Families across the nation are facing barriers to finding and paying for quality child care. The unique experiences of rural families can exacerbate this struggle: Many rural areas of the country have experienced stalled economic growth, have higher rates of child poverty, and see young children entering kindergarten already behind their metropolitan-area peers in early reading and math skills. Access to high-quality, affordable child care is especially necessary to support family economic security and early childhood development in rural communities.
column presents five key facts to know about child care in rural
America and outlines opportunities for improving access to quality,
affordable child care in rural communities.
1. On average, families in rural areas spend 12 percent of their income on child care
The cost of child care has been steadily growing, and families’ earnings have not kept pace. This has left many rural families struggling to piece together care that they can afford. New analysis from the 2014 Survey of Income and Program Participation (SIPP) finds that in rural areas, the average family with an employed mother spends $175 each week—or $9,100 per year—on child care. This amounts to 12.2 percent of the average rural family’s income. Meanwhile, families with an employed mother in metropolitan areas spend about $260 per week, on average, comprising 10.8 percent of average family income. These differences in spending are likely due to the lower cost of living in rural communities, where for example, real estate costs and teacher wages tend to be cheaper. These factors can make it slightly less expensive to operate a child care program in a rural community, which means that providers charge parents lower tuition than in areas where the costs associated with running a child care program are higher. Despite these differences, families in rural and metropolitan communities alike are spending well above what they should be: The federal government has defined affordable child care as not exceeding 7 percent of family income.
Rural families use regular child care at rates similar to metropolitan
families but are more likely to use home-based child care
rural and metropolitan families use regular child care at similar
rates, with about 60 percent of all children and 80 percent of children
with employed mothers receiving care from someone other than a parent
each week. (see Figure 1) While child care attendance rates are similar,
rural families are more likely to use home-based child care as their
primary child care arrangement. This difference is particularly stark
for preschool-age children. (see Figure 2)
Research confirms that parents of preschool-age children tend to prefer center-based child care for their children, while parents of infants and toddlers often prioritize care from a parent or relative. Despite these preferences, rural families are significantly less likely to use center-based preschool programs. When embarking on the child care search, parents need options in order to select a provider that best meets their family’s needs. Many parents are constrained to programs that are affordable and close to work or home, while parents with more resources and thus more child care options often place greater emphasis on elements of program quality such as curriculum or small class sizes. But the child care choices of rural families suggest that there may not be enough available center-based preschool programs to meet the need in these communities. These disparities in access to various care settings can have implications for child care quality and school readiness.
3. 60 percent of rural Americans live in a child care desert
Nearly two-thirds of rural families live in a child care desert, or an area where there are at least three young children for every licensed child care slot—or no licensed child care providers at all. One study of child care supply in nine states found that the lack of child care is extreme for infants and toddlers in rural areas, with babies outnumbering licensed child care slots by 9-to-1 across rural counties.
Certain characteristics of rural communities, such as smaller program sizes and dispersed populations, can make it difficult for rural child care providers to meet community needs or to stay afloat financially. For example, home-based child care programs typically have a maximum capacity of from 6 to 12 children, which may be too small to meet demand in some areas. In other areas, however, there may be not be enough families to fill a program, leaving child care providers with too little revenue to cover operating costs such as rent, utilities, and teachers’ salaries. And because rural families are dispersed over greater distances than families in metropolitan areas, some families struggle to find a conveniently located provider, with 1 in 5 families in rural areas citing location as their primary reason for difficulty finding child care.*
4. Family child care providers play an outsize role in rural child care supply
family child care providers represent one-fifth of all licensed child
care slots in rural communities, compared with 9 percent of licensed
capacity in suburban areas and 14 percent of licensed capacity in urban
areas.** In many states, this number is much higher, with family care
providers representing the majority of the licensed child care supply in
rural communities in Minnesota, Kansas, Oregon, and California. (see
Family child care homes are well-suited for rural communities, as they are smaller programs that may be closer to where families live, making them more accessible. Importantly, it is difficult to compare the supply of licensed family child care across states because some states do not require family child care providers to obtain a license, and others have a high threshold for licensure. In some states, for example, a family child care provider must become licensed once they start caring for more than one nonrelated child, while in other states the threshold for licensure is 12 children.
results in some states with a very low percentage of child care slots
in licensed family child care homes, even though many families use care
from family child care providers who operate without a license.
5. A typical teacher in a rural child care center earns just $23,000 per year
Early childhood educators play a critical role in educating and caring for young children and supporting rural economies, yet they often earn poverty-level wages. In rural communities, the median wage for a teacher is just $11.42 per hour, or about $23,000 annually. Largely due to such low wages, rural child care providers have difficulty attracting and retaining qualified teachers, who may be able to earn more teaching in a local school district or working in another industry.
Low wages are prevalent for early childhood educators regardless of where they live, however, with educators in metropolitan areas earning roughly the same low wages.
Public investments in child care are necessary to support children, families, and providers in rural communities
While rural communities experience unique challenges to building and maintaining their supply of quality, affordable child care, they also offer unique opportunities to serve children and families. Several policies could be bolstered or enacted to increase access to quality child care for rural families in the United States. Increasing funding for the Child Care and Development Block Grant, for example, would provide child care assistance to more rural families, and increase the subsidy rate so that rural child care providers could more easily meet their operating expenses and increase the quality of their programs. And passing the Child Care for Working Families Act would limit most working families’ child care payments to 7 percent of their income and make targeted investments in building the supply of licensed child care in child care deserts. Access to high-quality, affordable child care must also be central to any plan to build infrastructure in rural communities: Increasing child care supply and revitalizing child care facilities are vital to supporting not only rural communities but also the national economy.
Leila Schochet is a policy analyst for Early Childhood Policy at the Center for American Progress.
* Author’s analysis of National Center for Education Statistics, “2016 National Household Education Survey: Early Childhood Program Participation Survey,” available at https://nces.ed.gov/nhes/dataproducts.asp#2016dp (last accessed June 2019). This survey uses the 2010 Census “urban” and “rural” classification and relies on locales developed by the National Center for Education Statistics. More information is available here.
** Author’s analysis of the Center for American Progress’ child care deserts data set. More information about the data set and methodology is available here.
Governors Propose Nearly $3 Billion of Investments in Early Learning Programs
By Steven Jessen-Howard Posted on May 15, 2019, 5:00 am
Download the PDF here.
In 2018, a commitment to improving child care and other early childhood programs helped many gubernatorial candidates win election.1 With significant majorities of Republican, Democratic, and independent voters supporting increased funding for early learning, it’s no wonder that early childhood was a winning issue.2 Now, those campaign promises are turning into action as governors unveil their budget proposals.3 A Center for American Progress analysis of the latest budget proposals of governors from 49 states4—as well as the mayor of Washington, D.C.—reveals that the nation’s governors have proposed a combined $2.9 billion in new state funding for child care, preschool, and home visiting programs. This number is almost one-third of federal yearly spending on Head Start, and more than seven times that of the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program, demonstrating governors’ strong commitment to improving early childhood programs.
The need to invest in early learning
Investments in young children are among the most important that states can make because they support early childhood development, parent employment, and economic growth. The first years of life are a period of rapid brain development, and the experiences that children have during this critical period can shape future learning.5 When children have access to high-quality early learning experiences, they are more likely to be ready for kindergarten, to graduate high school, and to ultimately go to college.6
In addition, investments in early childhood benefit family economic security and economic growth. Two-thirds of young children have all parents in the workforce, making child care a necessity.7 Yet many parents end up spending a considerable portion of their paycheck on child care, which can amount to more than $10,000 per year for just one child. Policies that defray child care costs can boost employment and economic growth. For example, the universal pre-K program in Washington, D.C., spurred a 10 percentage point increase in its maternal labor force participation rate.8 One estimate of a large-scale federal child care investment found that it would create 700,000 new early educator jobs and allow 1.6 million mothers to rejoin the workforce.9 As states’ chief executives, governors have the responsibility and power to shape their state’s economic agenda; accordingly, they should make child care an important piece of promoting workforce participation and economic security for families.
Analysis of budget proposals
analysis of governors’ most recent budget proposals found that 32
governors and District of Columbia Mayor Muriel Bowser (D) proposed a
total of $2.9 billion in additional state funds for early care and
education programs. Funding is proposed for a range of programs, such as
expanding the number of families reached by home visiting programs;
constructing new child care facilities; expanding full-day kindergarten;
increasing the value and reach of child care subsidies; and more.
Of the proposed spending, preschool programs received the bulk of funding increases.10 While preschool is a worthy investment, states must also consider the needs of younger children. Infant and toddler child care is more expensive, harder to find, and often needed by parents who are stretched thin on time and money.11 Furthermore, home visiting programs have a demonstrated track record of improving infant and maternal health outcomes but are only available to a small fraction of families.12 While Ohio, Washington, and California made significant investments in these programs, few other states added any level of funding for home visiting. Moreover, in this budget cycle, Oregon and Vermont are among the only states that targeted new state funding specifically to infant and toddler child care.13
While many states increased investment, the five with the highest level of investment per child are highlighted below.
