Executive Summary

A better, more affordable country for all of us is possible, within reach, and necessary if we are to secure a brighter future for families everywhere. This report makes the case for building the care economy as a path to that better future. A vibrant vision for America’s economy must put public investments for care at the center. This approach supports people and families’ ability to thrive, increases broadly shared prosperity, and remains a necessary precondition for a growing United States economy and healthy democracy. For these reasons, care policy is widely and deeply supported by the public.1

The cost of unpaid caregiving in the United States is estimated to be over $1 trillion—and this estimate does not even account for the devaluation of the care workforce or the costs to those who need care.2 The cost burden of care that currently stifles economic stability for American families and hinders economic growth will be lifted by prioritizing public care investments and policies that support the ease of providing and caring for each other. These include:

  • Child Care for All. Guarantee that all families have child care that meets their families’ needs, is free or within families’ budgets, and includes the resources to build out a strong supply of options and a thriving community of early educators and child care programs. 
  • Paid Leave for All. Create a permanent, comprehensive federal paid family and medical leave program to allow family members to do any of the following: bond with a new child; deal with a personal or family illness or disability; handle needs that arise from a military deployment; or respond to needs arising when a worker or their family member or loved one experience sexual or domestic violence, without risking their job or critical income.
  • Paid Sick Leave for All. Ensure that all workers in the United States have access to paid sick leave when they need it to care for themselves and their loved ones.
  • Aging and Disability Care for All. Provide a robust home care benefit to strengthen Medicare, make home- and community-based services a mandatory Medicaid service, eliminate Medicaid waitlists, and establish a program for people not eligible for Medicaid or Medicare and who cannot afford to pay out of pocket. 
  • Good Jobs for All Care Workers. Guarantee that care jobs are good jobs that provide dignity and respect, family-sustaining pay and benefits, opportunities for professional development, and the ability to form and join a union to attract, retain, and support the workforce that’s needed to meet the growing care needs of everyone across the country.

Care Policies Are the Foundation of Strong Families, a Growing Economy, and Stable Democracy

A vibrant economic vision for America must prioritize care policies that support families, children, disabled people, older adults, and the people who care for them; and ensure people can manage their work and family responsibilities with ease. Everyone at some point in their life will need to give or receive care. In this economic vision, parents can find and afford convenient and flexible child care options that support their children’s development. Seniors and people with disabilities can find and afford care that supports family caregivers and enables loved ones to live full, independent lives at home in their communities. When someone has a serious illness or welcomes a new child, they can take needed time without losing pay or their job. The care workforce is paid wages and benefits to sustain their own families. 

In addition, in this economic vision, people can find good jobs that pay well, value their labor, include them in decisions about their work, and level the playing field between workers and employers. Work supports them to afford a roof over their head, food on the table, and time for care, rest, and leisure. Ensuring these needs are met prevents stress, debt, and overwhelm from piling up.

A society that delivers on these commitments—supporting care throughout the lifespan, thriving families and communities, a robust workforce, and broadly shared prosperity—is in the best position to sustain a vibrant economy and healthy democracy.

This vision guards against imbalances in power and the accumulation of wealth by the few at the expense of the many. Public dollars are responsive to people’s basic needs and ability to thrive economically. Everyone, not just corporations and the ultrawealthy, has the resources and power to make the best choices for themselves and their families. A society that delivers on these commitments—supporting care throughout the lifespan, thriving families and communities, a robust workforce, and broadly shared prosperity—is in the best position to sustain a vibrant economy and healthy democracy.

Care policies, including those that support child care, paid leave, aging and disability care, and workplace and labor standards that help ensure good jobs for care workers, are uniquely powerful in this vision. Care policies grow the economy by every measure—from the GDP and job numbers widely used today to measure economic prosperity, to individual and family security and well-being metrics that are not as commonly measured, but are just as essential.3

These policies are also popular. People from all political backgrounds agree that the cost of child care is too high,4 families shouldn’t have to choose between earning a paycheck and caring for a loved one with a serious medical need,5 and aging loved ones and people with disabilities should be able to receive care in their homes and communities.6 In addition, over the past decade, many of these policies have been implemented in states and localities. Such policies are models to learn from, as are the temporary federal care policies that were in place at the height of the COVID-19 pandemic. The effectiveness of these policies is not theoretical. We know that, when implemented well, they improve child and family well-being, reduce inequities, increase workforce participation, and have positive effects on businesses, tax revenue, and economic growth.7 

This report makes the case that the national vision for America’s economy must center care because care is a public good. Paid leave, child care, aging and disability care, and good care jobs support families to thrive, increase broadly shared prosperity, and are a necessary precondition for a growing and vibrant United States. For these reasons, care policy is widely and deeply supported by the public, and has momentum at the state and local level, which alongside pandemic-era lessons from temporary national level policies, gives us models from which to learn and build.

The Growing Power and Wealth of Corporations and the Ultrawealthy Is Leaving the Majority of Families Behind

The economic system in place today, characterized by free markets and limited government intervention, is rigged against working families. Corporations and ultrawealthy individuals—those with the most resources—have led decades of attacks on worker organizing that have scaled back workers’ ability to form and join unions, leading to a historic decline in union density that has severely diminished the power of workers to demand higher wages and benefits.8 Productivity gains have gone to those at the top in the form of amassing billions of dollars, while the labor of the American people has not translated into greater economic security for workers and their families.9 The result is that America’s workforce—the very heart of the U.S. economy—is being left behind while those at the top of the income scale continue to amass wealth.

The result is that America’s workforce—the very heart of the U.S. economy—is being left behind while those at the top of the income scale continue to amass wealth.

The current administration and majorities in Congress are making life even worse, implementing even bigger tax cuts for the ultrawealthy and corporations in the largest transfer of wealth in American history, paid for by cuts to Medicaid and Supplemental Nutrition Program (SNAP), while simultaneously attacking immigrants, who are vital members of our communities.10

When the wealthy few control the majority of assets, this particularly hurts the people with the least resources, undermining their ability to make ends meet and secure a good life for themselves and their families. The vast increase in income and wealth inequality exacerbates inequities across race, gender, ability, and country of origin.11 This inequality impacts every aspect of American life, from labor force participation and family economic security to people’s overall health and well-being. It also impacts overall economic growth and the stability of our democracy. 

In Today’s Economy, Care Remains Unaffordable or Out of Reach Entirely

For most families in America, simply getting by without stress, feelings of being overwhelmed, burnout, loneliness, or debt is unobtainable and unaffordable. Those with the most resources have used their wealth to lobby policymakers to underinvest in public goods and services, including child care, paid leave, and aging and disability care while unfairly stacking the deck for themselves with tax cuts that favor wealth. In addition, private equity firms have begun to target the care sector. These firms prioritize maximizing their profit margins, which means that their primary incentive is not to make care more affordable, accessible, or higher-quality, nor to pay care workers fairly.12

This vast power imbalance leaves families in every part of the country forced to make impossible choices while struggling to afford the care they or their family members need. A room in an institutional care or skilled nursing facility now costs approximately $100,000 per year, and aging and disability care at home, where most people want to receive it, costs between $69,000 and over $288,000 per year.13 In every state and the District of Columbia, center-based child care for two children costs more than rent; for many families, center-based child care for one infant costs more than $15,000 per year.14 The lack of affordable aging, disability, and child care all lead to tough choices and lost wages for family caregivers, disabled adults, and parents every year. Each year, the average family in the United States spends 248 hours on unpaid caregiving, the value of which collectively adds up to $1.1 trillion in unpaid care.15 The lack of federal paid family and medical leave alone means workers in the United States lose $34 billion in wages annually.16 

The expenses and wage losses resulting from providing unpaid care disproportionately make life harder for women, people of color, immigrants, people with disabilities, and the aging population. In particular, the reliance on the undervalued, underpaid, and unpaid labor of women—especially immigrants and women of color—contributes to greater inequities.17 This creates additional consequences for mothers, 64 percent of whom are either their family’s breadwinners or co-breadwinners. Supporting mothers’ employment is essential for the overall economic security of families.18 However, research shows that becoming a mother causes additional losses of income relative to men and to women without caregiving responsibilities.19 A 2023 report affirms that unequal caregiving responsibilities over a lifetime on average results in a $400,000 loss of lifetime earnings for women, and a loss of $1 million in lifetime earnings for Black women, increasing income barriers and compromising economic security in retirement.20

The aggregate effect of these trends is not only a challenge for families, but also a weaker economy, according to traditional economic measures. Research has shown that if women’s labor force participation were the same as in high-income countries that make significant public investments in care supports, there would be roughly 5 million more women in the U.S. labor force, translating into more than $775 billion in additional economic activity per year.21

In addition, the income and wealth inequality that a lack of affordable care options exacerbates has even contributed to the eroding of democracy. In a vicious cycle, this erosion simultaneously makes it harder to enact the care agenda. A 2004 analysis found that “each of the top 400 or so richest Americans had on average about 22,000 times the political power of the average member of the bottom 90 percent.”22 (No doubt, as wealth inequality has grown, this gap has only widened since then.) This further supports more recent findings which make clear that inequality contributes to polarization and cynicism, including a distrust in democracy and democratic institutions to solve people’s problems or make life better.23 Solving for care—ensuring that every family has what they need—is one of the most immediate and direct ways the government can rebuild trust and make life better for the majority of families.

