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Free preschool, home care and child care are within our grasp

Democrats' reconciliation bill could reshape care for the oldest and youngest Americans.

President Joe Biden pitched America on a major shift in how much support families can expect from the federal government. Much of his proposed American Families Plan is wrapped into the giant reconciliation bill Congress has debated for months. Next up in my deep dive into what’s in that bill, here’s what’s on the table regarding two often-ignored policy areas: child care and elder care.

The problem

American families are struggling to care for loved ones at both ends of their lifespans. Families with infants, according to the Center for American Progress, are paying an average of $16,000 per year for access to high-quality care, twice the monthly cost of a home mortgage in some areas. And as the baby boomer population grows older, the cost of long-term care for older Americans is prohibitive to many families.

American families are struggling to care for loved ones at both ends of their lifespans.

Meanwhile, there’s a massive shortage of qualified workers for both child care and home and community-based services, including those who work with disabled and older patients. The shortage, in part, owes to the frightfully low average pay of $12 to $13 an hour.

The promise

In announcing the human infrastructure element of his jobs plan, Biden pledged that low- and middle-income families would pay no more than 7 percent of their income for high-quality child care for children under 5. His American Jobs Plan calls on Congress to allocate more than $400 billion toward “expanding access to quality, affordable home- or community-based care for aging relatives and people with disabilities.”

The policy

In response to Biden’s call, the House Energy and Commerce Committee and the House Education and Labor Committee in September passed their recommendations for inclusion in the $3.5 trillion reconciliation package. Here’s what they say on four key policies.

Free universal preschool

The program would provide “a universal, high-quality, free, inclusive, and mixed delivery preschool program” to 3- and 4-year-olds across the country, per the education and labor committee’s fact sheet. The federal government would pay for the entirety of the program — which would roll out in high-need communities first — for the first three years, and $2.5 billion would be set aside to boost the pay for staff at Head Start programs, which currently offer preschool to kids under 5 from low-income families.

Birth Through Five Child Care and Early Learning Entitlement

This provision would put a cap of 7 percent of income on what families pay to state-licensed child care facilities for kids under 5. Federal money would be given to states that apply (or localities in states that don’t apply for funding) to boost pay rates of child care providers to ensure they earn a living wage and help cover parents’ costs for care. The entitlement and universal preschool together are expected to cost $450 billion over 10 years.

Direct-care worker support

The Department of Labor would distribute up to $1.4 billion in renewable three-year grants over the next decade to support direct-care workers, including nurse aides, home health aides, and personal- and home-care aides — basically everyone who works with older adults. Most of the funds would help “provide competitive wages, benefits, and other supportive services” to these workers.

HCBS expansion

Low-income Americans qualify for home- and community-based services under Medicaid — but 800,000 are on a waitlist. The energy and commerce committee recommended $190 billion over the next decade to expand access, about half of Biden’s original proposal. States implementing programs to boost their HCBS access and quality could receive major, permanent boosts to federal funding for medical and social-service programs.

The politics

Unlike the climate change provisions, there’s widespread agreement among Democrats in support of programs, but centrists are insisting the overall cost of the bill get slashed, leading to a fight over what gets left out. That means while progressives won big in making the child care subsidy a universal benefit, income caps may be added back on, reducing the number of families who can take part. And despite older people making up a key constituency for most politicians, home care may be one of the first programs to get the ax as politicians look to save a few bucks.

Also, many of the programs included in the bill last only six or seven years, leaving them vulnerable should a future Republican Congress pull the plug.


I started pre-K a few days after I turned 4. And thank goodness — I surely would have been bored to death waiting until I was 5 to start school. It wasn’t then something everyone can access, and it isn’t now. Meanwhile, as a firmly middle millennial, I’m actively avoiding thinking about the care my parents will need in the future, the cost of which I know is only growing more unsustainable.

This is the problem with the centrist focus on the top-line price tag. We don’t know which of these initiatives may be the one to get struck down. As a result, we don’t know which kid will struggle after lacking early educational options, which caretaker will quit a job for lack of a living wage or which older American will languish without the assistance they need to make their golden years comfortable.