California: California had the highest total increase in funding for early learning programs. Gov. Gavin Newsom (D) called for large spending increases to expand subsidized child care facilities and support the child care workforce; improve and expand campus child care options; provide statewide full-day kindergarten; and expand home visiting programs with a specific funding stream aimed at improving infant and maternal health for African Americans.14
Colorado: Gov. Jared Polis (D) has made universal full-day kindergarten one of his top priorities in an effort to improve educational outcomes, reduce the child care burden for families, and free up funding that local school districts can use to invest in preschool and child care.15
District of Columbia: Mayor Bowser’s budget proposed a greater per-child increase in funding than that of any state. Washington’s early learning investments are especially impressive since the district already offers universal full-day pre-K. The district plans to convert old school buildings into new child care centers, expand early action pre-K initiatives, improve provider rates, and expand the refundability of its child care affordability tax credit.16
New Mexico: In 2019, New Mexico established a department for early childhood education and care with nearly unanimous approval, demonstrating the state’s commitment to improving child well-being.17 Furthermore, Gov. Michelle Lujan Grisham (D) proposed $60 million to move the state toward universal pre-K, as well as increases in home visiting and early screening services.18
Oregon: Gov. Kate Brown (D) proposed more than $220 million for early childhood over the biennium. Her early childhood investments include the establishment of the Baby Promise program—which is aimed at increasing supply for infant and toddler child care—and a fund dedicated to improving equity within early childhood programs.19
requests are important signals of a governor’s priorities. This
analysis shows that many governors are following through on their
campaign promises and prioritizing investments in early learning
programs. While these budget proposals must still go through approval
and negotiation processes with state legislatures, they are a positive
first step and demonstrate a clear commitment from the executive, which
is crucial to reaching an endpoint that will benefit children and
Federal commitment can also promote access to affordable, high-quality child care.20 For example, recent funding increases for the Child Care Development Block Grant (CCDBG) have enabled states to improve and expand their child care systems.21 However, until a comprehensive solution such as the Child Care for Working Families Act is implemented, states will still need to step up and prioritize early learning programs in their budgets.22 Thankfully, these recent budget proposals show that many governors are doing just that and championing the need for increased investments to support children, their families, and the economy.
Steven Jessen-Howard is a research assistant for Early Childhood Policy at the Center for American Progress.
1 data are based on the author’s analysis of governors’ most recent
budget proposals. This analysis only includes increased investment that
comes from state funding. Increases from CCDBG or other federal funding
sources are not included; neither are proposed increases in city or
county budgets. In addition, the total only includes funding allocated
for state child care, preschool, full-day kindergarten, and home
visiting programs—or sources directly allocated to help parents afford
these services, such as a child care tax credit. Money allocated to
programs in which some level of funding could go toward child care or
home visiting services but these services are not the focus of the
program—and the amount allocated for such services is not defined—is not
counted. This includes broad increases to pre-K-12 systems if none of
the money is explicitly appropriated to pre-K, as enrollment in public
pre-K is significantly lower than that of other grades in most states.
addition, this count does not include inflation adjustments or other
marginal changes. As a result, it undercounts the total of new resources
allocated for child care. Many governors’ budgets are produced on a
biennial basis, with funding proposed for the next two years. If funding
is allocated across two years, the number is divided by two to
calculate the yearly increase.
Katie Hamm, Cristina Novoa, and Steven Jessen-Howard, “Newly Elected Governors Support Expanding Early Childhood Programs,” Center for American Progress, November 7, 2018, available at https://www.americanprogress.org/issues/early-childhood/news/2018/11/07/460604/newly-elected-governors-support-expanding-early-childhood-programs/. ↩
John Halpin, Karl Agne, and Margie Omero, “Affordable Child Care and Early Learning for All Families” (Washington: Center for American Progress, 2018), available at https://www.americanprogress.org/issues/early-childhood/reports/2018/09/13/457470/affordable-child-care-early-learning-families/. ↩
National Association of State Budget Officers, “Proposed & Enacted Budget Links,” available at https://www.nasbo.org/mainsite/resources/proposed-enacted-budgets (last accessed May 2019). ↩
Gov. Mark Gordon (R-WY) has not yet released a budget proposal. ↩
Center on the Developing Child at Harvard University, “InBrief: The Science of Early Childhood Development” (Cambridge, MA: 2007), available at http://developingchild.harvard.edu/wp-content/uploads/2015/03/InBrief-The-Science-of-Early-Childhood-Development.pdf. ↩
Hirokazu Yoshikawa and others, “Investing in Our Future: The Evidence Base on Preschool Education” (Washington: Society for Research in Child Development and New York: Foundation for Child Development, 2013), available at http://srcd.org/sites/default/files/documents/washington/mb_2013_10_16_investing_in_children.pdf. ↩
KIDS COUNT Data Center, “Children under age 6 with all available parents in the labor force in the United States,” available at https://datacenter.kidscount.org/data/tables/5057-children-under-age-6-with-all-available-parents-in-the-labor-force?loc=1&loct=1#detailed/1/any/false/871,870,573,869,36,868,867,133,38,35/any/11472,11473 (last accessed May 2019). ↩
Rasheed Malik, “The Effects of Universal Preschool in Washington, D.C.” (Washington: Center for American Progress, 2018), available at https://www.americanprogress.org/issues/early-childhood/reports/2018/09/26/458208/effects-universal-preschool-washington-d-c/. ↩
Ajay Chaudry and Katie Hamm, “The Child Care for Working Families Act Will Boost Employment and Create Jobs” (Washington: Center for American Progress, 2017), available at https://www.americanprogress.org/issues/early-childhood/reports/2017/12/07/443783/child-care-working-families-act-will-boost-employment-create-jobs/. ↩
Some new investments that benefit young children and their parents are not reflected in this analysis. Many states looked beyond child care, making investments to improve children’s well-being in other ways. For example, the governors of Kansas, Maine, North Carolina, and Wisconsin have proposed expanding Medicaid, which would provide health insurance and improved financial stability for thousands of children. Meanwhile, California is among the states leading the way on child poverty reduction and paid family leave proposals; Ohio is investing in its child welfare systems to help children remain with their families and adequately provide for those who have been neglected or abused; and Michigan is one of several states making overdue investments to prevent children from being exposed to lead. Early care and education programs provide significant benefits, but other comprehensive supports such as these are also necessary to promote child and family well-being. ↩
Steven Jessen-Howard and others, “Understanding Infant and Toddler Child Care Deserts” (Washington: Center for American Progress, 2018), available at https://www.americanprogress.org/?p=460128; Simon Workman and Steven Jessen-Howard, “Understanding the True Cost of Child Care for Infants and Toddlers” (Washington: Center for American Progress, 2018), available at https://www.americanprogress.org/issues/early-childhood/reports/2018/11/15/460970/understanding-true-cost-child-care-infants-toddlers/. ↩
National Home Visiting Resource Center, “2018 Home Visiting Yearbook” (2018), available at https://www.nhvrc.org/wp-content/uploads/NHVRC_Yearbook_2018_FINAL.pdf. ↩
State of Oregon, “2019-2021 Turning Point: An Agenda for Oregon’s Future” (Salem, OR: 2018), available at https://www.oregon.gov/gov/policy/Documents/019-21_turning-point.pdf; Office of Gov. Phil Scott, “Statement: Shared Commitment to Increasing Access to Quality Child Care,” Press release, February 1, 2019, available at https://governor.vermont.gov/press-release/statement-shared-commitment-increasing-access-quality-child-care. ↩
2019-20 California Governor’s Budget, “Early Childhood” (Sacramento, CA: 2019), available at http://www.ebudget.ca.gov/2019-20/pdf/BudgetSummary/EarlyChildhood.pdf. ↩
Office of Gov. Jared Polis, “FY 20: Polis Budget Letter” (Denver: 2019), available at https://drive.google.com/file/d/1tS59GK-qDaJYSLfrrAkS7WbSGUA2d0j4/view. ↩
Government of the District of Columbia, “FY 2020 Proposed Budget and Financial Plan” (Washington: 2019), available at https://cfo.dc.gov/sites/default/files/dc/sites/ocfo/publication/attachments/DC_OCFO_Budget_Vol_1.pdf. ↩
Dan Boyd, “New Mexico House OKs bill to establish Early Childhood Education and Care Department,” Las Cruces Sun-News, March 10, 2019, available at https://www.lcsun-news.com/story/news/local/new-mexico/legislature/2019/03/10/early-childhood-education-care-department-new-mexico-house/3123199002/. ↩
Office of Gov. Michelle Lujan Grisham, “Gov. Lujan Grisham releases executive budget proposal,” Press release, January 10, 2019, available at https://www.governor.state.nm.us/2019/01/10/gov-lujan-grisham-releases-executive-budget-proposal/. ↩
“Baby Promise” began with a pilot program using federal funding, but Gov. Brown’s requested budget included an additional $10 million in state general funds for the program, which is counted in this analysis. See State of Oregon, “2019-2021 Turning Point: An Agenda for Oregon’s Future.” ↩
Simon Workman and Steven Jessen-Howard, “Early Learning in the United States: 2018,” Center for American Progress, September 13, 2018, available at https://www.americanprogress.org/issues/early-childhood/reports/2018/09/13/457747/early-learning-united-states-2018/. ↩
National Women’s Law Center, “States Use New Child Care and Development Block Grant Funds to Help Children and Families” (Washington: 2019), available at https://nwlc.org/resources/states-use-new-child-care-development-block-grant-funds-help-children-families/. ↩
Leila Schochet, “Proposed Bill Would Help American Families Afford Child Care” (Washington: Center for American Progress, 2018), available at https://www.americanprogress.org/issues/early-childhood/reports/2018/09/13/457518/proposed-bill-help-american-families-afford-child-care/. ↩
Children’s Health Care Access Would Improve Under Universal Coverage Plans
By Madeline Twomey
Posted on June 12, 2019, 5:00 am
Download the PDF here.