Care Policies Strengthen Families’ Ability to Thrive

Valuing care and caregiving is central to how well we function as a society, supporting the social connections that bind our families and communities together. Care investments prioritize critical needs throughout the life span so people can live, learn, age, and work with dignity. Care investments reduce income inequality and other inequities deeply embedded in our economy, support local economies, and spur wage growth in high-demand yet vastly underpaid occupations. They support strong labor force participation and job growth, increased consumer spending, and tight labor markets in which workers have the power to engage in workplace decisions and change jobs. Care undergirds a full employment economy that values people’s labor where everyone who wants a job is able to find one. Care investments are the key to a more robust, sustainable economy, in which a larger share of people have the resources they need to thrive, build a better life, and have more freedom to participate in civic life and democracy.

The sections below describe the current state of (1) child care, (2) paid leave, (3) aging and disability care, and (4) care jobs and how public investments in each area improve family health and economic well-being and improve shared prosperity across all economic measures.

Child Care

An American economy that prioritizes care includes a child care system where every family can find, afford, and choose the child care option that best meets their needs. Children from all backgrounds would be safe, happy, healthy, and learning. The people who teach and work with children would be well compensated with good wages and benefits and have opportunities for professional development, empowered with a collective voice through pathways to join and build strong unions, allowing them to grow and prosper as they support and nurture the next generation to do the same. Parents would have less financial strain, as well as the peace of mind that comes with making sure the providers and educators who care for their children can also care for themselves and their own families with dignity. With families and educators working in partnership, children’s development and well-being would be supported.

Today, the American economy does not work for millions of children and families because of the broken child care system.

Unfortunately, however, the United States’ child care and early learning system is underfunded and inequitable. Child care is a textbook example of a market failure, where many parents struggle to find and afford child care options that meet their needs, while child care providers operate on razor-thin profit margins, and early educators are paid poverty-level wages.24 These high costs and the scarcity of child care lead many parents to be underemployed or forgo employment altogether to instead care for their children, which in turn undermines their financial security and weakens the economy. At the same time, there is a dearth of child care options in many communities, especially for infants and children with disabilities and for parents who work “nontraditional” hours. Today, the American economy does not work for millions of children and families because of the broken child care system.

Challenges in Current Child Care Policies

The Child Care and Development Block Grant (CCDBG) is the primary source of federal funding for child care.25 States receive CCDBG funds, which can be combined with other federal funding sources (such as the Temporary Assistance for Needy Families block grant) and state funding sources to provide subsidies to families with low incomes and to support state child care and early education systems.26 Unfortunately, due to decades of underfunding and a chronic child care workforce supply shortage, only 11 percent of the 11.5 million eligible children are actually served by this program.27 And millions more children are not eligible for CCDBG because of their families’ incomes or their education or employment situations. While federal programs such as Head Start also provide critical early care and education services to communities around the country, and support children’s health and well-being in a variety of ways, they still don’t meet the need for child care—even when combined with CCDBG.28 In 2025, the Trump administration began undermining child care and Head Start programs by freezing funds, firing staff, impeding programming that serves children and families, and more.29

In addition to federal child care funding, there are several child care-related provisions in the federal tax code. Unfortunately, the federal tax credit intended to support families who pay out of pocket for child and dependent care expenses—the Child and Dependent Care Tax Credit (CDCTC)—does not reflect the high cost of child care and is largely inaccessible for families with low and moderate incomes. Families with income less than $40,000 a year would receive little to no support from this tax benefit, even after modest expansions enacted as part of the 2025 budget reconciliation law.30 The CDCTC was temporarily expanded in 2021 in ways that help families with low and moderate incomes, but even then, because families only receive the benefits of the CDCTC when they file their taxes in the spring, the credit did little to help families with their child care bills throughout the year.31 There is also a tax provision under which employers can allow workers to put aside pre-tax dollars for child and dependent care expenses, which is even less accessible, and offers even less tax benefit, to low- and middle-income families.32

During the COVID-19 pandemic, temporary child care and early learning investments showed what is possible when the United States invests in care. The more than $50 billion invested in child care and early learning programs stabilized the child care sector and supported nearly 10 million children.33 These federal investments in states also helped set the stage for state leaders to invest in more robust child care policies. In September 2025, New Mexico became the first state to announce plans to implement free, universal child care.34 Connecticut, Vermont, Illinois, and Massachusetts have also made significant progress in making child care affordable for families, expanding options through investments in child care supply and improving wages and other working conditions through collective bargaining agreements where applicable. The 2023–24 school year set new records for state-funded pre-K enrollment and funding for children ages 3 and 4.35 Still, in the majority of states, child care is too expensive and hard to find, providers are barely making ends meet, and early educators are paid poverty-level wages. 

Economic Costs of Inadequate Child Care Policies

As a result of a patchwork of state and federal programs and inadequate funding, millions of families are left struggling to find and afford child care, while providers, including home-based providers who are mostly women of color-owned small businesses, do not receive the resources they need to keep the doors open, provide culturally responsive care, and support children to thrive in their earliest years.36 At the same time, private equity is taking over more of the child care market, extracting value and adding to inequities by serving wealthier communities and minimizing operating costs in ways that keep wages low and undermine the quality of care.37

The failure to invest in child care has a significant economic cost. Two-thirds of children from birth through age 17, and 70 percent of children under age 6, have all available parents—either both parents or a solo parent—in the workforce.38 Parental labor force participation is significantly impacted by the presence or absence of affordable, reliable high-quality child care, school, after-school, and summer camp options when and where they need them. The KPMG Parental Work Disruption Index found that an average of 1.34 million workers were affected by inadequate child care options each month in 2024, which meant up to 1.44 billion lost potential work hours.39 For those families, in aggregate, it’s a loss of between $15 billion and $44 billion in wages due to child care challenges, which is a huge stress on family budgets.40 In August 2025, 1.1 million part-time workers attributed reduced working hours to problems with securing reliable, affordable child care.41

This is an especially significant issue for moms’ labor force participation. The majority of mothers work outside the home for pay, and for breadwinner and co-breadwinner moms, labor force participation is nonnegotiable.42 Over the past forty years, as more women entered the labor force and brought home larger paychecks, they have driven 91 percent of the income gains experienced by middle-class families.43 Women of color, and Black women in particular, historically have had much higher levels of labor force participation when compared with white women, and they also experience many more job disruptions due to inadequate child care options.44

Child care-related work disruptions extend beyond lost income and economic security for women and families. States and localities are losing out on billions of dollars every year due to insufficient child care coverage. For example, research shows that Ohio’s economy loses $5.48 billion each year;45 Indiana’s loses $4.22 billion; and Florida’s loses $5.38 billion, due to a combination of losses to businesses and tax revenue connected to insufficient child care.46 The lack of a child care system to meet the needs of families and businesses alike has raised the risk of child care turning into a luxury good more than a public good.47

Today, the lack of affordable, high-quality child care options increases income and wealth inequality. Child care is one of the largest expenses on families’ monthly balance sheets. The national average annual price of child care for 2024 was $13,128.48 This is more than the annual cost of mortgage, rent, or public college tuition in the majority of states. For a married couple earning the median income, it would take 10 percent of that income to afford child care; for a single parent, the bite out of income would soar to 35 percent.49

Families with higher income are more likely to use paid child care (see Figure 1).50 Among parents with younger children, those with high incomes are about twice as likely as those with low or middle incomes to use twenty or more hours of paid child care per week.51 Households with young children with incomes lower than $75,000 per year are more likely to reduce work to provide child care, with about 35 percent of these households reducing work to care for children.52 In other words, the lack of affordable child care contributes to income inequality. Those with more income can better afford to pay for child care and participate in the labor force and in educational advancement opportunities, resulting in a self-reinforcing cycle. 

FIGURE 1

What Greater Public Investment in Child Care Would Do for Families and the Economy

When families have access to affordable, high-quality child care options, the adults in the family can increase their labor force participation and educational opportunities, which, in turn, can increase their income. A study from the Committee for Economic Development at the Conference Board found that paid child care usage leads to greater overall labor force participation at the state level.53 Child care bills that don’t break the bank have the added benefit of allowing parents to work more and earn more, eventually having more resources to afford essentials, saving and reducing debt, and accumulating assets and wealth.54 High-quality child care and family economic security both support children’s healthy development, which can support better educational, employment, and economic outcomes for them over time as well. 

Robust public investments in a comprehensive child care and early learning system will simultaneously create jobs and enable jobs: it supports good jobs for those working in child care, enables economic growth through higher spending among care workers with higher wages, and enables parental participation in work, education, job training, or other related activities.55 A 2023 study found that the U.S. economy loses $122 billion each year from the child care crisis. Families lose $78 billion per year as a result of child care challenges, employers lose $23 billion annually due to child care challenges faced by their workforce, and taxpayers lose $21 billion each year in lower local, state, and federal tax revenue.56 New research has also found that child care investments in particular help drive up women’s labor force participation.57 Data from 2022 shows that through both direct and spillover effects, the child care sector supported a total economic impact of $152 billion in output, $57 billion in household earnings, and 2.2 million jobs.58 In addition, research finds, “the U.S. child care industry generated $68.5 billion in revenue and $24.1 billion in purchases of goods and services. Over 1.5 million proprietors and workers were directly employed by the child care sector, collectively earning $32.7 billion in 2022.”59 The size of the U.S. child care market is estimated to grow from $65 billion in 2024 to $110 billion by 2033.60

Greater public investment in high-quality child care means that parents have more economic stability to house, feed, clothes and care for their children, and less stress and pressure in their own lives. These factors help them support their children’s healthy development and well-being, which is especially critical in the early years. Researchers have found that, “Healthy development in the early years (particularly birth to age 3) provides the building blocks for educational achievement, economic productivity, responsible citizenship, lifelong health, strong communities, and successful parenting of the next generation.”61 That is one of the many reasons investing in child care is such a popular issue among not only parents, but all voters. 

