politicians are stepping up. “I’m excited to see people like Sherrod Brown, Ron Wyden, and Cory Booker take these issues on in the Senate,” said Shabo, adding that there is also energy coming from younger and more diverse members of Congress like Rep. Jimmy Gomez (D-CA).

Advocates say they feel encouraged, too, by the fact that Republicans have seemed more open to family care proposals, even if the bills fall far short of what’s needed. Sen. Marco Rubio (R-FL) teamed up with Ivanka Trump in 2018 on a paid family leave bill funded by clawing back future Social Security benefits, leaving families in a retirement hole. But compared to the nonexistent conservative proposals for family care in years past, it was at least a start. Sen. Bill Cassidy (R-LA) has been working on a bipartisan version of a paid family leave policy.

The pandemic has unquestionably helped shift the politics around child care, forcing long-standing problems around care work into the public eye, and helping millions of Americans grasp the health and economic implications of not having robust systems in place.

The shifting politics are evident in the way the ongoing coronavirus stimulus debates have played out. In the Senate, Republicans included $15 billion in “back to work” child care grants in their COVID-19 stimulus package released in July. And in a coronavirus package passed in mid-March, lawmakers included ten paid sick days for employees of certain businesses suffering from COVID-19, and up to 12 weeks for parents caring for a new child, though only ten are paid.

“That was the first-ever federal paid leave mandate,” said Shabo. “It’s flawed, and up to 106 million workers could be denied, but it matters that it was included.”

Activists hope to capitalize on the political momentum and help steer the public conversation more to their “North Star”: universal family care. In some ways, that shouldn’t be too heavy a lift, given how many people could benefit from such a policy. According to government statistics, roughly eight million families pay for someone to watch their kids while they’re at work. Sixty-three percent of married couples with children have two working parents, and single parents are even more likely to need help balancing work and child care. The costs for these services have skyrocketed, and even before the pandemic access was a huge problem.

Increasingly, adults are balancing not just child care but caring for their aging parents at the same time. This kind of dual-caretaking situation falls disproportionately on Hispanic Americans, but is increasingly common for all families, especially as millennials rely longer on their parents for support than children in earlier generations did.

Long-term care is an expensive proposition and the costs are not generally covered under Medicare. For roughly half of Americans 65 years and older who will have long-term care needs, the average cost is more than $266,000, and more than half of that is paid out of pocket. The AARP estimates that relatives spend 20 percent of their own money on these caregiving costs.

The idea of some sort of publicly funded long-term care program has real political support. A 2018 Associated Press-NORC Center for Public Affairs Research poll found that approximately two-thirds of adults support a long-term care program like Medicare, including 76 percent of Democrats and 56 percent of Republicans.

While most politicians have tended to think of care work legislation as coming in discrete buckets—like one bill for paid family leave and one bill for child care—advocates for universal family care think conceptually combining all these elements into one program will be easier for voters to grasp. It also expands the constituency to everyone who needs care, for a child or parent or even themselves, in the case of sick leave.

“Everyone has a care story,” said Morales Rocketto. “For the average family, all these costs come out of the same bank account, and we’re all just looking at the bottom line. So what we want is the government to just say, we’re going to make a program that ensures you have enough to afford your care obligations.”

Universal family care wouldn’t come cheap, but this is a government-sized problem, she adds, so “we need a government-sized solution.”

New polling conducted by Data for Progress over the summer provides some quantitative support for the idea. Likely voters were asked if they’d support a payroll tax of 2.5 percent of their income to create a social-insurance fund for universal access to child care, elder care, long-term care, and paid family leave. A little more than half of all likely voters expressed support in the poll, including 49 percent of women. Among people of color, the support was even higher: 61 percent of Black respondents supported the proposal, as did 53 percent of Hispanic respondents. Forty percent of independents backed it, and 20 percent of respondents said they didn’t know one way or another.


Polling conducted in 2019 by the People’s Policy Project found similar enthusiasm for federal grants to school districts for free public child care. Fifty-seven percent of registered voters backed this idea, including more than half of independents.

One advantage care advocates have in the political arena is that this need for people to take care of themselves and their families is universally understood. “From a narrative perspective, we’re starting from a position of strength,” Shabo said.

To push the issue politically, advocates are hoping to link the fight for universal family care to the fight for racial and economic justice. When Seattle passed paid sick days in 2015, the UFCW was a critical partner to getting that through, as was SEIU when Massachusetts passed statewide paid family leave in 2018. Shabo says enlisting business allies early on has also been critical, since “the organized business lobby is almost always opposed” to new care policies.

Sen. Kirsten Gillibrand (D-NY), who has sponsored individual bills for national paid family leave and child care, says she thinks splitting the proposals up separately still makes more sense, but she agreed one could structure a universal home care policy that includes all care policies together.

Gillibrand pointed to her work on paid family leave, which began in 2013. “We worked so hard to make sure it was debated in the last two presidential cycles, and we know from state examples, like in California, that the business community has actually welcomed it once it’s in place,” she said. “All of these things would have made such difference during the pandemic if we had nationwide.”

She is optimistic about the political prospects for care work legislation. “I do think the country is open to these ideas, and Congress tends to be ten years behind the country on a good day,” she joked. “I think the pressure will grow because people need these solutions. We’re in a crisis and the landscape is ripe for change.”


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