Medicaid and the Children’s Health Insurance Program (CHIP) serve as lifelines for low- and moderate-income children. Both programs provide expansive, child-focused benefits that ensure that children enrolled in them have access to essential health care services. Coverage under Medicaid and CHIP has not only contributed to better health outcomes for children, but it has also increased their families’ financial stability and improved enrolled children’s educational attainment and future earnings.1
While the United States has significantly improved children’s access to health insurance in recent years—particularly through coverage gains made under the Affordable Care Act (ACA)—children’s health care is currently under attack.2 Uninsured rates among children are increasing:3 An estimated 828,000 children lost Medicaid or CHIP coverage in 2018 due to Trump administration policies and conservative states’ efforts to impose burdensome costs and paperwork requirements.4 As of 2017, approximately 4 million children remain uninsured in the United States and are unable to get the care they need.5
However, Medicare for All proposals seek to close this gap and ensure that all people—including children—have access to comprehensive health insurance that cannot be undermined by future sabotage. In 2018, the Center for American Progress released Medicare Extra for All, which, like other Medicare for All proposals, would continue the child-centered benefits of Medicaid and CHIP while also adding features that would make children’s health care coverage more secure.6
issue brief outlines Medicaid and CHIP’s critical role in providing
health care access for children as well as some of the barriers that
children currently face in gaining coverage. Universal coverage
proposals—including CAP’s Medicare Extra—provide an opportunity to
ensure comprehensive health insurance for all children, without the
threat of political sabotage or funding cuts. When children have
consistent access to health insurance, the benefits are immense and
reach far beyond the scope of the health care system.
Medicaid and CHIP’s history of success
Established in 1965, Medicaid provides health coverage to low-income adults, children, pregnant women, elderly adults, and people with disabilities.7 While both states and the federal government finance Medicaid, states administer the program.8 As a result, there is a fair amount of flexibility in program design, and eligibility and benefits can vary by state. However, every state must cover certain groups of children and provide Early and Periodic Screening Diagnostic and Treatment (EPSDT) services.9
EPSDT is an expansive benefit for all children under the age of 21 that requires coverage of periodic physical, mental, developmental, vision, hearing, and dental screenings in addition to all services that are medically necessary to detect and treat any physical and behavioral health conditions—regardless of whether or not the benefits are covered under the state plan.10 The goal of EPSDT is to catch health issues early in order to prevent any conditions from becoming serious or disabling. Research from Families USA found that, even when compared with large commercial plans, Medicaid’s health benefits—including EPSDT—are the “gold standard” of children’s health coverage.11
CHIP was created in 1997 to provide low-cost health coverage to children in families that earn too much money to qualify for Medicaid.12 Like Medicaid, it is also jointly financed by states and the federal government. Since its implementation, CHIP has expanded coverage to approximately 9 million children.13 States can administer CHIP through their Medicaid programs or through separate programs. Similar to Medicaid, CHIP eligibility, benefits, and cost-sharing requirements can vary by state. As a result, some states have more generous eligibility standards than others. According to the Henry J. Kaiser Family Foundation, 19 states offer coverage to children with family incomes that are more than 300 percent of the federal poverty line, while two states—Idaho and North Dakota—limit coverage to those with family incomes that are below 200 percent of the federal poverty line.14 Other states fall somewhere in the middle. While separate CHIP programs are not required to provide EPSDT benefits, several states have opted to provide this type of coverage, resulting in approximately two-thirds of CHIP-eligible children receiving EPSDT services nationally.15
The ACA improved children’s coverage further by increasing the federal matching rate for CHIP and expanding Medicaid eligibility for children.16 As of 2017, nearly 37 million children were enrolled in Medicaid and more than 9 million were enrolled in CHIP.17 Additionally, high levels of adult enrollment spurred a “welcome mat” effect for their children, where Medicaid expansion for adults was associated with higher levels of coverage for children.18 As a result, there was a historic decrease in the rate of uninsured children after the ACA’s implementation.19 In 2016, more than 95 percent of children had health insurance.20
Access to both Medicaid and CHIP have significant benefits for children and their families alike. First, research has shown that, in addition to receiving essential health services, children in low-income families with access to Medicaid experience long-term benefits, including better health status, greater academic achievement, and increased future earnings.21 CHIP and Medicaid also help address racial disparities in health care, with African American and Hispanic children making up 58 percent of children covered by these programs.22
Second, families with access to Medicaid and CHIP are less likely to experience financial insecurity and to have medical debt or file for bankruptcy. 23 And when parents are covered by Medicaid, children also experience the benefits. Research suggests that children’s health is directly influenced by the health of their parents and caregivers, with healthy parents contributing to positive childhood development.24 Moreover, when parents gain coverage, children are more likely to be covered as well.25 In states that expanded Medicaid to low-income nonelderly adults under the ACA, higher numbers of children enrolled in Medicaid and/or CHIP. A 2017 study published in Health Affairs estimated that between 2013 and 2015, 710,000 children in low-income families gained coverage because of Medicaid expansion.26
The current threats to children’s health coverage
Despite the high-water mark of children’s health coverage after the ACA’s implementation, President Donald Trump has consistently tried to undermine access to health care, including for children. President Trump and his allies in Congress have notoriously made several attempts to repeal the ACA, with most of these proposals including funding caps for Medicaid.27 Following these efforts’ failures, President Trump has continued to work tirelessly to dismantle key components of the ACA and undermine access to Medicaid. Several Trump-endorsed policies have added confusion and administrative hurdles for getting covered and, as a result, children have lost coverage.28
The Georgetown Health Policy Institute Center for Children and Families (CCF) estimated that children’s enrollment in Medicaid and CHIP decreased by more than 2 percent in 2018.29 Despite claims from the Trump administration that coverage losses were a result of a strong economy, experts at the CCF found that declining enrollment could be attributed to the administration and conservative allies’ efforts to harm health care access.30
The following policies under the Trump administration have contributed to losses in children’s coverage.
First, the Trump administration has undermined Medicaid access by approving waivers that allow states to impose barriers to accessing coverage. Section 1115 waivers—named after the relevant section of the federal Social Security Act—allow states to waive certain federal requirements and test new approaches to delivering Medicaid.31 Some 1115 waivers can be positive, such as waivers supporting efforts to cover substance abuse treatments. However, the Trump administration continues to approve harmful waivers, including imposing work requirements for parents, charging premiums and other cost sharing, and eliminating retroactive coverage. These initiatives often include onerous paperwork requirements, which impose additional barriers to gaining coverage such as requiring enrollees to have internet access to log working hours.32 This has proven to result in otherwise eligible individuals losing coverage.
Efforts to impose administrative hurdles in Medicaid enrollment only serve to harm children and families. For example, a recent work requirement proposal in Florida would threaten the coverage of more than 100,000 low-income parents, which would undoubtedly affect the well-being of their children.33 In Texas, more than 4,000 children per month are being removed from Medicaid due to frequent—and oftentimes erroneous—eligibility checks.34 Some states are even seeking Medicaid waivers that would take away EPSDT coverage from adolescents over the age of 18 despite the current mandate that all children under 21 receive these benefits.35
Second, after failing to repeal the ACA and slash funding for Medicaid legislatively, President Trump and his administration have repeatedly sought to undermine these programs through administrative action. In lieu of full repeal, the Trump administration has continued to work to sabotage the ACA by signing a tax bill that eliminated the individual mandate, cutting funding for enrollment assistance, and shortening enrollment periods.36 These efforts have caused confusion among enrollees, with individuals unsure of if they qualify for public coverage or if they can even enroll in marketplace plans. As a result, children’s coverage gains under the ACA are reversing.
