The Biden administration’s $2 trillion infrastructure plan is a radical reimagining of what infrastructure means.
The American Jobs Plan does spend big on traditional infrastructure — roads, bridges, broadband, buildings — but it also includes funding for the country’s caregiving infrastructure, proposing major investments in home care for older people and persons with disabilities and funding to upgrade and add child-care centers. A second plan, which will arrive within weeks, is expected to include additional investments in universal preschool, child care affordability and paid family leave.
In other words, the care economy is being recognized for what it is: invisible scaffolding that allows American workers to actually get the job done.
Investments in the care economy are not only long overdue, but also essential to the economic recovery and quality job growth. Functioning and affordable care is a public good: It is the foundation for Americans to provide for their families, tend to their loved ones and perform their jobs.
The pandemic and the economic dislocation that resulted from it revealed how essential that foundation truly is — and how unstable it was, too. Schools and child care centers closed. The informal child care provided by grandparents and other relatives suddenly became unsafe. As coronavirus cases surged, families feared for relatives in nursing homes and searched for safe care for vulnerable loved ones at home. Women shouldered a disproportionate share of the economic cost, psychological burden and responsibility for care.
Like millions of other working mothers during the pandemic, the two of us have struggled to manage full-time jobs while simultaneously minding our young children at home; one of us also balanced that with care for a terminally ill parent.
So we viscerally understand how, and why, more than 10 percent of mothers with young children left their jobs at some point in 2020 because of child care responsibilities. By February, according to the National Women’s Law Center, there were 2.3 million fewer women in the labor force than in the previous February — a monumental loss of talent that is certain to hold back economic recovery.
Even before the pandemic, too many Americans had difficulties finding or affording care for children and disabled or older relatives. Our caregiving infrastructure is so broken that even while many families are unable to pay for care, the low wages paid to caregivers leave them unable to make ends meet.
The Biden administration’s proposed investment in home care directs an additional $400 billion over eight years to Medicaid’s home- and community-based services program, reversing decades of underinvestment by allowing more patients to receive long-term care and supportive services at home. By doing so they will save money and honor people’s wishes to stay in their communities. That demand is strong — nearly 850,000 people across the country are on the program’s waiting lists.
It’s not just the very young, people with disabilities, or the elderly who win here. This infrastructure act would offer a long-overdue pay raise for direct care workers, who, like child care workers, are disproportionately women and workers of color. They are essential workers, but undervalued and, all too often, underpaid. Over a decade ago researchers at the Levy Economics Institute at Bard found that investing in the care sector produces twice as many jobs per dollar invested than a similar investment in physical infrastructure.
Yet researchers at the organization PHI, which has worked for decades to transform elder care and services for people with disabilities, have found that 15 percent of direct care workers live in poverty and more than 40 percent rely public assistance. Direct care work is among the most common occupations among low-wage workers, particularly female ones; it is work that often does not require much education and training, and these jobs experience high turnover.
The administration's investments will have an outsize impact on the present — and future — of work: Direct care work is among the fastest-growing occupations in the country, with more than 1.1 million new jobs projected by 2029. The administration’s next plan should include similar measures to improve the pay and conditions of child care workers, alongside affordability of care.
The American Jobs Act makes clear that the additional Medicaid funding will allow for higher wages, better benefits and union representation for direct care workers — while also expanding access to home care services for more patients. Now Congress needs to turn the plan into law — and fund it.
While critics debate the semantics of what constitutes infrastructure, over 76 percent of Americans support major investments in care infrastructure. No matter what you call it, the investments are good for workers, families, the health care system and the economy as a whole.
Molly Kinder is a fellow and Martha Ross is a senior fellow at the Metropolitan Policy Program at the Brookings Institution.
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