Symposium | It's Still the Post-Neoliberal Moment

Do Not Abandon the Care Agenda

By Shilpa Phadke Shayna Strom

Tagged child careEldercarePolicy

Reading all the post-election punditry, it would be easy to conclude that voters didn’t buy into President Biden’s post-neoliberal economic ideas—or, by extension, his vision of an economy where care is a public good and the government plays a meaningful role in ensuring access to it.

Yet that would be the wrong conclusion. It would be hard to see the election as a referendum on the care agenda, since the Administration wasn’t actually able to deliver on those policies. Voters don’t automatically give credit for promises—they give credit for what you actually accomplish. Many Americans are struggling to make ends meet, worrying that they have to choose between keeping their jobs and taking care of sick family members, and paying huge amounts of money for care out of pocket—sometimes more than the cost of their mortgage or college tuition. Post-election, care is as urgent a priority as ever. It is central to the economic security, well-being, and potentially even the democratic health of the nation. And delivering on this vision is key to ensuring the success of a post-neoliberal economy—one that is sustainable, equitable, and resilient.

The Care Agenda

As has been discussed before in the pages of this magazine, the care agenda is comprised of policies that help families manage their caregiving needs while ensuring care workers have high-quality jobs. These policies include access to affordable, high-quality child care; voluntary, universal free preschool; ensuring people have the ability to care for an aging family member or those with disabilities; and the creation of a national paid family and medical leave policy to help workers take time away after the birth of a child, to recover from a serious illness, or to care for a loved one with a significant health condition, without impacting their economic well-being. The care agenda can also encompass policies that provide income support to help families manage the high cost of raising children, such as the child tax credit, which makes a huge difference in family financial stability. Of course, child care and other early education policies also support the well-being of children by fostering brain development and foundational skills such as early literacy.

Importantly, the care agenda is also about work and the country’s economic growth. Because for most of us, work is an economic necessity. And in order for workers to participate in the labor force, we need to help them access care so they don’t have to choose between earning a living and taking care of their family members. By increasing labor force participation among parents, care policy can boost short-term economic growth. Yet significantly, investing in children is also one of the best public investments we can make. Early childhood programs provide essential support to infants and young children as they develop the human capital they will need as the workers of tomorrow. Research on early care and education programs finds that every dollar in spending generates roughly $8.60 in economic benefits in the long term. Accordingly, by investing in children’s well-being and ultimate economic success, care policy can increase economic growth over the long term, too.

Without care support, families—and especially women—are left in a precarious position. Of course, our care policies are rooted in a history where women, especially women of color, assumed the role of caregiver. These long-standing assumptions about “women’s work” surface racist and sexist stereotypes that continue to play out today. These stereotypes devalue women’s work at home and see the role of caregiving as one that still belongs in the private sphere. The result is the reality we see today, in which women’s work is often segregated into low-wage occupations concentrated in the service and care sectors. Black women and Latinas especially are overrepresented in the long-term care and child-care workforce. And the growing inequality between those who can afford care and those who can’t is so stark that even care workers often can’t afford child care or long-term care for their own loved ones despite dedicating their lives to caring for others. Many do not have a single day of paid family and medical leave.

Most other high-income countries have figured out a better way. The United States is an outlier among industrialized nations in its lack of work-family policies. We don’t guarantee paid time off for working parents to care for a new child, and we are one of only a handful of wealthy countries without federal universal long-term care insurance or federal paid family and medical leave. Instead, the current system leaves people struggling on their own.

The Big Biden-Harris Bet on Care

When the Biden Administration introduced the Build Back Better framework in 2021—including the American Rescue Plan (ARP) and what would later become the legislation known as the Build Back Better Act—it marked a significant shift away from the market-driven, neoliberal approach that has long dominated American economic and social policy. Although the plans were drafted in the midst of the COVID-19 pandemic, they were designed not only as a response to the immediate needs of families and the economy, but as long-overdue investments in areas that had been chronically underfunded. The Build Back Better framework proposed bold investments in the care economy, which it framed as essential to economic growth. This vision aimed to move away from treating care as an individual responsibility and instead depicted it as a public good that supports families, workers, and the broader economy.

The ARP, passed into law in 2021, was the first step in this broad agenda, providing immediate relief to families through direct stimulus payments, extended unemployment benefits, and investments in public health to respond to the COVID-19 pandemic. It included short-term investments in the care agenda: emergency funding to stabilize the child-care sector; an expanded child tax credit with refundability; and funding for home and community-based care for seniors and those with disabilities.

The other parts of the proposed Build Back Better framework—the American Families Plan and American Jobs Plan—contained a number of care provisions, including long-term care and supports; universal preschool; access to affordable, quality child care; paid family leave; and policies to lower the costs of health care and higher education. These initiatives were seen as necessary investments in human capital, and they had a clear focus on addressing care as a key pillar of equitable economic recovery. While some pieces of Build Back Better eventually passed into law as part of the Inflation Reduction Act, all of the direct care-related provisions ultimately stalled in Congress.

Yet the Biden-Harris Administration continued its momentum on the care agenda by issuing an executive order on care. Later, during the 2024 election, Vice President Harris made the care economy a key focus of her campaign, emphasizing its importance for the well-being of families and the broader economy. She proposed several new policies aimed at supporting families, including a new home care plan within Medicare and an expanded child tax credit that for the first time included a $6,000 credit for new parents upon the birth of a child.