Third, the Trump administration’s budget and regulatory priorities reveal an anti-children’s health agenda. In 2017, President Trump proposed cutting CHIP by 20 percent.37 In 2018, the Trump administration once again proposed slashing CHIP—this time by $7 billion. In 2019, the president’s budget included a nearly $1.5 trillion cut to Medicaid over 10 years. Most recently, the Trump administration issued a proposal for changing the methodology for updating the federal poverty line, using a lower measure of inflation which would reduce eligibility for Medicaid and cut financial assistance for families enrolled in marketplace plans.38
With the support of the Trump administration, Congress has also impeded access to health care coverage for children. Due to CHIP’s block grant financing structure, there is no entitlement to coverage, and states can freeze or cap enrollment or require waiting periods.39 Additionally, CHIP’s funding is not permanent and must be reauthorized. In September 2017, Congress failed to extend funding for CHIP, and states went without federal funding for 114 days.40 While Congress eventually reauthorized funding for the program in 2018, it is clear that funding for CHIP remains at risk under President Trump.
it currently stands, slight shifts in parents’ incomes can disrupt
coverage and push children and their families off Medicaid and CHIP.
Even children who are covered by their parent’s private employer-based
coverage are subject to policy changes and cost increases—and strict
income requirements can leave them without access to these programs.
Medicare for All proposals expand access to health care for children
Considering the uncertain future of health care access for children and families under the Trump administration, progressive policymakers have put forward new approaches to protect and expand access to health coverage. Medicare for All proposals generally set out to integrate public programs in addition to strengthening existing benefits.41 For example, unlike traditional Medicare, Rep. Pramila Jayapal’s (D-WA) Medicare for All and Rep. Rosa DeLauro’s (D-CT) Medicare for America legislation both guarantee coverage for vision, hearing, and dental benefits.42
these proposals also maintain benefits that are essential to children’s
health, including pediatrics and the full EPSDT benefit. These plans
also include maternal health benefits, guaranteeing consistent access to
comprehensive coverage throughout pregnancy and after birth. The
structure of these universal coverage proposals includes automatic
enrollment, which further protects children and their families from
onerous paperwork requirements, and benefits and eligibility would not
vary by state. All of the prominent universal coverage proposals offer
similar benefits for children and their families, but the following
section outlines how CAP’s proposal would specifically ensure access to
Medicare Extra and Medicare for America
In 2018, CAP released Medicare Extra, a plan that would guarantee universal coverage for all Americans.43 Under Medicare Extra, newborns, individuals enrolled in Medicaid, and those purchasing insurance through the individual market would automatically be moved into a public program that builds on Medicare’s current benefits. Individuals with an offer of employer-sponsored coverage that they like would be able to choose between that plan and Medicare Extra. Cost sharing and premiums would be limited and would vary by income.
Benefits under Medicare Extra
CAP’s 2018 report, “Medicare Extra for All: A Plan to Guarantee
Universal Health Coverage in the United States,” Medicare Extra would
provide comprehensive benefits, including free preventive care, free
treatment for chronic disease, and free generic drugs. The plan would
guarantee the following benefits:
Primary and preventive services
Hospital services, including emergency services
Prescription drugs and medical devices
Maternity, newborn, and reproductive health care
Mental health and substance use disorder services
Habilitative and rehabilitative services
Dental, vision, and hearing services
Early and periodic screening, diagnostic, and treatment services for children
CAP’s plan has since been developed into legislation, titled “Medicare for America,” which was introduced by Reps. DeLauro and Jan Schakowsky (D-IL).44 Like other universal coverage proposals, Medicare for America would build on the progress of Medicaid and CHIP by guaranteeing continuity of coverage for children and their parents regardless of income, age, or health status. Children enrolled in Medicaid and CHIP would automatically be transitioned into Medicare for America, and families with private insurance who face costs or coverage barriers would also have the option to transition to the new program. Individuals with incomes of up to 200 percent of the federal poverty level—including families currently enrolled in Medicaid—would have no cost-sharing requirements or premiums. There would be no administrative hurdles or paperwork requirements in order to receive coverage. Moreover, states that currently have more generous benefits than current federal standards would be required to provide wraparound coverage to ensure that additional costs are not imposed on families.
Medicare for America also increases payments to providers by linking them to Medicare rates, which are higher than Medicaid payment amounts. The plan also increases funding for primary care and other nonprocedural services, which children are more likely to utilize. Payment increases would subsequently work to increase provider participation. Research has shown that when Medicaid rates increase, more pediatricians agree to treat children covered by the program.45 After the implementation of the ACA, Medicaid payments for primary care increased, and the number of primary care pediatricians accepting Medicaid patients grew.46
the significant portion of the population that Medicare Extra would
cover, providers would have a greater incentive to cover these patients.
And with more providers to choose from, children and their families
could more easily access the care they need. It is important to note,
however, that during the implementation of any universal coverage
program, all stakeholders—including physicians and patient
advocates—must be included in determining payment rates for services for
children that are not currently enrolled in the Medicare program.
health must be a priority in any major health care reform. While
Medicaid and CHIP are widely seen as a leading standard for providing
children’s health insurance, Medicare for All proposals, including
Medicare Extra and Medicare for America, would build on the programs’
success by guaranteeing coverage for everyone—regardless of income, age,
health status, or state of residence. With all children and families
gaining access to comprehensive health care coverage, these proposals
would improve the health care system for everyone.
Madeline Twomey is a research assistant for Health Policy at the Center for American Progress.
Center on Budget and Policy Priorities, “Medicaid Works for Children,” January 19, 2018, available at https://www.cbpp.org/research/health/medicaid-works-for-children. ↩
Julie L. Hudson and Asako S. Moriya, “Medicaid Expansion For Adults Had Measurable ‘Welcome Mat’ Effects On Their Children,” Health Affairs 36 (9) (2017): 1643–1651, available at https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2017.0347. ↩
Joan Alker and Olivia Pham, “Nation’s Progress on Children’s Health Coverage Reverses Course” (Washington: Georgetown University Health Policy Institute Center for Children and Families, 2018), available at https://ccf.georgetown.edu/wp-content/uploads/2018/11/UninsuredKids2018_Final_asof1128743pm.pdf. ↩
Tricia Brooks, Edwin Park, and Lauren Roygardner, “Medicaid and CHIP Enrollment Decline Suggests the Child Uninsured Rate May Rise Again” (Washington: Georgetown University Health Policy Institute Center for Children and Families, 2019), available at https://ccf.georgetown.edu/2019/05/28/medicaid-and-chip-enrollment-decline/. ↩
Henry J. Kaiser Family Foundation, “Health Insurance Coverage of Children 0-18,” available at https://www.kff.org/other/state-indicator/children-0-18/? (last accessed May 2019). ↩
CAP Health Policy Team, “Medicare Extra for All: A Plan to Guarantee Universal Health Coverage in the United States” (Washington: Center for American Progress, 2018), available at https://www.americanprogress.org/issues/healthcare/reports/2018/02/22/447095/medicare-extra-for-all/. ↩
Tricia Brooks and Kelly Whitener, “Medicaid and CHIP 101: Medicaid and CHIP’s Foundational Role in Covering Kids and Families” (Washington: Georgetown Health Policy Institute Center for Children and Families, 2018), available at https://ccf.georgetown.edu/wp-content/uploads/2018/09/Medicaid-and-CHIP-101.pdf. ↩
Georgetown University Health Policy Institute Center for Children and Families, “EPSDT: A Primer on Medicaid’s Pediatric Benefit” (Washington: 2017), available at http://ccf.georgetown.edu/wp-content/uploads/2016/03/EPSDT-fact-sheet.pdf; Medicaid and CHIP Payment and Access Commission, “EPSDT in Medicaid,” available at https://www.macpac.gov/subtopic/epsdt-in-medicaid/ (last accessed June 2019). ↩
Dee Mahan, “Medicaid’s Children’s Benefit—EPSDT—Supports the Unique Needs and Healthy Development of Children” (Washington: Families USA, 2018), available at https://familiesusa.org/sites/default/files/product_documents/Report-EPSDT_Supports_the_Unique_Needs_and_Healthy_Development_of_Children.pdf. ↩
Families USA, “The Children’s Health Insurance Program (CHIP)” (Washington: 2017), available at https://familiesusa.org/product/children-health-insurance-program-chip. ↩