According to recent polling data, 68 percent of all voters say access to high-quality, affordable child care is “essential/very important” to strengthening the economy and 71 percent of small business owners think that access to high-quality, affordable child care is essential or important to strengthening the economy and helping workers.62 Another poll found that 77 percent of voters say it is important for the government to guarantee access to affordable child care for everyone who needs it.63

By the numbers, greater public investment in affordable child care would:

  • Provide a path to more work hours and job advancement. A nationwide survey of 1,175 parents in 2024 found that among parents with children age 5 and under, nearly one in three would increase their work hours, and one in four would seek a new job if reliable, affordable child care were available.66
  • Increase long-term income. A 1 percent increase in the labor force participation rate for women (72.9 percent to 73.6 percent) is associated with an expected $72.8 billion long-run increase in total personal income.67

Paid Leave

An American economy that prioritizes care includes workplace policies that make the basic cost of living more affordable, make it easier for caregivers to both care and work, and ensure that regardless of race, gender, and ability, people are able to freely choose their careers and make decisions about work. The bottom line when it comes to paid leave is that all workers should have the time they need to care for themselves and their families when they need it without risking their job or their paycheck.

The United States has no national paid family and medical leave or paid sick leave policy. Even unpaid leave under the Family Medical Leave Act (FMLA) is inaccessible and unaffordable for many. Far too many people are faced with impossible choices between taking the time they need to take care of their own health, provide care for a loved one, or welcome a new child and losing the job or paycheck they need to make ends meet and put food on the table and pay rent. The absence of common-sense, family-forward workplace policies exacerbates economic and care challenges, with significant costs for workers and their families, public health, and the economy.

Paid Family and Medical Leave

Paid family and medical leave enables people to receive wage replacement when they take extended time off from work for qualifying reasons, such as bonding with a new child, managing their own serious health condition, or caring for a loved one with a serious health condition.

Currently, thirteen states and the District of Columbia have paid medical and family leave laws in place.68 But the majority of private-sector workers in the United States do not have access to paid family and medical leave.69 In 2023, the Bureau of Labor Statistics (BLS) found that only 27 percent of private-sector workers have paid family leave.70 As of 2025, less than 50 percent have access to short-term disability, which some eligible workers may use on its own or alongside paid family and medical leave, if available.71 When paid family and medical leave benefits are at the discretion of employers, the most underpaid low-wage workers are the least likely to have access to paid leave. Among the most underpaid workers, many of whom are women and workers of color, only 5 percent have access to paid family leave through their employers.72 These inequalities across income are deepened by racial and gender inequities, with Black, Latina, and immigrant women being more likely to work in kinds of jobs that often do not have access to paid family and medical leave.73 Black women lose an estimated 3.9 billion in wages each year due to unpaid leave.74 Workers with disabilities are also less likely to have access to paid family and medical leave, with only 26.5 percent of disabled workers having access compared to 37 percent of non-disabled workers.75 Lack of access to paid leave makes it more difficult to balance care needs with work.

The lack of access to paid family leave or personal medical leave costs U.S. families $34 billion per year in lost wages.76 More than half (56 percent) of family caregivers experience financial strain and work interruptions as a result of caregiving.77 Both women and men over the age of 50 who leave the workforce to care for an aging parent lose over $400,000 in earnings and retirement savings, with women losing almost $460,000, further entrenching gendered income inequality while making everybody less economically secure.78

The uneven distribution of who has paid leave contributes to income and wealth inequality in the United States. Those without paid leave are forced to forgo their paychecks and, in some cases, even risk their jobs if they take leave when they need it, which sets them back further economically. People may forgo medical care, which can have a devastating personal and financial impact.

A person’s health and well-being are linked to their ability to work. Paid leave helps workers and their loved ones access timely health care, improves maternal mental health, and creates more financially stable families.79 Further, access to paid family and medical leave increases women’s labor force participation, which supports family economic security and improves national economic growth.80 Paid family and medical leave also increases the labor force participation of unpaid family caregivers providing care for aging and disabled family members, boosting their economic security.81 With its immense benefits to workers and their families, paid leave is overwhelmingly popular across the political spectrum: 81 percent of voters support a national paid leave program.82

By the numbers, greater public investment in paid family and medical leave would:

  • Support family caregivers, reducing racial and gender inequities in wages and work. With paid family and medical leave, 3.7 million more women caregivers, 850,000 more Black caregivers, and 1 million more Latinx caregivers could enter the labor force by 2030.83
  • Increase lifelong earnings for workers. One study finds that, by helping workers stay at the same employer rather than needing to find a new job after leave, paid family medical leave policies would increase aggregate household income by $28.5 billion dollars.92 Around $9.4 billion of this would be generated from increased spending on goods and services by people with access to paid leave, buoying the economy.93

Paid Sick Leave

Seventeen states and the District of Columbia have laws requiring employers to provide some paid or earned sick leave.94 This type of leave is for short-term use, for illness, injury, or seeking medical care. While, nationally, substantially more workers have access to paid sick leave than paid family and medical leave, access is both inconsistent and largely reliant on the voluntary actions of employers.

Twenty-five million workers still do not have a single day of paid sick leave.95 (See Figure 2.) While 96 percent of the top 10 percent of wage-earners have access to paid sick days, only 41 percent of those in the bottom 10 percent of wage-earners have access to paid sick days.96 Only 19 percent of home care workers have access to employer-provided paid sick leave.97

FIGURE 2

The 25 million workers without paid sick leave currently are most often underpaid and part-time workers, who are more often women and people of color.98 Women are more likely than men to be balancing work with caregiving responsibilities such as caring for a child or an aging loved one.99 Access to paid sick leave makes a healthier and more productive workforce: increasing access to preventative care, reducing the likelihood that workers show up to work sick, and improving collective public health.100

Workers and families around the country and across the political spectrum overwhelmingly agree with the basic principle that people should be able to take a day off to care for themselves or a loved one, as evident from the recently passed ballot initiatives for paid sick leave in states from Alaska to Nebraska.101

By the numbers, greater public investment in paid sick leave would:

  • Reduce health care costs and improve public health. National paid sick leave is estimated to result in $1.1 billion in savings for hospital emergency departments each year.102
  • Reduce the number of people going into work while sick. Going into work while sick—a phenomenon called “presenteeism”—is estimated to cost the economy $293 billion each year due to reduced productivity.106 

Aging and Disability Care

An American economy that prioritizes care recognizes that everyone will need to give or receive care at some point during their lives, and robust aging and disability care is central to ensuring that people have the freedom to choose where they live, work, and age.

The Current Aging and Disability Care System Does Not Meet Needs or Expectations

While some aging and disability care can take place in institutional facilities such as nursing homes, the vast majority of people—more than 90 percent of older adults and 89 percent of people with disabilities—would prefer to live and age at home and in their communities.107 In order to do so, they need aging and disability care in the form of home- and community-based services (HCBS), including transportation and assistance with communication, getting dressed, or other day-to-day tasks that enable them to fully participate in their communities.108 Care recipients need the option to self-direct their own care, determining how care is provided and hiring a caregiver of their choice, including a family member, if preferred.109 People with disabilities need support to participate in employment, and family caregivers, who often take time out of the paid workforce to provide care, need support as well.110 However, the current patchwork system leaves many out, and forces people who require care to become impoverished to access the services they need, utilize institutional settings when they would prefer to live and age at home, rely on the unpaid labor of undersupported family caregivers, or to go without care entirely. 

Medicaid, a state and federal partnership, is the primary source of funding for aging and disability care, both for institutional care facilities and for home- and community-based services. Since private insurance and Medicare do not cover the majority of long-term care, Medicaid pays for nearly 70 percent of all home- and community-based services.111 More than 7.8 million people with disabilities and older adults rely on Medicaid HCBS.112 Medicaid has strict financial eligibility requirements that force people to spend down assets if they need care. Despite the overwhelming preference that care recipients have for living and aging at home, Medicaid home- and community-based care is optional for states to provide, while institutional care facilities are a required service under federal law.113 As a result, most states operate waiting lists for HCBS, with more than 710,000 people remaining on such lists in 2024.114 Most wait an average of forty months before receiving home- and community-based services through Medicaid waivers.115 Many others do not qualify for Medicaid at all because they do not meet the strict income and asset requirements.116

Public education is also needed, because many people assume that private insurance or Medicare will cover the support that they or their loved ones will need as they age. Many people incorrectly believe that Medicare covers long-term care.117 Such a change to Medicare would be popular: 88 percent of voters support expanding Medicare to cover long-term, in-home care.118 Overwhelmingly, people value home- and community-based services and support increased investment. In a recent poll, 90 percent of likely voters said they believed there should be no cuts to HCBS, and a majority wanted increased funding.119 The need for long-term care is only growing, but the investment of public dollars has not met the need.120

At the height of the COVID-19 pandemic, the federal government temporarily did invest in Medicaid home- and community-based services. States used these funds to expand services to beneficiaries; strengthen workforce recruitment, retention, and training; provide respite services for family caregivers; and improve services for the children, families, and disabled and older adults who rely on them. Notably, all states increased opportunities for care recipients to self-direct their own care, giving people more freedom in how they receive services.121 Unfortunately, these investments were temporary rather than permanent investments that care recipients and caregivers need. 

