The Care Package: Support for Family Care Provision in the U.S.

Introduction and Overview

Every day in the United States, millions of people wake up and face a version of the same impossible arithmetic. They need to earn income. They also need to care for their children, their aging parents, a spouse or sibling with a disability, or themselves — especially when illness strikes. The market offers no solution to this equation. The government offers patchwork. And so families improvise — women in particular absorb the shortfall in unpaid labor, often at permanent cost to their earnings, their retirement security, and their own health.

This is not a private misfortune. It is a public failure, and an expensive one.

The care that families provide — raising children, supporting elderly parents, tending to those who cannot fully care for themselves — is among the most economically productive work in any society. Children who receive attentive, high-quality care in their early years are more likely to become healthy, educated, productive adults. Workers who can take time to recover from illness or to be present at a family crisis return to their jobs more quickly and with greater stability. Caregivers who receive adequate support are less likely to exit the labor force permanently, less likely to fall into poverty in old age, and more likely to participate fully in economic and civic life. The benefits of care are not merely sentimental — they are measurable, and they are large.

Yet the United States persistently underinvests in care and consistently treats it as a personal rather than a shared responsibility. We spend less than half of what comparable wealthy nations spend on early childhood programs as a share of GDP. We are the only high-income country without a national paid parental leave policy. Our system of support for elderly and disabled individuals is means-tested to the point of cruelty, requiring many families to exhaust their savings before receiving assistance and funneling care into nursing homes, even when home-based support would serve people better and cost less. The result is a care deficit that falls hardest on those least able to bear it: low-income families, workers in jobs without benefits, and the women who disproportionately provide unpaid care when public provision falls short.

The costs of this deficit are not borne equally. Research consistently documents that inadequate support for caregiving suppresses women’s labor force participation and depresses their lifetime earnings. Mothers who leave employment during their children’s early years — often because affordable care is simply unavailable — face lasting wage penalties that compound over careers and into retirement. Families caring for an elderly or disabled adult spend on average more than a quarter of their income on that care, a burden that falls with particular force on Black and Hispanic families, who have less accumulated wealth to draw upon. Children growing up in poverty face developmental disadvantages with lifelong consequences, yet more than one in four American children under seventeen are excluded from the full benefit of the primary federal child support program by restrictions that penalize the families who need help most.

These are not the inevitable features of a wealthy society. They are the results of specific policy choices — and they can be changed.

The Game Changers Care Package

Three bold, interconnected proposals — universal child care, paid family and medical leave plus long-term care support, and a monthly child allowance — would transform life for American families. Together, they form a coherent package that addresses caregiving at every stage of life: from infancy through old age. Other wealthy nations have already figured this out. It’s long past time the United States did too.

These proposals would work together to give families the flexibility they need. They build on policies that have already been put in place by individual states or experimented with at the federal level. They are game-changers because they are all conceived as free, universal benefits that would be funded by taxes on income from capital, rather than from labor. They all promise social benefits that far exceed their cost.

Other comparable nations have demonstrated this. Countries that have invested in universal child care, paid family leave, and adequate support for aging and disabled individuals have not sacrificed economic dynamism to do so. They have expanded women’s workforce participation, reduced child poverty, improved population health, and in many cases generated public returns that substantially exceed the cost of the investment. The evidence from states within the United States that have implemented paid family leave programs, expanded child care access, and shifted long-term care toward home- and community-based services confirms the same pattern: these policies pay for themselves in reduced poverty, improved health outcomes, and increased labor supply, while also producing something harder to measure but no less real — a reduction in the daily stress and insecurity that care gaps impose on ordinary families.

The three proposals developed in this Game Changers Care Package — universal child care, paid family and medical leave combined with expanded long-term care support, and a universal monthly child allowance — form a coherent response to this failure. They address caregiving across the full life course, from infancy through old age. They are designed to work together, with each reinforcing the others: affordable child care enables parents to work and earn; paid leave allows them to respond to family needs without permanent economic penalty; a child allowance provides a universal floor of support that no family falls below. Taken together, they represent not an expansion of welfare as it is conventionally understood, but a fundamental reorientation of how we value and support the work of care — recognizing it, at last, as the indispensable foundation of everything else the economy produces.

The time for modest adjustments has passed. The following pages make the case for something bolder.

Important synergies between the elements of this portfolio of proposed policies can

help overcome potential tensions between reducing child poverty, advancing gender equality, and rewarding family and community care provision in the U.S.  Fully universal child care services address an immediate problem for parents of small children seeking to earn sufficient income to support their families and have long-run implications for women’s lifetime earnings trajectories. Paid family and medical leave, like home and community based long-term care for disabled individuals and the elderly, provides support for in-home care of dependents. A universal basic income for children in the U.S., which could also be referred to as a family allowance, builds on and expands current tax subsidies in ways that could dramatically reduce child poverty in the short run.

Advancing these policies in concert leads to a more complicated picture than choosing to prioritize one or the other (especially in terms of funding details) but it is more likely to help us achieve important common goals.[1] All three policy proposals emphasize the public-good argument for financing, and refer, where relevant, to social-cost-benefit analysis. Public expenditures on care provision are often interpreted as a drag on economic growth because growth is defined almost entirely in terms of Gross Domestic Product (the final value of all goods and services purchased in a country), and investment is defined in ways that largely exclude investments in the production, development, and maintenance of human capabilities.[2]

Policy issues vital to the care economy extend well beyond the three proposals here, inviting collaboration with other game-changing policy groups. The two most direct overlaps lie with the health care working group, and the labor working group. Out of respect for an initial division of labor we have omitted consideration of the health care system as a whole, policies regarding job flexibility, penalties for part-time employment, and rights to remote access to employment from home.

Acknowledgements

The author is grateful for the assistance of Kate Bahn, Jennifer Glass, James Heintz, Julie Kashen, Katherine Moos, Laura Valle-Gutierrez and Jaimie Worker 

[1] Jennifer Glass  and Carolyn E. Waldrep. “Child allowances and work-family reconciliation policies: What best reduces child poverty and gender inequality while enabling desired fertility?” Population Research and Policy Review 42:5 (2023), https://doi.org/10.1007/s11113-023-09823-w

[2] Nancy Folbre, Making Care Work. Why Our Economy Should Put People First. University of California Press, 2026.