Henry J. Kaiser Family Foundation, “Where Are States Today? Medicaid and CHIP Eligibility Levels for Children, Pregnant Women, and Adults” (Washington: 2019), available at https://www.kff.org/medicaid/fact-sheet/where-are-states-today-medicaid-and-chip/. ↩
Tricia Brooks and Kelly Whitener, “At Risk: Medicaid’s Child-Focused Benefit Structure Known as EPSDT” (Washington: Georgetown University Health Policy Institute Center for Children and Families, 2017), available at https://ccf.georgetown.edu/wp-content/uploads/2017/06/EPSDT-At-Risk-Final.pdf. ↩
Thomas Huelskoetter, “The Trump Budget Threatens Children’s Health” (Washington: Center for American Progress, 2017), available at https://www.americanprogress.org/issues/healthcare/news/2017/05/30/433056/trump-budget-threatens-childrens-health/. ↩
Centers for Medicare and Medicaid Services, “Unduplicated Number of Children Ever Enrolled in CHIP and Medicaid” (Washington: 2018), available at https://www.medicaid.gov/chip/downloads/fy-2017-childrens-enrollment-report.pdf. ↩
Hudson and Moriya, “Medicaid Expansion For Adults Had Measurable ‘Welcome Mat’ Effects On Their Children.” ↩
Robin Rudowitz, Rachel Garfield, and Elizabeth Hinton, “10 Things to Know about Medicaid: Setting the Facts Straight,” Henry J. Kaiser Family Foundation, March 6, 2019, available at https://www.kff.org/medicaid/issue-brief/10-things-to-know-about-medicaid-setting-the-facts-straight/. ↩
Olivia Pham, “U.S. Continues Progress in Children’s Health: Over 95% of U.S. Children Have Health Insurance,” Say Ahhh! Blog, September 12, 2017, available at https://ccf.georgetown.edu/2017/09/12/u-s-continues-to-make-progress-in-childrens-health-over-95-of-u-s-children-have-health-insurance/. ↩
Center on Budget and Policy Priorities, “Medicaid Works for Children.” ↩
Families USA, “The Children’s Health Insurance Program (CHIP).” ↩
Brooks and Whitener, “Medicaid and CHIP 101.” ↩
Georgetown University Health Policy Institute Center for Children and Families, “Health Coverage for Parents and Caregivers Helps Children” (Washington: 2017), available at https://ccf.georgetown.edu/wp-content/uploads/2017/03/Covering-Parents-v2.pdf. ↩
Hudson and Moriya, “Medicaid Expansion For Adults Had Measurable ‘Welcome Mat’ Effects On Their Children.” ↩
Henry J. Kaiser Family Foundation, “Compare Proposals to Repeal the Affordable Care Act,” available at https://www.kff.org/interactive/proposals-to-replace-the-affordable-care-act/ (last accessed June 2019). ↩
Tricia Brooks, Edwin Park, and Lauren Roygardner, “Medicaid and CHIP Enrollment Decline Suggests the Child Uninsured Rate May Rise Again” (Washington: Georgetown University Health Policy Institute Center for Children and Families, 2019), available at https://ccf.georgetown.edu/2019/05/28/medicaid-and-chip-enrollment-decline/. ↩
Brooks and Whitener, “Medicaid and CHIP 101.” ↩
Bret Schulte, “Arkansas Works Program Drops 12,000 From Medicaid,” U.S. News & World Report, November 20, 2018, available at https://www.usnews.com/news/best-states/articles/2018-11-20/medicaid-work-requirements-in-arkansas-drop-thousands-from-health-program. ↩
Julio Ochoa, “Thousands Could Lose Coverage Under Proposed Medicaid Work Requirements,” WJCT, April 17, 2019, available at https://news.wjct.org/post/thousands-could-lose-coverage-under-proposed-medicaid-work-requirements. ↩
Elizabeth Byrne, “Texas removes thousands of children from Medicaid each month due to red tape, records show,” The Texas Tribune, April 22, 2019, available at https://www.texastribune.org/2019/04/22/texas-takes-thousands-kids-medicaid-every-month-due-red-tape/. ↩
Families USA, “1115 Medicaid Waiver Element: EPSDT,” available at https://familiesusa.org/1115-waiver-element-epsdt (last accessed May 2019). ↩
Dylan Scott, “The Trump administration’s latest steps to undermine the Affordable Care Act, explained,” Vox, July 12, 2018, available at https://www.vox.com/policy-and-politics/2018/7/12/17561214/obamacare-open-enrollment-2019-premiums-trump. ↩
Huelskoetter, “The Trump Budget Threatens Children’s Health.” ↩
Aviva Aron-Dine and Matt Broaddus, “Poverty Line Proposal Would Cut Medicaid, Medicare, and Premium Tax Credits, Causing Millions to Lose or See Reduced Benefits Over Time” (Washington: Center on Budget and Policy Priorities, 2019), available at https://www.cbpp.org/research/poverty-and-inequality/poverty-line-proposal-would-cut-medicaid-medicare-and-premium-tax. ↩
Brooks and Whitener, “Medicaid and CHIP 101.” ↩
Sarah Kliff, “CHIP is finally getting funded—after 114 days without a budget,” Vox, January 22, 2018, available at https://www.vox.com/2018/1/22/16919640/chip-funding-congress-shutdown. ↩
Medicare for All Act of 2019, H.R. 1384, 116th Cong., 1st sess. (February 27, 2019), available at https://www.congress.gov/bill/116th-congress/house-bill/1384. ↩
Medicare for America Act of 2018, H.R. 7339, 115th Cong., 2nd sess. (December 19, 2018), available at https://www.congress.gov/bill/115th-congress/house-bill/7339/text. ↩
CAP Health Policy Team, “Medicare Extra for All.” ↩
Medicare for America Act of 2018. ↩
Lisa Rapaport, “Medicaid payment increases tied to greater pediatrician participation,” Reuters, January 12, 2018, available at https://www.reuters.com/article/us-health-kids-medicaid/medicaid-payment-increases-tied-to-greater-pediatrician-participation-idUSKBN1F12OC. ↩
Suk-fong S. Tang and others, “Increased Medicaid Payment and Participation by Office-Based Primary Care Pediatricians,” Pediatrics 141 (1) (2018): 1643–1651, available at https://pediatrics.aappublications.org/content/141/1/e20172570. ↩
Working Families Are Spending Big Money on Child Care
By Rasheed Malik Posted on June 20, 2019, 10:01 am
Download the PDF here.
American families are struggling with the costs of child care—a key element in the ever-rising expenses associated with middle-class opportunity. Quality, affordable child care allows parents who want to work to stay in the labor force, encourages the healthy development of young children, and supports families at a stage in their lives during which small investments return large social dividends.1 Absent large-scale policy action on this issue, young adults have reported child care expenses as the top reason they are having fewer children than they would like.2 In fact, in 2018, the U.S. fertility rate fell to a record low for the third straight year, falling below the replacement rate needed to keep the population constant from one generation to the next.3
For those who do have young children, parenthood in the United States can feel like a relentless series of financial challenges. Over the past two decades, middle-class wages have barely kept pace with the rate of inflation, while the costs of securing a family in the middle class—including the necessary costs of housing, education, health care, and child care—have risen considerably.4 During this same time, income inequality has escalated, with wealth and incomes for the top 1 percent and the upper middle class pulling away from the rest of Americans.5
Under the current policies, most parents must cover the full cost of child care on their own, an expense that few can afford. Even low-income families—whose children likely qualify for child care assistance—are often forced to pay for child care, since fewer than 1 in 6 subsidy-eligible children receives assistance.6 Meanwhile, to the extent that child care is affordable for parents at all, this is only because the child care workforce effectively subsidizes child care costs with low worker wages. The typical U.S. child care worker earns just $11 per hour.7
In reality, most young children have working parents, making child care integral to family life.8 To understand better the cost burden on families and the types of arrangements that parents make to manage financially, this issue brief examines recent data on child care payments and patterns that provide insight into the types of child care that families use. This issue brief reports findings from a new analysis of child care spending data from the most recent wave of the Survey of Income and Program Participation (SIPP), released in May 2019.9 (see Methodological note) This nationally representative survey, designed and implemented annually by the U.S. Census Bureau, offers broad-ranging, detailed information on households’ income dynamics, assets, health insurance, employment, participation in assistance programs, and child care arrangements, among other subjects. The author analyzed family incomes, demographics, child care spending, and the number and types of child care arrangements used by families with at least one child under age 5.
An overview of the SIPP results
The results of the child care spending analysis show that among working families with children under age 5 that pay for child care, average child care spending amounts to nearly 10 percent of the average family income, or 40 percent higher than the U.S. Department of Health and Human Services’ definition of affordability.10 This is also an 11 percent increase from the 8.9 percent of average family income spent on child care that the U.S. Census Bureau found in a 2013 analysis of SIPP data.11 Lower-income families spend a much higher percentage of their income on child care, while higher-income families spend more overall. This is not surprising, given that higher-income families use licensed child care—which is likely to be safer and of higher quality—much more frequently than lower-income families. Finally, all families, regardless of their income level, frequently juggle multiple child care arrangements, with more than half of young children in multiple child care arrangements and nearly one-quarter using three or more arrangements.