At the same time, many states are pursuing policies to increase access to home- and community-based services because of the growing demand for services. California recently increased the Medi-Cal Aged, Blind, and Disabled income limit to 138 percent of the federal poverty level (FPL), and the amount of assets a person can have to be eligible for Medicaid from $2,000 to $130,000 for a single person.122 Oregon also strengthened its Medicaid program by expanding the Oregon Project Independence program to older adults and people with disabilities with incomes up to 400 percent of the federal poverty level (about $5,200 per month) and who do not have resources that exceed the cost of six months in a nursing facility.123 In Washington State, the state legislature established the WA Cares Fund, the first statewide long-term care social insurance program in the country. Funded through modest payroll contributions, the program helps pay for hiring home care workers, home modifications, meal deliveries, compensation for family caregivers, and more when residents need long-term care, paying out benefits beginning in 2026.124 These policies mean that more people can get the care that they need and deserve without having to sacrifice income and draining savings to do so. 

The Impacts of Scarce Public Investment in Aging or Disability Care

Because Medicare does not cover most long-term care, older adults and people with disabilities who are ineligible for Medicaid must pay out-of-pocket for aging and disability care, rely on unpaid friends and family for care, or go without care entirely. Private-pay long-term care services are prohibitively expensive and pose a significant financial burden for those most in need. In 2023, the median annual costs of care in the United States were $68,640 for full-time home health aide services and $288,288 for round-the-clock home health aide services—costs that are out of reach for most Americans.125 Private long-term care insurance is also unaffordable for most people and is limited in scope.126 The U.S. Department of Health and Human Services estimates that the average American turning 65 today will incur $120,900 in future long-term care costs, with families paying for over one-third of the cost out-of-pocket.127 Such high costs would quickly exhaust the resources of older adults and people with disabilities, making it harder for families to make ends meet, save for the future, and take care of themselves and their loved ones. Family caregivers are often left to shoulder the resulting gaps in care. Family caregivers provide an estimated value of $600 billion in unpaid caregiving contributions.128 These estimates don’t include other financial challenges, such as lost wages resulting from needing to limit working hours, accumulated debt, lost retirement contributions and savings, and out-of-pocket caregiving costs. The country’s failure to support investments in aging and disability care impact the ability of older adults and disabled people to get consistent, life-sustaining care even as the care workforce is underpaid and undervalued. 

Recent and devastating federal funding cuts to Medicaid, Medicare, and the Affordable Care Act further entrench this imbalance, while also creating significant state budget shortfalls and that will have negative, downstream effects on existing care supports.129 This is in part because Medicaid dollars are the single largest source of federal funding for states, and federal and state dollars combined make up nearly one-third of state budgets.130 States will be unable to make up for such a loss in funding without making cuts to critical goods and services.131 As an optional Medicaid service, home- and community-based services are likely to be among the first services that states will consider eliminating.132 Additionally, without public investment that includes clear policy guardrails, long-term care is vulnerable to increasing privatization and financialization, with private equity firms now owning about 10 percent of the home care sector.133 Private equity’s involvement has been shown to raise prices for those who need care while cutting wages for care workers to minimize costs.134 As the need for care grows, with the number of older adults who need care expected to double by 2080, investing public dollars in aging and disability care that empowers those who need care, resources for family caregivers, and supports good jobs for care workers is ever more urgent.135

What Greater Public Investment in Aging and Disability Care Would Do for Families and the Economy

Such investments would not only lower costs for families, but also strengthen the broader economy. Most critically, increased investments to strengthen HCBS would mean that older adults and people with disabilities have more freedom to receive the care they need in the setting of their choice, including through self-directed care. These policies improve the overall health and well-being of care recipients and caregivers. It would also increase family caregivers’ economic security by ensuring that aging and disability supports are not only widely available, but also affordable, decreasing financial strain and preventing accumulation of debt.136 Fuller access to supports such as respite care and compensation for family caregivers can help alleviate stressors that affect their health, well-being, and ability to participate in the workforce.137 As discussed above, these policies also impact women’s income and participation in the labor force because women are more often relied upon to provide care to children and other family members.138

Investing in aging and disability care also supports the care economy by creating good care jobs.139 And it would improve the health and well-being of millions across the country, as well as the dignity and economic security of everyone who gives and receives care. 

By the numbers, greater public investment in aging and disability care would:

  • Meet the growing demand for care people prefer. Over 90 percent of older adults and 89 percent of people with disabilities prefer to live and age at home and in their communities;143 86 percent of voters think Congress should take action to improve the availability of quality, affordable HCBS.144
  • Promote job growth and a strong economy. Previously proposed investments to bolster home- and community-based services included would have created more than 740,000 jobs, both through directly created home care jobs and indirect job creation as workers spend new wages that strengthen local economies.146

Good Jobs for Care Workers

An American economy that prioritizes care includes good jobs for the care workforce, with family-sustaining pay and benefits, and the ability to form and join a union. Care work would be a highly-valued and respected profession and the sector would attract and retain the workforce that’s needed to meet the growing care needs of all across the country. Care workers of all kinds would have what they need to take care of themselves and their families, and care recipients would have the high-quality, reliable, and affordable services they need to live, age, and work with dignity in the setting of their choice.

Care Workers Are Undervalued, Underpaid, and Underprotected

Care workers—child care and direct care workers, including personal care aides, home health aides, and direct support professionals—provide life-sustaining care that allows families and communities to thrive and live and age independently at every stage of life. Care work includes everything from caring for children, to assisting people with disabilities, to everyday household tasks such as cleaning services, laundry, and meal preparation. Not only is supporting care workers essential for their and their families’ well-being, care work is critical for the well-being of care recipients and the broader economy, supporting people with care needs and caregiving responsibilities to participate in the paid workforce.

Despite the critical nature of this work, care continues to be devalued, relying on underpaid labor of care workers and unpaid family caregivers while also contributing to the persistence of racial and gender inequities. The devaluation of care work is inextricable from the country’s legacy of chattel slavery, when enslaved Black women were forced to care for the family members of their enslavers.147 Today, racial and gender-based inequities persist. Unpaid caregiving, two-thirds of which is done by women, is worth more than $1 trillion.148 Asian women and Latina women both spend about an hour a day on average providing unpaid care—the highest out of any group—providing $5,600 and $5,100 in unpaid care per capita each year, respectively.149 Black women and white women, who average the most time of any group caring for people outside of their household, are providing $4,100 and $5,000 total in unpaid care per capita each year, respectively.150 Women of color are also more likely to be “sandwich caregivers”—providing unpaid care to an adult while also caring for children at home.151 These disparities demonstrate the compounding challenges of providing unpaid care, such as difficulties reentering the workforce and economic insecurity, further entrenching existing gender and racial inequities. 

Wages in the care workforce are limited by an underinvestment of federal and state dollars, making occupations in the care sector among the lowest paid in the workforce overall.152 As a result, families often lack the resources to compensate providers in line with the true value of their work, making public investment even more essential to fill in the gaps left by the failure of the current economic system. The national median hourly wage for all jobs in the United States is $23.80, meaning care workers are paid less than similar workers in other industries, even when controlling for characteristics such as education, demographic characteristics, geography, and credentials.153 Nationally, people who work with children in child care and preschool are paid a median wage of $15.41 an hour.154 Home-based child care providers—those who provide care in their own homes or private households—are paid a median wage of just $9.01 an hour.155 Direct care workers, which include personal care aides, home care workers, direct support professionals, residential care aides, and nursing assistants in nursing homes, are paid an annual median wage of $17.36 an hour, with home care workers paid the least at a median of $16.77 per hour.156 These national averages hide regional and state specific variations. For example, in the South, where care workers are overwhelmingly Black, Latina, and immigrant women, they tend to be paid less than the national average, and union density is especially low.157

In addition to low pay, care jobs often lack benefits such as health insurance, retirement, and paid time off.158 Complex, emotionally and physically demanding work with little to no support or resources makes it difficult to attract and retain the workers necessary to meet rapidly growing demand. From 2014 to 2023, the direct care workforce added more than 1.5 million jobs, reaching 5 million.159 Projections indicate that the direct care field will need to add nearly 740,000 new jobs from 2024 to 2034, outpacing every occupation in the country in terms of new jobs added to the labor force.160 Meanwhile, today, child care employment remains 100,ooo jobs below pre-pandemic trends, despite the vast demand.161 Without improving the pay, benefits, and working conditions of the care jobs, the sector will struggle to fill these openings, stretching the workforce even thinner and jeopardizing life-sustaining care that people across the country rely on. 

