--- title: "Care Is Infrastructure | A Government That Works for the People" canonical: "https://govthatworks.org/care" description: "Child care, pre-K, paid leave, family caregiving, home- and community-based services, and the care workforce are treated as one economic infrastructure system." --- Foundations of a secure life · Chapter 24 # Care Is Infrastructure Child care, pre-K, paid leave, family caregiving, home- and community-based services, and the care workforce are treated as one economic infrastructure system. This page separates the book’s proposals from current-law evidence. Dollar figures attributed to the plan are author planning estimates unless otherwise stated. **Read the source text in the book**Care Is Infrastructure [Open Chapter 24](/reader?ch=24#chapter-24) Care supply, affordability, leave, and long-term services ## The chapter treats care as economic infrastructure because work depends on it. Child care ### Cap family payments at 7% of income Providers would receive operating support so affordability is not achieved by cutting worker pay. Family copayments would be capped at 7% of income, with zero copayments for the low-income tier defined in implementing law. Pre-K ### Universal voluntary pre-kindergarten Three- and four-year-olds would have access to quality voluntary pre-K through a mixed delivery system, with compensation standards designed to reduce churn between preschool and elementary classrooms. Paid leave ### Twelve weeks of social insurance Paid family and medical leave would provide progressive wage replacement through a dedicated social-insurance contribution rather than relying only on employer-provided leave. Family caregivers ### Recognize unpaid care in tax and retirement policy The framework includes caregiver tax relief and Social Security caregiver credits for periods spent caring for young children or disabled relatives. HCBS ### End the optional-benefit waiting-list structure Home- and community-based long-term services would become a required benefit of the National Health Guarantee rather than a state option that can produce long waiting lists. Care workforce ### Wage floors + career ladders The book treats worker supply as the binding constraint: direct-care and child-care jobs need living wages, training pathways, and staffing capacity before affordability caps can be universalized. DOL child-care data**One-child prices consumed 8.9%–16% of median family income in 2022.** The national range varies sharply by age, setting, and county. That is why the calculator lets visitors enter the market price they actually face. HCBS**More than 600,000 people were on Medicaid HCBS waiting or interest lists in 2025.** KFF cautions that state lists use different definitions; the figure measures reported lists, not one standardized national queue. Supply guardrail**Affordability cannot outrun workforce capacity.** The book’s failure trigger pauses the regional cap rollout if licensed capacity has not grown by at least one-fifth after three years. Child care 7% income-cap calculator ## Compare a household’s market bill with the proposed family-payment ceiling. Market prices are user-entered because child-care prices vary widely by county, age, and provider type. The result shows the family-facing cap, not the total cost of providing care. Household income $80,000Children under 5 1Annual market price per child $15,600 Low-income zero-copay tier applies Current entered market cost**$15,600** Maximum family payment**$5,600** Family cost reduction**$10,000** Public/provider financing gap**$10,000** Care affordability and access indicators | Measure | Published figure | Caution | | --- | --- | --- | | Full-day care for one child · 2022 county-price data | $6,552–$15,600 annual range | U.S. Department of Labor range across provider type, child age and geography; not a single national price. | | Full-day care as share of median family income | 8.9%–16.0% | County/provider-age measures from the National Database of Childcare Prices. | | Medicaid HCBS waiting / interest lists · 2025 | 606,895 people | KFF notes these lists are an incomplete measure of unmet need because state screening and list practices differ. | **Goal** Care for children, aging parents, and people with disabilities that families can afford and workers can live on, with no one forced to choose between a job and a sick relative. **Instrument** Child care financed as infrastructure with operating support, a family payment cap of 7 percent of income, and wage parity for providers; twelve weeks of paid family and medical leave as social insurance; supports for family caregivers; home and community-based services as a required benefit of the National Health Guarantee; direct-care wage floors and career ladders. **Who pays** Child care and pre-kindergarten $60 billion to $90 billion a year from general revenue; paid leave $50 billion to $70 billion from a dedicated contribution; long-term services inside the Health Trust. Author planning estimates; Appendix E. **Who implements** States and providers in a mixed delivery system; the American Health Trust for long-term services; the paid-leave administering agency; the Department of Labor for workforce programs. **Legal vehicle** Federal statute throughout. **Principal risk** Subsidies expand faster than the workforce, producing waiting lists and higher prices instead of more care. **Measure of success** Licensed child care slots per hundred children under five; the share of families paying more than 7 percent of income for care; paid-leave take-up across income groups; home-care waiting lists eliminated; direct-care turnover below 30 percent a year. **Failure trigger** If, three years into a region’s phase-in, licensed capacity has not grown by at least a fifth, the cap’s rollout in that region should pause while workforce funding is increased. The Strongest Counterargument & the Author's Response ### Best case against Subsidies expand faster than the workforce, producing waiting lists and higher prices instead of more care. ### The author's response Funding must flow to provider capacity as well as to family affordability. The statute should phase in the family payment cap region by region as provider capacity is certified, rather than nationally on a single date. ### What remains uncertain The chapter makes workforce capacity the binding constraint and pauses a region’s affordability-cap rollout if licensed capacity has not grown sufficiently after three years. Evidence & sources ## Primary data and research used on this page [**U.S. Department of Labor · National Database of Childcare Prices**County-level child-care price data, 2008–2022](https://www.dol.gov/agencies/wb/topics/featured-childcare)[**KFF · Medicaid HCBS waiting lists**State-reported waiting and interest lists through 2025](https://www.kff.org/medicaid/a-look-at-waiting-lists-for-medicaid-home-and-community-based-services-from-2016-to-2025/) **Read the source text in the book**Care Is Infrastructure [Open Chapter 24](/reader?ch=24#chapter-24)