Increases in the share of families paying for child care and the amount they are spending would not necessarily be a bad thing if families were using higher-quality care for their children. However, the findings in this issue brief show that middle-class and low-income working families have less access to licensed child care but must spend a larger share of their income when they do pay for child care. It is important to consider the long-term economic impacts of these findings, as the middle class is shrinking in most metropolitan areas and wage growth is increasingly concentrated among the richest households.12 A public investment in child care can effectively act as wage increases for millions of middle-class and low-income families, who are often in their lowest earning years as young adults.
Child care spending among working families with young children
According to the U.S. Department of Health and Human Services (HHS), child care is considered affordable if it costs families no more than 7 percent of their income. Across nearly every category—whether it be marital status, race, age, education level, or income—families paying for child care spend, on average, a greater share of their income than the HHS benchmark of affordability.13 In fact, on average, working families paying for child care spend about 40 percent more than what is considered affordable.14 The Survey of Income and Program Participation asks parents how much their family spends on child care in a typical week, for all children under age 15. While most child care spending is on care for children younger than age 5, school-age children with working parents can also require child care before or after school.15 The resulting household-level estimates of child care costs consider the full array of child care expenses that families incur so that parents can participate in the workforce.
A descriptive summary of child care spending by demographic variables is presented in Table 1. It shows the number of families with children under age 5, the percentage of families making child care payments, and the average income and child care expenditure among families with children under age 5 in which the surveyed parent—almost always the mother—is employed.16 The author uses the term “working families” to refer to these households in the discussion of the findings.
These 5.1 million working families spent an average of $250 per week on child care, which is about 10 percent of the average family income.17 Since child care expenditures were recorded slightly differently in the 2014 SIPP than in the 2008 SIPP, this increase in child care spending could be partly due to changes in the survey design.18 Additionally, without more information about the quality of the child care these parents are paying for, it is difficult to determine whether this increase in spending comes from rising costs of child care or greater demand for higher-quality child care.
About 30 percent of working families with children under age 5 are considered low income.19 Only 4 in 10 low-income working families pay for child care, but among those that do, child care costs consume 35 percent of their income—five times more than what is considered affordable. Middle-class working families making from 200 percent to 399 percent of the federal poverty level are spending an average of 14 percent of their income on child care, which is twice the child care affordability standard. (see Figure 1)
SIPP data show that high-income families are much more likely to pay for child care. As other research has noted, while the mean of child care spending has risen dramatically in recent years, the median has not risen as quickly.20 This is because high-income parents are increasing their investment in their children’s care and education at a faster rate than ever before.21 This raises concerns about widening inequalities among young families in the absence of wide-ranging public investment in early care and education.
The overall share of working families paying for child care increased by more than 20 percent since the last SIPP census report, rising from a rate of 45.5 percent of families to 55.3 percent.22 The largest increases in the share paying for child care were among families with mothers over age 35, Non-Hispanic white mothers, Asian mothers, and mothers with a bachelor’s degree or higher. Each of these groups is associated with higher family incomes than the other groups within their category—race or education level, respectively—supporting the observation that higher-income families are more likely to pay for child care.
with the percentage of families paying for child care, there are
differences in the share of family income spent on child care between
groups with different demographic characteristics. For example,
unmarried parents spend more than twice what married couples spend as a
proportion of their family income. Parents without a high school degree
spend a much bigger portion of their paycheck on child care than parents
who are college graduates, though they are only half as likely to pay
for it at all. Unmarried parents and parents without a high school
degree earn less, on average, than groups that spend a smaller share of
their income on child care. In absolute terms, these families pay less
for care than their higher-income peers. Relative to their lower
incomes, however, child care is a larger expense for these low-income
Number and type of working families’ child care arrangements
The cost of child care can vary significantly by the type of child care. Families often consider a variety of factors when selecting child care, including cost, location, quality, and operating schedule. For low-income families, cost and location constraints are driving factors behind the type of child care they use. Table 2 reports the share of children in each type of child care arrangement recorded by the SIPP. The survey allows parents to indicate as many child care arrangements as they need for each child, although the number of hours is not recorded for each care arrangement. Thus, this analysis cannot determine the primary child care arrangement where the child spends the most time. For this table, the author has combined substantially similar categories for the sake of comparability with previous Census Bureau analyses of the SIPP.23 The population of interest for this analysis is the estimated 15.7 million children under age 5 in at least one child care arrangement while their parents are working, in school, or otherwise unavailable to care for them.24
For this population of young children, there are three broad child care categories: relative care, which includes parents, siblings, and grandparents or other relatives; licensed child care, which includes child care centers, preschool or pre-K, Head Start programs, and family child care homes; and other child care arrangements, such as self-care, in which the child is left alone without a caregiver, or unlicensed nonrelative care. An estimated 80 percent of children under age 5 spend at least some time with a relative during the week; 47 percent spend some time in licensed child care; and 24 percent spend some time in an unlicensed, nonrelative child care setting. About 56 percent of young children who need child care spend at least some time in the sole care of a grandparent.25 Typically, this is not their only child care arrangement. More than half of children under age 5 who need child care are in two or more care arrangements, with 25 percent in three or more care arrangements. While grandparent care is most common, a growing share of children under age 5—47 percent—spend at least some time in a licensed child care setting such as a child care center, pre-K, Head Start programs, or a family child care home. These categories sum to more than 100 percent because most children are in multiple child care arrangements.
After dividing the larger category of relative care into three distinct groups—nuclear family, grandparents, and other relatives—the author examined the prevalence of multiple care arrangements across the resulting five basic child care types: licensed care; nuclear family care; grandparent care; other relative care; and nonrelative unlicensed care. Using these five categories, this study finds that 56 percent of young children spend time in at least two types of child care, with 24 percent spending time in three or more types of care and 5 percent spending time in four types of care.26
Use of licensed child care for children in families in the top income quintile is twice as high as use in the bottom income quintile. (see Figure 2)27 States set standards that child care providers must meet in order to become licensed in that state, including the number of children a provider can care for before licensing is required, fireproofing, and minimum adult-to-child ratios. Nonprofit, for-profit, or publicly funded child care providers make up the licensed child care market. The increased rate of licensed child care among high-income families is likely part of the reason that high-income families are more likely to pay for child care, as well as why they are paying more for child care, on average.
Child care affordability should be a central goal for policymakers pursuing an inclusive growth strategy for the American economy—one that generates short-term as well as long-term economic benefits. Lawmakers must act to invest in solutions that increase child care supply, support child care workers, and make quality child care affordable for working families. The recently reintroduced Child Care for Working Families Act is one current proposal that addresses costs while also ensuring quality. It does so by greatly increasing child care assistance for low-income and middle-class families and raising wages considerably for the underpaid child care workforce.28
work-family policies are likely to pay for themselves in the long run,
while acting as an economic catalyst for labor supply in the short run.
An equitably designed policy approach can also direct many of the
benefits to women, middle-class working families, and families of color,
who have shouldered the cost of policy inaction for decades. A
progressive economic growth strategy that includes bold child care
investments will help families at a critical moment in their lives,
allowing more young parents to stay in the labor force while improving
the quality of child care for millions of children.
Rasheed A. Malik is a senior policy analyst for Early Childhood Policy at the Center for American Progress.
this issue brief, the author analyzed the 2014 panel of the Survey of
Income and Program Participation, which conducted annual waves of
interviews with a nationally representative sample of about 53,000
households and was released in 2019. This analysis uses data from Wave
3, for which interviews were completed in June 2016. Questions about
child care arrangements were asked of the reference parent for each
child under age 15. In most cases, the mother is the reference parent.
If neither parent is in the household, the guardian is the reference
parent. Usage of child care arrangements, as well as child care
expenses, refer to a typical week in December of the reference year,
which for Wave 3 interviews is 2015. The SIPP does not collect
information on hours, location, or cost per arrangement. Reference
parents were asked about how much they spent on child care overall, for
all arrangements for all their children.