The exclusion of care workers from workplace rights and protections makes it even harder for the sector to organize and demand family-sustaining wages, benefits, and better working conditions. For example, New Deal-era policies guaranteeing minimum wages, overtime pay, health and safety protections, and the right for workers to join together and form unions, originally excluded domestic and agricultural workers—occupations held by mostly Black workers.162 More recently, the 2014 U.S. Supreme Court decision Harris v. Quinn ruled that Medicaid direct care workers providing home- and community-based services for older adults and disabled people could not be required to pay the portion of union dues that support collective bargaining, a major blow for workers organizing in the care sector.163 Care workers today continue to experience attacks on what few workplace rights they’ve been able to secure.164

As a result, care workers often face economic insecurity and poor working conditions. Still, care workers have successfully pushed back against their undervaluation by organizing to improve wages, benefits, working conditions, and the quality of services for care recipients. For example, New Jersey recently joined eleven other states, two major cities, and the District of Columbia in passing a Domestic Workers’ Bill of Rights which guarantees basic labor rights and protections in the workplace that domestic workers—including child care and home care workers—are entitled to.165 Michigan home care workers recently won restoration of their collective bargaining rights and secured additional support for care recipients needing home- and community-based services in the state.166 Washington, D.C. established the D.C. Early Childhood Educator Pay Equity Fund in 2022, a first-in-the-nation initiative to raise compensation for early childhood educators across the early learning system. In fiscal year 2023, the policy increased caregiver compensation by 40 percent, supporting staff retention.167

Despite progress made throughout the years, anti-immigrant policies put in place by the current administration and state lawmakers in many states, including a mass detention and deportation agenda, threaten the care workforce, exacerbate the challenges paid and unpaid care workers face, and put people in need of the care they provide at risk. Immigrant workers have long been essential to our communities and to the care sector, making up nearly 30 percent of all home care workers, 21 percent of workers in nursing facilities, 23 percent of child care workers, and 42 percent of domestic workers in the U.S.168 The number of Americans turning 65 and older has outpaced the growth of working-age adults, and the U.S.-born workforce alone will not be able to meet the nation’s rapidly growing care needs.169 Cruel anti-immigrant policies that force people out of their jobs and communities further threaten an already fragile system, jeopardizing the well-being of families and communities nationwide.

The Impact of Undervaluing Care Workers

Poor working conditions, low pay, and no benefits mean that care workers aren’t able to take care of themselves and their own families. The impact of a lack of good care jobs is clear: one-in-three direct care workers live in low-income households, and nearly half (49 percent) rely on some form of public assistance, such as Medicaid and SNAP.170 Many direct care workers are also doubly reliant on Medicaid: the program is the key funding source for their pay, and over a third of home care workers rely on Medicaid for their own health care coverage.171 Child care workers’ families are more than twice as likely to experience poverty as other workers’ families and struggle to afford the cost of child care for their own children.172 Domestic workers are three times as likely to experience poverty and less than one in ten receive retirement benefits and health insurance through their employer.173 It’s important to note that many immigrant care workers aren’t eligible for public assistance due to their immigration status, leaving many workers without a way to secure basic necessities despite their essential contributions to such programs with taxes from their wages and purchases.174

Low compensation remains a key driving factor behind challenges facing the care sector, resulting in difficulty recruiting and retaining workers, high turnover, and limited support for providers, which are often small businesses with few employees. High turnover, in particular, disrupts the consistency and reliability of care that older adults, people with disabilities, and family caregivers need. This is true across the care sector, but especially evident among nursing assistants in nursing homes for whom the annual median turnover rate is nearly 100 percent.175 This can have devastating effects on families: staffing shortages in nursing homes have been shown to be associated with increased deaths of nursing home residents.176 These challenges are likely to worsen in the years ahead with attacks on minimum staffing standards for nursing homes and the recent federal budget bill’s cuts to Medicaid, which limits states’ ability to sustain or increase direct care workforce investments.177 The economic reality of care workers does not reflect or recognize the complexity and value of the work they do in all settings.

Importantly, the current administration’s attacks on immigrants will reduce the size of the care labor force, squeezing the labor supply further and negatively impacting careworkers’ ability to support themselves, their families, and care recipients.178 Increased threats of family separation, detention or deportation in schools, workplaces, child care programs, and more may prevent people from receiving basic services or going to work out of fear. Not only does it impact the emotional and physical well-being of children and families foremost, it also puts their economic security even more at risk. One analysis found that the deportation of undocumented residents from mixed-status households would reduce median household income by 47 percent.179

Anti-immigrant policies also have broader economic consequences. Research has shown that a mass deportation policy could reduce cumulative GDP by $4.7 billion over ten years.180 Without immigrant care workers, even more family caregivers may be forced to leave the workforce or reduce their work hours in order to provide care. Caregivers already lose an estimated $522 billion in wages each year due to caregiving, and employers lose an estimated $33 billion per year due to employees’ caregiving responsibilities.181 Without sustained immigration to the United States, GDP growth will be near impossible, and allowing for larger flows of immigration is one of the only options for policymakers who do not want to see the rate of GDP growth slow.182

What Good Jobs for Care Workers Would Do for Families and the Economy

Making care jobs good jobs is necessary to support the well-being of families across the nation and build a more equitable and inclusive economy. In addition to a strong, family-sustaining wage floor for care workers in their respective industries, the bargaining power that unions can provide is one of the most direct pathways to securing better pay, benefits, and job security. According to one analysis, if all direct care and child care workers were covered by union contracts, due to the wage-boosting effects of such agreements, these workers would likely see significant wage increases.183 They would also be much more likely to have health insurance, paid time off, and equitable pay, since these provisions are often included in collective bargaining agreements.184 Raising pay for care workers addresses the workforce recruitment and retention crisis, and reduces the need for care workers to depend on the public programs which also need ongoing, robust investments to support people in meeting their basic needs. Better earnings for care workers also stimulates economic growth because lower income workers are more likely to spend a greater proportion of new, increased earnings on previously unaffordable basic needs and services, rather than saving it.185

As mentioned in the previous section, prioritizing public investments in aging and disability care supports good jobs for care workers by creating millions of jobs and stimulating the economy as workers spend new wages. When care jobs are good jobs, care workers are able to take care of themselves and their families with safety and dignity. This would mean more consistent and reliable care for older adults, people with disabilities, families, and children, giving people more freedom in where they live, age, and work. Pressure would be relieved from family caregivers who are often forced to take time out of the workforce to meet caregiving responsibilities, boosting their emotional and financial well-being, in addition to increasing women’s labor force participation. Employers would benefit from reduced employee turnover and increased retention, reducing the costs associated with training and hiring new workers. Everyone benefits when care jobs are good jobs: workers are better off, people receive better and more consistent services, and family caregivers are more secure.

By the numbers, greater public investment in good jobs for care workers would:

  • Support and resource care and caregiving. The economic output of unpaid caregivers’ labor is worth more than $1 trillion annually.189 Compensating unpaid caregivers for this essential work would support the economic security of caregivers and enable economic growth.

An Economic Vision for America Centered on Care

A vibrant economic vision for the United States prioritizes care policies, including:

  • Child Care for All. Guarantee that all families have child care that meets their families’ needs, is free or within families’ budgets, and includes the resources to build out a strong supply of options and a thriving community of early educators and child care programs.
  • Paid Leave for All. Create a permanent, comprehensive federal paid family and medical leave program to allow family members to do any of the following: bond with a new child, deal with a personal or family illness or disability, handle needs that arise from a military deployment, or respond to needs arising when a worker or their family member or loved one experience sexual or domestic violence, without risking their job or critical income.
  • Paid Sick Leave for All. Ensure that all workers in the United States have access to paid sick leave when they need it to care for themselves and their loved ones. 
  • Aging and Disability Care for All. Provide a robust home care benefit to strengthen Medicare, make home and community-based services a mandatory Medicaid service, eliminate Medicaid waitlists, and establish a program for people not eligible for Medicaid or Medicare and who cannot afford to pay out of pocket. 
  • Good Jobs for All Care Workers. Guarantee that care jobs are good jobs that provide dignity and respect, family-sustaining pay and benefits, opportunities for professional development, and the ability to form and join a union to attract, retain, and support the workforce that’s needed to meet the growing care needs of everyone across the country. 

A future where families’ decisions about care depend on what they want, rather than what they can afford, is within reach.

Looking Ahead

An American economy that prioritizes care is a prerequisite for an American future that includes flourishing individuals, families, and communities, greater equality, shared economic prosperity, and a stronger democracy. Care investments must be central to the economic policy agenda because it is what families need. That is and should be enough of a reason. A care-centered economy not only supports families, it drives economic growth and democratic stability.

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Acknowledgments: The authors are tremendously grateful to Amy Matsui, Whitney Pesek, and Julie Vogtman from the National Women’s Law Center; Anali Algeria from the Child Care for Every Family Network; Dawn Hucklebridge and Molly Weston Williamson from Paid Leave for All; Amber Christ and Natalie Kean from Justice in Aging; Kate Bahn from the Institute for Women’s Policy Research; Robbie Bellamy and Sarah Nolan from SEIU; Gayle Goldin from The Century Foundation, and Nicole Jorwic from Caring Across Generations for their contributions to this report. 

The authors also would like to thank the CARE Fund for their support for this report.