Ultimately, despite their visions for supporting families, the Biden Administration and the Harris-Walz ticket did not succeed in persuading Congress or the electorate to make those visions into a reality. And the result is still felt deeply in Americans’ lives. In a recent news article, Ron Klain, Biden’s first chief of staff, reflected on the election: “We didn’t deliver what people wanted—help with child care, help with elder care, more security in their lives. Instead we delivered more remote things—bridges and roads, clean energy, future jobs in future [semiconductor plants].… Losing the caring stuff [from Build Back Better] hurt us badly.” Moreover, voters strongly supported state ballot initiatives on issues like paid sick leave and child care, and surveys continue to demonstrate robust support for caregiving policies. In other words, care is both good policy and good politics.

Care and the Post-Neoliberal Vision

Care is still crucial to a post-neoliberal vision—and the reasons have not changed since the election. If anything, the election showed just how squeezed people are financially, and care is a major driver of overall household costs. The cost of long-term care for the elderly and caring for disabled loved ones has almost doubled over the last two decades. Child care is consuming an ever larger share of household incomes, with most families now spending nearly a quarter of their income on it. For families under the poverty line, that grows to almost a third of their income—an unsustainable amount that leaves little for savings or life’s other necessities.

As the U.S. population ages, care (and in particular elder care) is going to be an even more urgent problem. The United States will need more than 800,000 new home health and personal aides over the next decade due to the demand of taking care of aging Baby Boomers. Meanwhile, as more people return to the office post-pandemic (including the federal government), cost and access to child care will become an increasing burden for workers. Finally, at a time when people are particularly frustrated with large corporations and their role in the economy, the rising trend of private equity ownership in the caregiving sector should concern us—and may lead to reduced quality of care, higher costs for families, and a more unstable workforce.

Most families now spending nearly a quarter of their income on child care.

Today, only wealthy families have the ability to pay for high-quality care for their loved ones or to care for them personally by taking time out of the workforce. As we continue to define the kind of economy we want to live in, care and caregiving are core parts of the vision for a post-neoliberal society—one that treats people with dignity, not as commodities; that provides a healthy and fair working environment for care workers; and that allows everyone to participate fully in the economy and society.

Beyond all the more “traditional” reasons that the care economy matters, care may also be important for democracy. The literature on right-wing populism suggests that voters who support populist parties do so not only for economic reasons, but also for cultural ones—including a feeling that they lack agency and autonomy over their own lives. Across the globe, these are the voters who feel like society looks down on them, regardless of their social class.

Care is itself an issue of dignity and respect, not just economics. People want freedom in their day-to-day lives, not the feeling that they risk losing their job if they stay home from work for even one day to take care of a sick infant or aging parent. Without that choice, care is just one more area where Americans are losing control over their lives, a feeling that drives a growing anger and frustration with the status quo. Families want to make sure their loved ones are well cared for, either by them or by someone else who will treat their loved ones like family. Giving people meaningful choices about care could help them to feel like they have more dignity and autonomy, regardless of their income or type of work.

What Comes Next

With President Trump back in office, it is reasonable to ask what it will look like to make progress on care over the next four years. During the presidential campaign, the Trump-Vance ticket mentioned child care and even proposed a caregiver tax credit (although their proposals on care fell short of the more transformative policies the Biden-Harris Administration had pushed for). Given the importance of care across the ideological spectrum and the financial strain it puts on families across the country, it seems reasonable to expect that some progress on the care agenda might be feasible at the federal level, including potentially in the upcoming legislative fight over the expiring Trump tax cuts.

The question is: What will that work on care look like? Will it in fact make a real difference in Americans’ lives? And will other key policies, such as Medicaid, be harmed in the process? Some of the bipartisan or conservative care policies under discussion do not take the care system’s market failures seriously enough, and do not have a material role for government in remedying those failures. Additionally, it is important that any care policy supports Americans across the income spectrum and regardless of family structure (e.g., benefiting two-parent working households as well as one-parent working households). All of this suggests that, while it is theoretically possible to design a policy to address care issues in a neoliberal way, any plan that would make a meaningful impact on the problem would also advance a post-neoliberal vision for the economy. 

It’s also worth remembering that regardless of what happens at the federal level in the coming years, there can continue to be significant work at the state level. As mentioned above, one of the bright spots of the 2024 election was the strong support for care policies, even in traditionally conservative areas. For example, paid sick leave ballot initiatives passed by wide margins in Alaska, Missouri, and Nebraska, nearly matching or exceeding Trump’s support in those states. This momentum testifies to the fact that care is an urgent issue that resonates across the political spectrum.

It is hard to imagine an effective care infrastructure being built only at the state level given the ideological differences between states, the potential patchwork of policies, and the inherent inequity of a state-by-state strategy. But state experiments are important: They benefit the people who live in those states, help to showcase the merits of care infrastructure, and provide potential models for future federal policies, ultimately changing the landscape for work on the national level.

The potential for the care agenda is really just beginning. Care is central to the needs and hopes of so many Americans, and a core part of the promise of a post-neoliberal economy. In the coming years, hopefully there will be far more conversation on what a meaningful care infrastructure looks like. Whether at the federal or state level, there is a great deal of important work to be done. Americans from many different economic backgrounds and across the political spectrum are counting on all of us to find a way to deliver for their families and their futures.

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Shilpa Phadke most recently served as the Deputy Director of the White House Gender Policy Council in the Biden-Harris Administration. She leads her own consulting practice serving philanthropic and nonprofit clients.

Shayna Strom is the President and CEO of the Washington Center for Equitable Growth.

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