Leila Schochet, “The Child Care Crisis Is Keeping Women Out of the Workforce” (Washington: Center for American Progress, 2019), available at https://www.americanprogress.org/issues/early-childhood/reports/2019/03/28/467488/child-care-crisis-keeping-women-workforce/; Erik Ruzek and others, “The Quality of Toddler Child Care and Cognitive Skills at 24 Months: Propensity Score Analysis Results from the ECLS-B,” Early Childhood Research Quarterly 28 (1) (2014); Hirokazu Yoshikawa and others, “Investing in Our Future: The Evidence Base on Preschool Education” (New York: Foundation for Child Development and Washington: Society for Research in Child Development, 2013), available at http://fcd-us.org/sites/default/files/Evidence%20Base%20on%20Preschool%20Education%20FINAL.pdf. ↩
Claire Cain Miller, “Americans Are Having Fewer Babies. They Told Us Why.”, The New York Times, July 5, 2018, available at https://www.nytimes.com/2018/07/05/upshot/americans-are-having-fewer-babies-they-told-us-why.html. ↩
Bill Chappell, “U.S. Births Fell To A 32-Year Low In 2018; CDC Says Birthrate Is In Record Slump,” NPR, May 15, 2019, available at https://www.npr.org/2019/05/15/723518379/u-s-births-fell-to-a-32-year-low-in-2018-cdc-says-birthrate-is-at-record-level. ↩
Jennifer Erickson, “The Middle-Class Squeeze” (Washington: Center for American Progress, 2014), available at https://www.americanprogress.org/issues/economy/reports/2014/09/24/96903/the-middle-class-squeeze/. ↩
Richard V. Reeves, “Really it’s not just the 1 percent,” Brookings Institution blog, July 27, 2017, available at https://www.brookings.edu/blog/social-mobility-memos/2017/07/27/really-its-not-just-the-1-percent/. ↩
Office of the Assistant Secretary for Planning and Evaluation, “Factsheet: Estimates of Child Care Eligibility and Receipt for Fiscal Year 2015” (Washington: U.S. Department of Health and Human Services, 2019), available at https://aspe.hhs.gov/pdf-report/factsheet-estimates-child-care-eligibility-and-receipt-fiscal-year-2015. ↩
Marcy Whitebook and others, “Early Childhood Workforce Index – 2018” (Berkeley, CA: University of California, Berkeley, Center for the Study of Child Care Employment, 2018), available at http://cscce.berkeley.edu/files/2018/06/Early-Childhood-Workforce-Index-2018.pdf. ↩
Annie E. Casey Foundation KIDS COUNT Data Center, “Children under age 6 with all available parents in the labor force in the United States,” available at https://datacenter.kidscount.org/data/tables/5057-children-under-age-6-with-all-available-parents-in-the-labor-force?loc=1&loct=1#detailed/1/any/false/871,870,573,869,36,868,867,133,38,35/any/11472,11473 (last accessed June 2019). ↩
U.S. Census Bureau, “2014 Survey of Income and Program Participation, Wave 3,” available at https://www.census.gov/programs-surveys/sipp/data/datasets/2014-panel/wave-3.html (last accessed June 2019). ↩
U.S. Department of Health and Human Services Administration for Children and Families, “Child Care and Development Fund (CCDF) Program,” Federal Register 81 (190) (2016): 67438–67595, available at https://www.gpo.gov/fdsys/pkg/FR-2016-09-30/pdf/2016-22986.pdf. ↩
U.S. Census Bureau, “Who’s Minding the Kids? Child Care Arrangements: 2011 – Detailed Tables: Table 6: Average Weekly Child Care Expenditures of Families with Employed Mothers that Make Payments, by Age Groups and Selected Characteristics,” available at https://www.census.gov/data/tables/2008/demo/2011-tables.html (last accessed June 2019). ↩
Pew Research Center, “America’s Shrinking Middle Class: A Close Look at Changes Within Metropolitan Areas” (Washington: 2016), available at https://www.pewresearch.org/wp-content/uploads/sites/3/2016/05/Middle-Class-Metro-Areas-FINAL.pdf. ↩
U.S. Department of Health and Human Services Administration for Children and Families, “Child Care and Development Fund (CCDF) Program.” ↩
Author’s calculation based on U.S. Census Bureau, “2014 Survey of Income and Program Participation, Wave 3.” ↩
Catherine Brown, Ulrich Boser, and Perpetual Baffour, “Workin’ 9 to 5” (Washington: Center for American Progress, 2016), available at https://www.americanprogress.org/issues/education-k-12/reports/2016/10/11/145084/workin-9-to-5-2/. Note: The analysis in this brief does not capture summer child care expenses, since respondents are asked to describe their child care expenses for a typical week in December. For more information on the challenges of finding child care during the summer, see Cristina Novoa, “Families Can Expect to Pay 20 Percent of Income on Summer Child Care” (Washington: Center for American Progress, 2018), available at https://www.americanprogress.org/issues/early-childhood/news/2018/06/11/451700/families-can-expect-pay-20-percent-income-summer-child-care/. ↩
The author calculates that 96 percent of the reference parents in this survey are mothers. ↩
Author’s calculation based on U.S. Census Bureau, “2014 Survey of Income and Program Participation, Wave 3.” ↩
In the 2008 SIPP design, the child care expenses were recorded for each arrangement and for each child under age 15. However, in the 2014 SIPP design, this was changed to record household-level spending for all children under age 15. Limiting the sample to families with children under age 5 allows for reasonable comparability, but it is possible that this survey design change may have altered the respondents’ recollection of how much was spent on child care. ↩
In this issue brief, “low income” is defined as any family income below 200 percent of the federal poverty level, which for a family of four is $51,500 per year. Office of the Assistant Secretary for Planning and Evaluation, “2019 Poverty Guidelines,” available at https://aspe.hhs.gov/2019-poverty-guidelines (last accessed June 2019). ↩
Andrew Flowers, “The Cost Of Child Care Might Not Be Skyrocketing,” FiveThirtyEight, July 23, 2015, available at https://fivethirtyeight.com/features/the-cost-of-child-care-might-not-be-skyrocketing/; Chris M. Herbst, “The Rising Cost of Child Care in the United States: A Reassessment of the Evidence” (Bonn, Germany: Institute of Labor Economics, 2015), available at http://ftp.iza.org/dp9072.pdf. ↩
U.S. Census Bureau, “Who’s Minding the Kids? Child Care Arrangements: 2011 – Detailed Tables: Table 5: Families with Employed Mothers that Make Child Care Payments, by Age Groups and Selected Characteristics,” available at https://www.census.gov/data/tables/2008/demo/2011-tables.html (last accessed June 2019). ↩
The categories were made up by combining three Head Start categories into one, all family member-based care being combined into relative care, and “child care center” being combined with “preschool/nursery school” and “Head Start” to make the “child care facility” category. “Any licensed care” includes all children in either a child care facility or a family child care home. ↩
Note: There are approximately 19.8 million children under age 5 in the United States. The author estimates from the SIPP that 21 percent of these children are always in the care of a parent, without any need for child care. ↩
Note: “Children needing care” is defined as the 79 percent of children under age 5 who spend some time in the care of someone else while the surveyed parent works/goes to school/is not available. ↩
The five categories that the author constructed are “licensed care,” “nuclear family,” “grandparent,” “other relative,” and “nonrelative care.” Licensed care contains the following types of care: child care center; nursery/preschool; Head Start; and family child care. Nuclear family care contains the following types of care: reference parent; spouse; or sibling over age 15. The other three categories are taken from the SIPP itself. ↩
Note: This data set does not identify which providers are licensed, so the author has used a set of provider types as a proxy for licensure. This includes Head Start, family child care homes, child care centers, and nursery schools or preschools. ↩
Child Care for Working Families Act of 2019, H.R. 1364, 116th Cong., 1st sess. (February 26, 2019), available at https://www.congress.gov/bill/116th-congress/house-bill/1364/text. ↩
5 Revelations From Children in Border Patrol Facilities
By Cristina Novoa Posted on July 3, 2019, 9:03 am
In the past year, at least seven migrant children—Mariee Juárez (age 18 months), Wilmer Josué Ramírez Vásquez (age 2), Jakelin Caal Maquín (age 7), Felipe Alonzo Gómez (age 8), Darlyn Valle (age 10), Juan de León Gutiérrez (age 16), and Carlos Hernández Vásquez (age 16)—have died after being taken into custody by the U.S. Border Patrol.
As their families confront the grief of losing a child, it is important not to mistake these deaths for isolated tragedies. Recent accounts demonstrate that these events are symptoms of a broader agenda that victimizes families. Detention centers, a visible consequence of this agenda, are not just bad for children; they are deliberately run in cruel, dangerous ways.
In a recent lawsuit against the Trump administration, attorneys and physicians detailed the abysmal conditions in which children in government custody are held.* They are asking a federal judge to hold the U.S. government in contempt of court for “flagrant and persistent” violations of the 1997 Flores Settlement Agreement, which sets basic standards of protection for the treatment of children in government custody.
The firsthand testimonies of migrant
children currently being held in immigration facilities reveal, in
painful detail, a systematic failure to uphold the basic dignity and
well-being of children. Here are five of the most significant
revelations from these testimonies.