Notes

  1. “NWLC Releases Election Night Polling on Gender Justice Issues,” National Women’s Law Center, 2024, https://nwlc.org/resource/2024-election-night-survey-results/.
  2. Kate Gallagher Robbins and Jessica Mason, “If Americans Were Paid For Their Caregiving, They Would Make More Than $1.1 Trillion,” National Partnership for Women and Families, 2025, https://nationalpartnership.org/if-americans-were-paid-for-their-caregiving-they-would-make-more-than-1-1-trillion/.
  3. Nancy Folbre, “Care Provision and the Boundaries of Production,” Journal of Economic Perspectives 38, no. 1 (2024): 201–20, https://doi.org/10.1257/jep.38.1.201.
  4. Joe Walsh, “New Bipartisan Policy Center, Cygnal Poll: Republican Primary Voters View Child Care as Essential for Employment, Economic Success,” Bipartisan Policy Center, June 2025, https://bipartisanpolicy.org/press-release/poll-republican-primary-voters-child-care-opportunity-2025/.
  5. “NEW Nationwide Poll on State of Men in America: Family, Care & Masculinity,” Paid Leave For All, June 2025, https://paidleaveforall.org/new-nationwide-poll-on-state-of-men-in-america-family-care-masculinity/.
  6. “Support for Greater Government Role in Health Care for Older Adults,” Associated Press-NORC Center for Public Affairs Research, Long-Term Care Poll, September 2022, https://www.longtermcarepoll.org/project/support-for-greater-government-role-in-health-care-for-older-adults/.
  7. Julie Kashen, Anna Wadia, Choua Vue, Allison Cook, “Investing in the Care Economy Works: Learning from the American Rescue Plan,” The Century Foundation, February 28, 2023, https://tcf.org/content/commentary/investing-in-the-care-economy-works-learning-from-the-american-rescue-plan/.
  8. “Unions aren’t just good for workers—they also benefit communities and democracy,” Economic Policy Institute, 2025, https://www.epi.org/publication/unions-arent-just-good-for-workers-they-also-benefit-communities-and-democracy/#epi-toc-5.
  9. Americans for Tax Fairness. “Total Billionaire Wealth Tops $7 Trillion As GOP Aims To Cut Healthcare, Food Aid To Give Rich More Tax Cuts,” June 2025.
  10. Bobby Kogan, “The House Republicans’ Budget Bill Guts Basic Needs Programs for the Most Vulnerable Americans to Give Tax Breaks to the Rich,” Center for American Progress, May 2025, https://www.americanprogress.org/article/the-house-republicans-budget-bill-guts-basic-needs-programs-for-the-most-vulnerable-americans-to-give-tax-breaks-to-the-rich/; “As Medicaid and Medicare Turn 60, Congress Enacts Law That Guts Coverage, Endangers Services and Shutters Local Hospitals To Finance More Tax Giveaways to Corporations,” Americans for Tax Fairness, July 2025, https://americansfortaxfairness.org/total-billionaire-wealth-tops-7-trillion-gop-aims-cut-healthcare-food-aid-give-rich-tax-cuts/.
  11. Rebecca Riddell, “UNEQUAL: The Rise of a New American Oligarchy and the Agenda We Need,” Oxfam America, November 2025, https://www.oxfamamerica.org/explore/research-publications/unequal-the-rise-of-a-new-american-oligarchy-and-the-agenda-we-need/.
  12. Elliot Haspel, “The End User Is a Dollar Sign, It’s Not a Child,” The 74, April 22, 2024, https://www.the74million.org/zero2eight/the-end-user-is-a-dollar-sign-its-not-a-child-how-private-equity-and-shareholders-are-reshaping-american-child-care/; “Equity for Whom? An Introduction to Private Equity’s Impacts on the Disability Community,” DREDF, 2024, https://dredf.org/equity-for-whom-1/.
  13. Priya Chidambaram and Alice Burns, “10 Things About Long-Term Services and Supports (LTSS),” KFF, July 8, 2024, https://www.kff.org/medicaid/issue-brief/10-things-about-long-term-services-and-supports-ltss/.
  14. “Child Care in America: 2024 Price & Supply,” Child Care Aware, 2024, https://info.childcareaware.org/hubfs/2023_Affordability_Analysis.pdf.
  15. Kate Gallagher Robbins and Jessica Mason, “If Americans Were Paid For Their Caregiving, They Would Make More Than $1.1 Trillion,” National Partnership for Women and Families, 2025, https://nationalpartnership.org/if-americans-were-paid-for-their-caregiving-they-would-make-more-than-1-1-trillion/.
  16. Emily Andrews, Sapna Mehta, and Jessica Milli, “Working People Need Access to Paid Leave,” Center for Law and Social Policy, November 2024, https://www.clasp.org/wp-content/uploads/2024/09/2024.9.25_Need-for-Paid-Leave.pdf.
  17. “Unseen Work, Unmet Needs: Exploring the intersections of gender, race and ethnicity in unpaid care labor and paid labor in the U.S.,” Oxfam, 2024, https://www.oxfamamerica.org/explore/research-publications/unseen-work-unmet-needs/.
  18. Sarah Jane Glynn, “Breadwinning Mothers Continue To Be the U.S. Norm,” Center for American Progress, 2019, https://www.americanprogress.org/article/breadwinning-mothers-continue-u-s-norm/.
  19. Claudia Goldin, Sari Pekkala Kerr, and Claudia Olivetti, “When the Kids Grow Up: Women’s Employment and Earnings across the Family Cycle,” National Bureau of Economic Research, August 2022, https://www.nber.org/papers/w30323.
  20. Amy Royce and Amy Matsui, “Unsupported: Undervinetsment in the Care Economy Drives Gender and Racial Wealth Gaps,” American Bar Association, January 6, 2023, https://www.americanbar.org/groups/crsj/publications/human_rights_magazine_home/wealth-disparities-in-civil-rights/unsupported/; “The Economic Security and Health of Older Women of Color,” National Women’s Law Center and Justice in Aging, 2023, https://nwlc.org/wp-content/uploads/2023/07/Economic-Security-Brief-FINAL-7-12-23.pdf.
  21. Sarah Glynn, “The Cost of Doing Nothing, 2023 Update: The Price We Still Pay without Policies to Support Working Families,” U.S. Department of Labor, Women’s Bureau, 2023, https://static1.squarespace.com/static/6536b8dab487e203ecaa28ae/t/67c7b3ff09741d60c3f6fc6c/1741140991792/The+Cost+of+Doing+Nothing%2C+2023+Update.pdf.
  22. Allison A. Tait, “Inheriting Privilege,” Minnesota Law Review 106, no. 4 (2022): 1959, https://scholarship.law.umn.edu/minnlrev/vol106/iss4/6, citing Jeffrey A. Winters and Benjamin I. Page, “Oligarchy in the United States?” Perspectives on Politics 7, no. 4 (December 2009): 731–51, https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3786351.
  23. Eli Rau and Susan Stokes. “Economic Inequality Threatens Democracy,” AFT, 2025, https://www.aft.org/ae/fall2025/rau_stokes.
  24. Sandra Black and Jesse Rothstein, “Public investments in social insurance, education, and child care can overcome market failures to promote family and economic well-being,” Washington Center for Equitable Growth, 2021, https://equitablegrowth.org/public-investments-in-social-insurance-education-and-child-care-can-overcome-market-failures-to-promote-family-and-economic-well-being/.
  25. Congressional Research Service. “The Child Care and Development Block Grant: In Brief,” 2024. https://www.congress.gov/crs-product/R47312
  26. Ibid.
  27. Nina Chien, “Estimates of Child Care Subsidy Eligibility and Receipt for Fiscal Year 2021,” U.S. Department of Health and Human Services, ASPE Office of Human Services Planning, September 2024, https://aspe.hhs.gov/sites/default/files/documents/a91fd97aa80b53fa52a52d38cd323509/cy2021-child-care-subsidy-eligibility.pdf; “Office of Child Care, “FY2021 Final Data Table 1—Average Monthly Adjusted Number of Families and Children Served,” U.S. Department of Health and Human Services, current as of January 9, 2025, https://acf.gov/occ/data/fy-2021-final-data-table-1. The 11 percent is the comparison of the 1.3 million children served by CCDBG to the 11.5 million federally eligible.
  28. Julie Kashen, “ The Top Six Reasons We Need Comprehensive Child Care and Pre-K,” The Century Foundation, February 24, 2022. https://tcf.org/content/commentary/top-six-reasons-need-comprehensive-child-care-universal-pre-k/
  29. Ruth Friedman, “Trump and Republicans in Congress Are Making The Child Care Crisis Even Worse,” The Century Foundation, October 2025, https://tcf.org/content/commentary/trump-and-republicans-in-congress-are-making-the-child-care-crisis-even-worse/; Karla Coleman-Castillo, “Attacks on Head Startare Part of a Sustained Strategy to Undermine Progress for Families with Low Incomes: A Timeline of the Trump Administrations Efforts to Eliminate the Program,” National Women’s Law Center, October 2025, https://nwlc.org/wp-content/uploads/2025/09/Attacks-on-Head-Start-are-Part-of-a-Sustained-Strategy-to-Undermine-Progress-for-Families-with-Low-Incomes.pdf.
  30. Margot Crandall-Hollick, “The 2025 Reconciliation Law Makes Some Modest Changes to Child Care Tax Benefits, Provides Little Help For Low-Income Families,” Tax Policy Center, July 2025, https://taxpolicycenter.org/taxvox/2025-reconciliation-law-makes-some-modest-changes-child-care-tax-benefits-provides-little.
  31. Congressional Research Service. “The Child and Dependent Care Tax Credit (CDCTC): Temporary Expansion for 2021 Under the American Rescue Plan Act of 2021 (ARPA; P.L. 117-2),” 2021. https://www.congress.gov/crs-product/IN11645
  32. Amy Matsui and Amy Royce, “The Tax Code Caregivers Need—And Deserve,” Tax Notes Federal, March 2025, https://nwlc.org/resource/the-tax-code-caregivers-need-and-deserve/.
