How Build Back Better supports caregiving and why it urgently matters 


December 14, 2021

“We have a once-in-a-generation opportunity to transform care in America and we can’t afford not to.” 

  • — Ai-Jen Poo, Co-Director of Caring Across Generations and Co-Founder and Executive Director of the National Domestic Workers Alliance 

“We can start here, remove the blinders of our biases, accurately value care work, correct market failures, and allow the economy to grow unfettered.” 

  • — Dr. Michelle Holder, President and CEO, Washington Center for Equitable Growth 

“We’ve been at similar inflection points in our history and failed to act. Fifty years ago this week, President Nixon vetoed a bipartisan universal child care bill, with reverberations that run through the lives of generations of women and families. Since then, women have fought for gains in the workforce, but the pandemic mercilessly revealed these gains were built on a foundation of sand.” 

  • — Melissa Boteach, Vice President for Income Security and Child Care/Early Learning, National Women’s Law Center 

The care economy – including child care, home and community-based care, and paid family and medical leave – is intricately linked to the economic well-being of not just families in the U.S. but the country overall. And the provisions in President Biden’s Build Back Better plan that support care infrastructure are critically needed, right now and in years to come. 

Those are some of the conclusions offered by a trio of experts who testified before the House Select Committee on Economic Disparity and Fairness in Growth last week in support of both the Build Back Better plan and a stronger domestic work force. Chaired by Rep. Jim Hines (D-CT), the hearing, titled “Growing Our Economy by Investing in Families: How Supporting Family Caregiving Expands Economic Opportunity and Benefits All Americans,” examined the link between federal investments in affordable family care and inclusive economic growth. 

The experts, Ai-jen Poo of the National Domestic Workers Alliance; Dr. Michelle Holder of the Washington Center for Equitable Growth; and Melissa Boteach of the National Women’s Law Center, offered a transformative vision of what the U.S. could look like with proper investments in the care economy. 

Poo, whose organization represents 2.2 million care workers, said every day in the U.S., 10,000 people are turning 65 years old. Americans are living longer (or at least were before the pandemic) due to improved health care and technology. But the care economy is unprepared for what is to come. 

“By 2050, 27 million people will need long-term care in America,” Poo said. “The vast majority of those people will want to age at home and we have neither the infrastructure nor the workforce to support it.” 

She said the caregiving workforce is depleted by poor pay and a lack of benefits – the average home care worker earns $18,200 a year. Only one in five domestic workers has health insurance. Fewer than one in 10 domestic workers are covered by employer-provided retirement. Virtually no workers have paid family and medical leave. 

“These conditions lead to high turnover rates and chronic worker shortages, especially in rural communities, ultimately hurting the accessibility and quality of care for the people who need it,” she said. 

But she said the $150 billion included in Build Back Better for home and community care “will create and support 390,000 new jobs each year over 10 years, nearly 300,000 of which are living-wage care jobs. It will also add an estimated $4 billion in additional income for current workers and their families each year.” 

Dr. Holder offered some personal observations as both an economist and a caregiver – she is a mother of two and also cares for her own mother, who recently had to be hospitalized after a serious accident.  

“Because I have a position that provides me with paid family leave, I am able to take personal time off to coordinate my mother’s in-hospital care, as opposed to taking unpaid leave or being told if I take the time off, I may not have a position when I return,” she said. “And because I can afford child care for my 10-month-old — as the President of a national economic think tank, my salary can accommodate that cost – I’m able to testify at this hearing right now. But many individuals and families in our country don’t have these benefits from their employers or can’t afford these costs.” 

For those who before the pandemic might not have heard the phrase “care economy,” Dr. Holder offered a definition. 

“The care economy is the system in which workers and families provide services vital to caring for the U.S. population,” she said. “From medical care to laundry, care is expensive, so many families forego the support they need. As a result, the economy suffers. Economists call this a market failure.” 

And she argues that racial bias is behind this market failure. 

“Biases toward economic inputs that are easily quantifiable and against women of color lead us to undervalue care, under-invest in this economic bedrock and constrict growth,” she said. “To be blunt, when decision-makers see women of color working, they decide that labor itself must not be valuable. Indeed, regardless of race, gender, or educational level, all care workers receive wages that are about 5 percent lower than wages paid for similar work that does not involve care.” 

Still, Dr. Holder sees tremendous hope in the Build Back Better package. 

“We are on the cusp of change,” she said. “The House-passed Build Back Better infuses resources into our child care and pre-K systems, more accurately valuing care by requiring pay parity between child care workers and school teachers, makes unprecedented investments in home and community-based services and supports for older adults and people with disabilities, and recognizes that caring for children is work by extending the monthly, fully refundable Child Tax Credit without a requirement where parents work for pay.” 

Boteach discussed the status of women in the workforce, and how, as the pandemic continues, the lack of support for caregivers has caused great harm. 

“It is December 2021 and women have the same labor force participation rate as our mothers did in 1989,” she said. “Since February 2020, over 1.4 million women have left the workforce completely, while others cut back their hours to manage caregiving. Studies of parents with young children during the pandemic affirm that mothers were four to five times more likely to have reduced their work hours or adjusted their schedules because of caregiving than fathers.” 

And Boteach said the crisis is not hitting all women equally, noting that Latinx and Black women have been pushed out of the labor force at twice the rate of white women. 

What is behind this catastrophe? Lack of care infrastructure, Boteach said. 

“Even before the pandemic, families struggled to find and afford care options for children, seniors, and people with disabilities,” she said. “When COVID-19 hit, this fragile house of cards came tumbling down. Child care programs shuttered and schools closed. COVID-19 ravaged congregate care settings, and many care workers either risked health and life to work, or were laid off as the economy shut down.” 

But even as the pandemic raged, Boteach said, children still needed to be cared for – as did older parents and people with disabilities. 

“That work disproportionately fell to women,” she said. “And these tremendous pressures, combined with massive job losses in women-dominated industries, pushed many mothers and caregivers out of the labor force entirely. Caregiving is the work that makes all other work possible.” 

You can watch the entire hearing here. (Note that the official part of the hearing begins 1:22:58 into the video.) 

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