  33. Diane Girouard, “Federal Relief Funds: State Progress, Summer 2021,” Child Care Aware of America, August 2021, https://info.childcareaware.org/blog/federal-relief-funds-state-progress-summer-2021; Rachel Wilensky, “ARPA Saved Child Care, But Recovery Requires Significant Federal Funding,” Center for Law and Social Policy, September 2022, https://www.clasp.org/blog/arpa-saved-child-care-but-recovery-requires-significant-federal-funding/.
  34. Austin Fisher, “New Mexico governor announces free universal child care,” SourceNM, September 2025, https://sourcenm.com/2025/09/08/new-mexico-governor-announces-free-universal-child-care/.
  35. “The State of Preschool 2024,” The National Institute for Early Education Research, 2025, https://nieer.org/sites/default/files/2025-04/2024NIEERStateofPreschool-1.pdf.
  36. “The US Child Care System Relies on Women of Color, but Structural Barriers Systematically Disadvantage Them,” Urban Institute, 2023, https://www.urban.org/urban-wire/us-child-care-system-relies-women-color-structural-barriers-systematically-disadvantage#:~:text=In%20listed%20child%20care%20homes,the%20cost%20of%20providing%20care.
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  38. “Children under age 6 with all available parents in the labor force in United States” Annie E. Casey Foundation Kids Count Data Center, https://datacenter.aecf.org/data/tables/5057-children-under-age-6-with-all-available-parents-in-the-labor-force?loc=1&loct=1#detailed/1/any/false/1096,871,870,573,869/any/11472,11473.
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  41. “People at work 1 to 34 hours in all and in nonagricultural industries by reason for working less than 35 hours and usual full- or part-time status,” U.S. Department of Labor, Bureau of Labor Statistics, August 2025, https://www.bls.gov/web/empsit/cpseea25.htm.
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  43. Isabel Sawhill and Katherine Guyot, “Women’s work boosts middle-class incomes but creates a family time squeeze that needs to be eased”, Brookings Institute, May 2020, https://www.brookings.edu/articles/womens-work-boosts-middle-class-incomes-but-creates-a-family-time-squeeze-that-needs-to-be-eased/#:~:text=Without%20women%27s%20contributions%2C%20middle%2Dclass,income%20gain%20for%20their%20families.
  44. Nina Banks, “Black women’s labor market history reveals deep-seated race and gender discrimination,” Economic Policy Institute, February 2019, https://www.epi.org/blog/black-womens-labor-market-history-reveals-deep-seated-race-and-gender-discrimination/; Cristina Novoa, “How Child Care Disruptions Hurt Parents of Color Most,” Center for American Progress, June 2020, https://www.americanprogress.org/issues/early-childhood/news/2020/06/29/486977/child-care-disruptions-hurt-parents-color/.
  45. “Untapped Potential: Ohio,” U.S. Chamber Foundation, https://www.uschamberfoundation.org/education/untapped-potential-report-ohio.
  46. “Untapped Potential: Indiana,” U.S. Chamber Foundation, https://www.uschamberfoundation.org/education/untapped-potential-indiana; “Untapped Potential: Florida,” U.S. Chamber Foundation, https://www.uschamberfoundation.org/education/untapped-potential-florida.
  47. Elliot Haspel, “Unless Congress acts, only the rich will be able to afford child care,” Washington Post, October 2021, https://www.washingtonpost.com/outlook/2021/10/21/childcare-collapse-congressional-funding/.
  48. “Child Care in America: 2024 Price and Supply,” Child Care Aware of America, May 2025, https://www.childcareaware.org/price-landscape24/#LandscapeAnalysis.
  49. Ibid.
  50. “CED Family Child Care Affordability Calculator” The Conference Board, October 2022, https://www.conference-board.org/publications/ced-family-child-care-affordability-calculator.
  51. “Economic Well-Being of U.S. Households in 2023,” Board of Governors of the Federal Reserve System, May 2024, https://www.federalreserve.gov/publications/files/2023-report-economic-well-being-us-households-202405.pdf.
  52. “Childcare Costs, Reduced Work, and Financial Strain: New Estimates for Low-Income Families,” U.S. Department of Commerce, June 2024, https://www.commerce.gov/news/blog/2024/06/childcare-costs-reduced-work-and-financial-strain-new-estimates-low-income#:~:text=Government%20and%20private%20sector%20support%20for%20high%20quality%20child%20care,an%20under%2Dsupply%20of%20care.
  53. The Conference Board, “Child Care in the State Economies: Part 3: Child Care and Regional Economic Growth,” December 2024, https://ced-microsite.files.svdcdn.com/production/documents/241002_CCSE-2024-Report_Part-3_Final.pdf?dm=1733774339.
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  56. Sandra Bishop, “$122 Billion: The Growing, Annual Cost of the Infant-Toddler Child Care Crisis,” Ready Nation Council For a Strong America, 2023, https://strongnation.s3.amazonaws.com/documents/1598/05d917e2-9618-4648-a0ee-1b35d17e2a4d.pdf?1674854626&inline;%2520filename=%2522$122%2520Billion:%2520The%2520Growing,%2520Annual%2520Cost%2520of%2520the%2520Infant-Toddler%2520Child%2520Care%2520Crisis.pdf%2522.
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  66. Laura Valle-Gutierrez, “Supporting Mothers Requires a Child Care Guarantee,” The Century Foundation, 2024, https://tcf.org/content/commentary/supporting-mothers-requires-a-child-care-guarantee/.
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  77. AARP and National Alliance for Caregiving. Caregiving in the US 2025. Washington, DC: AARP. July 24, 2025. https://doi.org/10.26419/ppi.00373.001.
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  79. Molly West Williamson, “Lack of Paid Leave Hurts Americans’ Health,” Center for American Progress, May 2024, https://www.americanprogress.org/article/lack-of-paid-leave- hurts-americans-health/; “The Interconnection of Paid Family and Medical Leave and Maternal Mental Health,” Policy Center for Maternal Mental Health, March 2025, https://policycentermmh.org/the-interconnection-of-paid-family-and-medical-leave-and-maternal-mental-health/; Jessica Mason, “Strong State Evidence for Paid Leave: A Look at Connecticut, Rhode Island and Washington State,” National Partnership for Women and Families, August 2025, https://nationalpartnership.org/report/strong-state-evidence-for-paid-leave-connecticut-rhode-island-washington/.
  80. Sam Abbott, “New research shows paid leave increases mothers’ labor force participation following childbirth” Washington Center for Equitable Growth, March 2020, https://equitablegrowth.org/new-research-shows-paid-leave-increases-mothers-labor-force-participation-following-childbirth/; Molly West Williamson, “Guaranteeing Comprehensive, Inclusive Paid Family and Medical Leave and Sick Time,” March 2024, https://www.americanprogress.org/article/playbook-for-the-advancement-of-women-in-the-economy/guaranteeing-comprehensive-inclusive-paid-family-and-medical-leave-and-sick-time/.
  81. Joelle Saad-Lessler, “How does paid family leave affect unpaid care providers,” Journal of the Economics of Ageing 17 (October 2020), https://www.sciencedirect.com/science/article/abs/pii/S2212828X2030030X.
  82. “Polling on Paid Leave (September 2024),” Data for Progress, September 2024, https://www.dataforprogress.org/datasets/polling-on-paid-leave.
  83. Amanda Novello, “Paid Leave Could Keep More Than 6 Million Caregivers Connected to the Labor Force by 2030,” National Partnership for Women and Families, November 2021, https://nationalpartnership.org/wp-content/uploads/2023/02/paid-leave-caregivers-connected-2030.pdf.
  84. Sam Abbott, “New research shows paid leave increases mothers’ labor force participation following childbirth,” Center for American Progress, March 2020, https://equitablegrowth.org/new-research-shows-paid-leave-increases-mothers-labor-force-participation-following-childbirth/.
  85. “Getting To Know the New FAMILY Act,” Center for American Progress, July 2023, https://www.americanprogress.org/article/getting-to-know-the-new-family-act/#chapter-duration-and-benefit-amounts-9.
  86. Curran McSwigan, Anthony Colavito, and Zach Moller, “The US Economy Needs Paid Leave,” Third Way, May 2024, https://www.thirdway.org/memo/the-us-economy-needs-paid-leave.
  87. Eileen Appelbaum and Ruth Milkman, “Leaves that Pay: Employer and Worker Experiences with Paid Family Leave in California,” Center for Economic and Policy Research, 2011, https://www.cepr.net/documents/publications/paid-family-leave-1-2011.pdf.
  88. Ibid.
  89. Molly West Williamson, “America’s Small Businesses Need a National Paid Leave Program,” Center for American Progress, September 2024, https://www.americanprogress.org/article/americas-small-businesses-need-a-national-paid-leave-program/.
  90. “Small Businesses Support a National Paid Family and Medical Leave Program,” National Partnership for Women and Families, October 2024, https://nationalpartnership.org/report/small-businesses-support-national-paid-family-medical-leave-program/.
  91. “California small business owners support expanding paid family leave protections, increasing paid sick days,” Small Business Majority, July 2023, https://smallbusinessmajority.org/sites/default/files/research-reports/ca-small-business-support-paid-family-leave-and-paid-sick-days.pdf.
  92. Lenore Palladino and Chirag Lala, “The Economic Effects of Investing in Quality Care Jobs and Paid Family and Medical Leave,” Political Economy Research Institute University of Massachussetts Amherst, June 2021, https://peri.umass.edu/wp-content/uploads/joomla/images/publication/Economic-Effects-of-Investing-in-Quality-Care-Jobs-and-Paid-Family-and-Medical-Leave2.pdf.
  93. Ibid.
  94. “Paid Sick Time Laws,” A Better Balance, accessed October 2025, https://www.abetterbalance.org/paid-sick-time-laws/
  95. Jessica Mason, “As Voters Demand It, Paid Sick Days Access Expands But 25 Million Workers Still Left Out,” National Partnership for Women and Families, September 2025, https://nationalpartnership.org/voters-demand-paid-sick-days-access-expands-25-million-workers-still-left-out/.
  96. Ibid; figures referring to paid sick leave access rates among private workers.
  97. Isabela Salas-Betsch, “Universal Paid Sick Time Would Strengthen Public Health and Benefit Businesses,” Center for American Progress, May 2023, https://www.americanprogress.org/article/universal-paid-sick-time-would-strengthen-public-health-and-benefit-businesses/.
  98. Ibid.
  99. Ibid.
  100. A Better Balance, “Paid Sick Leave Is Good For Business,” April 2025, https://www.abetterbalance.org/resources/sickleavebusinesscase/.
  101. “Minimum Wage and Paid Sick Leave Frequently Asked Questions,” Alaska Department of Labor and Workforce Development, 2025, https://labor.alaska.gov/lss/ballot-1-faq-2025.html; “Nebraska Healthy Families and Workplace Act,” Nebraska Department of Labor, 2025, https://dol.nebraska.gov/LaborStandards/PaidSickTime/PSTFAQs.
  102. “Paid Sick Time Is Good for Business, Families, and Public Health,” A Better Balance, 2024, https://www.abetterbalance.org/wp-content/uploads/2024/04/Paid-Sick-Time-is-Good-for-Business-Families-and-Public-Health.pdf.
  103. Meredith Slopen, “The impact of paid sick leave mandates on women’s employment and economic security,” Journal of Policy Analysis and Management 43, (February 17, 2024): 1129–51, https://doi.org/10.1002/pam.22582.
  104. Hilary Wething and Meredith Slopen, “Paid sick leave improves workers’ health and the economy,” Economic Policy Institute, January 2025, https://www.epi.org/blog/paid-sick-leave-improves-workers-health-and-the-economy/.
  105. “Paid Sick Time Is Good for Business, Families, and Public Health,” A Better Balance, 2024, https://www.abetterbalance.org/wp-content/uploads/2024/04/Paid-Sick-Time-is-Good-for-Business-Families-and-Public-Health.pdf.
  106. “Paid Sick Days Are Good for Business,” National Partnership for Women and Families, October 2025, https://nationalpartnership.org/wp-content/uploads/2023/02/paid-sick-days-good-for-business-and-workers.pdf.
  107. “Voters in Every Congressional District Oppose Cuts to Medicaid,” Data for Progress and Caring Across Generations, 2025, https://www.dataforprogress.org/blog/2025/4/23/voters-in-every-congressional-district-oppose-cuts-to-medicaid.
  108. Priya Chidambaram and Alice Burns, “10 Things About Long-Term Services and Supports (LTSS),” KFF, 2024, https://www.kff.org/medicaid/10-things-about-long-term-services-and-supports-ltss/; Amber Christ and Natalie Dean, “Medicaid Home and Community Based Services for Older Adults with Disabilities: A Primer,” Justice in Aging, 2021, https://justiceinaging.org/wp-content/uploads/2021/04/HCBS-Primer.pdf.
  109. Salom Teshale, Wendy Fox-Grage, Kitty Purington, “Paying Family Caregivers through MedicaidConsumer-Directed Programs: State Opportunities and Innovations, National Academy for State Health Policy, 2021, https://nashp.org/paying-family-caregivers-through-medicaid-consumer-directed-programs-state-opportunities-and-innovations/.
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  113. “Mandatory and Optional Benefits,” MACPAC, March 15, 2021, https://www.macpac.gov/subtopic/mandatory-and-optional-benefits/.
  114. “Number of People Waiting for Medicaid Home Care (HCBS), by Target Population and Whether States Screen for Eligibility,” KFF, 2024, https://www.kff.org/medicaid/state-indicator/number-of-people-waiting-for-hcbs-by-target-population-and-whether-states-screen-for-eligibility/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D.
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  120. “Direct Care Workers in the United States: Key Facts 2025,” PHI, 2025, https://www.phinational.org/resource/direct-care-workers-in-the-united-states-key-facts-2025/.
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  123. “Oregon Project Independence—Medicaid (OPI-M): Benefits and Eligibility,” American Council on Aging, 2025,https://www.medicaidplanningassistance.org/oregon-project-independence/.
  124. “How the Fund Works,” WA Cares Fund, 2025, https://wacaresfund.wa.gov/how-it-works.
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  128. Susan C. Reinhard, Selena Caldera, Ari Houser, Rita B. Choula, “Valuing the Invaluable: 2023 Update Strengthening Supports for Family Caregivers,” AARP, 2023, https://www.aarp.org/content/dam/aarp/ppi/2023/3/valuing-the-invaluable-2023-update.doi.10.26419-2Fppi.00082.006.pdf.
  129. Wesley Tharpe, Katie Berge, Allison Orris, “House Republican Reconciliation Bill Would Force States to Cut Food Assistance, Health Care, and Other Vital Services,” Center on Budget and Policy Priorities, June 3, 2025, https://www.cbpp.org/research/state-budget-and-tax/house-republican-reconciliation-bill-would-force-states-to-cut-food.
  130. “2024 State Expenditure Report,” National Association of State Budget Officers, 2024, https://higherlogicdownload.s3.amazonaws.com/NASBO/9d2d2db1-c943-4f1b-b750-0fca152d64c2/UploadedImages/SER%20Archive/2024_SER/2024_State_Expenditure_Report_S.pdf.
  131. Mia Ives-Rublee, “Federal Medicaid Cuts Would Force States To Eliminate Services for Disabled Adults, Older Adults, and Children,” Center for American Progress, 2025, https://www.americanprogress.org/article/federal-medicaid-cuts-would-force-states-to-eliminate-services-for-disabled-adults-older-adults-and-children/.
  132. Jessica Schubel, Alison Barkoff, H. Stephen Kaye, Marc Cohen, and Jane Tavares, “History Repeats? Faced With Medicaid Cuts, States Reduced Support For Older Adults And Disabled People,” Health Affairs, April 16, 2025, https://www.healthaffairs.org/content/forefront/history-repeats-faced-medicaid-cuts-states-reduced-support-older-adults-and-disabled.
  133. “Wall Street on Your Doorstep: Protecting Home Care From Private Equity Abuses,” Americans for Financial Reform Education Fund, May 2025, https://ourfinancialsecurity.org/wp-content/uploads/2025/05/Wall-Street-on-Your-Doorstep.pdf.
  134. Ibid.
  135. “Future Change In Caregiving Networks: How Family Caregivers And Direct Care Workers Support Older Adults Now And In The Future,” U.S. Department of Health and Human Services, Office of Behavioral Health, Disability, and Aging Policy, 2023, https://aspe.hhs.gov/sites/default/files/documents/a449863a8c93838d37f78ccf29e9231f/future-change-caregiving-networks.pdf.
  136. “Caregiving in the U.S. 2025,” AARP and National Alliance for Caregiving, July 2025, https://www.aarp.org/pri/topics/ltss/family-caregiving/caregiving-in-the-us-2025/.
  137. Karen Shen, “Who benefits from public financing of home-based long term care? Evidence from Medicaid,” Journal of Public Economics, 236 (August 2024): 105151, https://www.sciencedirect.com/science/article/pii/S0047272724000872.
  138. Ibid.
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  140. Jane Tavares and Kerry Glova, “The 80%: Low-Income Older Adults Die 9 Years Earlier than Those with Greatest Wealth,” National Council on Aging, 2025, https://assets.ncoa.org/ffacfe7d-10b6-0083-2632-604077fd4eca/df44501b-7c8e-43ac-8e12-2373288f71d4/2025_80_Percent_Report.pdf; Zachary A. Morris, Stephanie Rennane, Nanette Goodman, Daniel Mont, Michelle Ballan, Amber Davis, Stephen McGarity, Brooke Ellison, Ghenet Weldeslassie, “The disability squeeze: Out-of-pocket expenses and unmet needs for disability-related goods and services in the U.S.,” Disability and Health Journal, 2025, https://doi.org/10.1016/j.dhjo.2025.101930.
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  147. Alyssa Fortner and Shira Small, “Honoring Black Women’s Labor in the Child Care Sector,” Center for Law and Social Policy, February 2025, https://www.clasp.org/blog/honoring-black-womens-labor-in-the-child-care-sector/.
  148. Kate Gallagher Robbins and Jessica Mason, “If Americans Were Paid For Their Caregiving, They Would Make More Than $1.1 Trillion,” National Partnership for Women and Families, 2025, https://nationalpartnership.org/if-americans-were-paid-for-their-caregiving-they-would-make-more-than-1-1-trillion/.
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  150. Ibid.
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  185. “Increasing Wages for Low-Income Workers Is Key for a Full Economic Recovery,” Roosevelt Institute, 2022, https://rooseveltinstitute.org/blog/increasing-wages-for-low-income-workers-is-key-for-a-full-economic-recovery/.
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  188. Christian Weller, Beth Almeida, Marc Cohen, and Robyn Stone, “Making Care Work Pay: How Paying at Least a Living Wage to Direct Care Workers Could Benefit Care Recipients, Workers, and Communities,” Leading Age, 2022, https://leadingage.org/wp-content/uploads/2022/10/Making-Care-Work-Pay-Report.pdf.
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