1. Guards intentionally intimidate children
Testimonies reveal how detention center staff sometimes punish children for showing fear or sadness—natural emotions for children who are tired, hungry, and cold. One youth from El Salvador observed how an officer would chide children who cried: “I am in a room with dozens of other boys. Right now, there is a 12-year-old who cries a lot. Others try to comfort him. One of the officers makes fun of the boys who cry.” Rather than extend reassurance, something an adult with authority should surely be able to do—and a key part of promoting healthy socio-emotional development—officers extend ridicule.
Beyond demonstrating a shocking lack of compassion toward frightened children, testimonies also show that some guards appear to deliberately scare children in their custody. One 12-year-old from Ecuador explained the extent of officials’ intimidation tactics: “During the night when we’re trying to sleep they come in and wake us up, yelling and scaring us. Sometimes children rise up in the night and officials yell at them to lay back down.” Another 12-year-old from Guatemala explained how staff punished a hungry teen for hiding food in his room:
“The guards at
the second facility were mean and scary. They yelled at us. One day the
guards demanded to know who had food. ‘Whoever has food will go to
prison,’ they yelled. They wanted to know if anyone had snuck in food in
the cell. They found one kid who was about 15 or 16 years old who had
. The officials handcuffed his wrists. My cousin and I were
very shocked and scared.”
Being insensitive to children’s emotional
needs is one thing, but it is clear that some guards knowingly sow fear
and uncertainty in their young charges.
2. Agents still separate families
Despite President Donald Trump falsely claiming to have ended family separation, U.S. Customs and Border Protection staff continue the practice. In recent testimonies, a 5-year-old from Honduras explained his fear after immigration agents separated him from his father; and a young mother from El Salvador described how she and her 1-year-old daughter were both separated from her fiancé:
“They came and took our
daughter and me out of the cell and separated my fiancé from us. We were
all very upset. Our baby was crying. I was crying. My fiancé was
crying. We asked the guards why they were taking our family apart and
they yelled at us … We have not seen him since.”
These revelations come on the heels of a recent news story that showed that children as young as 4 months old have been separated from their families under the Trump administration’s zero-tolerance policy. The science could not be more clear: Separating families has long-term consequences for children’s psychological and physical health. And yet, according to children’s testimonies, the practice continues.
3. Poor sanitation is affecting children’s health
Proper sanitation is so central to health that the Centers for Disease Control and Prevention identify it as both a critical public health practice and the simplest way to avoid illness, particularly in group settings where disease can spread quickly. However, without regular access to soap and water in detention centers, children are getting sick. Recent stories of influenza outbreaks in detention centers are echoed in children’s accounts. One 17-year-old from Guatemala described how the poor sanitation has affected his health: “When I got here … I was completely well and have no medical problems. I do have my immunizations. I didn’t get sick until I got here, but I was next to someone who was sick, and the next day, I got sick, too.”
For individuals who are young parents, there’s the added strain of taking care of their children’s needs. One 17-year-old mother from Honduras laments: “I have not been able to wash and clean my baby since June 4th. We do not have toothbrushes or toothpaste or towels in the cages. My daughter’s onesie is very dirty.” Because babies’ immune systems are less mature, proper sanitation is especially important to their health. Yet detention centers are woefully neglectful in providing this basic necessity.
4. Hunger is rampant
Although children receive regular meals, such as oatmeal for breakfast and frozen burritos for dinner, it is simply not enough. Children in custody report feeling hunger so intense that it interferes with their sleep. One 12-year-old child from Guatemala even commented: “I’m so hungry that I’ve woken up in the middle of the night with hunger. Sometimes I wake up from hunger at 4 a.m., sometimes at other hours.” Others note that the food lacks nutrition, criticizing centers’ failure to provide milk, fruit, or vegetables. As one 8-year-old from Guatemala commented, “There are always cookies but the food does not fill you up and I am hungry.” Or the food simply makes them ill; one teenage mother from Honduras explained that the food is so bad that it gives her stomach aches. Public health experts such as Rafael Perez-Escamilla characterize the food options in detention centers as “appalling,” the sort of diet associated with obesity and chronic disease.
A lack of food and drinkable water is particularly dangerous for young breastfeeding mothers in detention. Good nutrition and proper hydration are critical for producing breastmilk, and when a mother’s nutrition is compromised, so is her infant’s. Yet in a court declaration, pediatrician Dr. Dolly Lucio Sevier noted that breastfeeding mothers held at the Ursula processing center in McAllen, Texas, only drink half the water they need.
5. Children are subject to humiliating invasions of privacy
Finally, children are forced into close quarters with little hope of privacy. Testimonies provide many examples of children being held in crowded rooms where they must regularly share blankets and sleeping mats with others. According to one 11-year-old girl from Ecuador, as many as 10 children share a single mat. These rooms, in which overhead lights shine 24 hours a day, offer no place to hide, use the bathroom, change clothes, or wash. The same 11-year-old continues: “The toilet is inside of the room where we sleep. There is no separate room, just two stalls with no doors.”
Conditions are no better for young parents; one 16-year-old mother from Honduras reported spending four days in an outdoor cage with her baby, desperately looking for clothing, diapers, and baby wipes—and publicly changing her infant on the ground. These conditions violate these young migrants’ human dignity and have even been compared to “torture.”
From her home in Guatemala, Jakelin dreamed about learning to read and write. And Juan’s teacher described him as intelligent but shy, a hard worker who helped his father in the coffee fields. Together with Mariee, Wilmer, Felipe, Darlyn, and Carlos, these children’s deaths are devastating losses to families who will grieve for the rest of their lives. Though each death represents an irrevocable loss, they are not isolated. Cruel and inhumane policies connect these stories to those of the anonymous children whose testimonies have recently come to light. The United States must do all it can to stop these unconscionable policies. Otherwise, future tragedies are inevitable.
Cristina Novoa is a senior policy analyst for Early Childhood Policy at the Center for American Progress.
*Author’s note: According to The New York Times, on June 28, 2019, U.S. District Court Judge Dolly Gee of the Central District of California asked that an independent monitor ensure that the government quickly deals with the conditions in Border Patrol. Gee gave a July 12 deadline for the Trump administration to report on what has been done “post haste” to fix the conditions.
3 Ways Federal Financial Aid Could Work Better for Student-Parents
By Ben Miller Posted on September 4, 2019, 5:00 am
Student-parents are one of the most overlooked groups in higher education from a policy perspective. Data from the National Center for Education Statistics estimate that 22 percent of college students today have a dependent child, more than half of whom are single parents. The U.S. higher education system does a particularly poor job of serving these students. Just one-third of student-parents finish college within six years. And among student-parents who borrow, half default on their loans within 12 years of starting college.
are also significant racial and gender implications in better serving
student-parents. About one-third of Black or African American students
have children, as do 30 percent of Native Hawaiian or Pacific Islander
students. And more than two-thirds of student-parents across the largest
racial and ethnic groups are women.
colleges must do more to ensure that student-parents succeed, the
federal financial aid and loan repayment systems also fail to properly
account for the needs of this group. These shortcomings can leave
individuals who are struggling with the costs of raising young
children—including the high cost of child care—and who are working jobs
that may not pay enough with insufficient financial support from the
This column presents three policy ideas aimed at improving the federal aid system for student-parents. These solutions focus on ways to better account for these individuals’ financial needs. The first and third ideas would need to come with special accountability provisions to ensure that institutions do not aggressively recruit student-parents to obtain more money from them without doing more to serve them well. Importantly, these ideas do not focus on improvements that institutions themselves can make—a key issue—but rather on what can be done at the federal level when allocating financial aid. This column also does not detail the absolute need for broader investments in making child care more affordable and accessible, such as increasing the Child Care and Development Block Grant and the Child Care Access Means Parents in School Program.
1. Award larger Pell Grants to student-parents
Many other countries structure their financial aid systems so that student-parents receive additional awards. For example, Canada provides up to $1,600 per child, or $200 per month, each academic year to full-time students who have dependents younger than age 12. In U.S. dollars, that’s the equivalent of about $1,200, or $150 a month. Finland, similarly, supplements its study grant with an additional 75 euros per month—about $84, or $672 over an eight-month academic year, while Germany provides 130 euros per month—about $145, or $1,160 per academic year—for each child under age 10.
Congress could create additional provisions in the Pell Grant program to similarly provide greater funds for student-parents. These funds would not be enough to cover anywhere close to the full cost of child care—nor would they address underlying structural issues related to the lack of available spots in high-quality child care options—but they would at least recognize that parents face larger costs than nonparents, including for things that go beyond child care, such as food or clothing.
For example, Congress could provide an additional $1,000 for each child of a Pell Grant recipient, capped at $3,000 per year. Given that about 2.2 million student-parents received a Pell Grant in the 2015-16 academic year, this increase would have an estimated additional cost of about $3.1 billion, assuming awards are ratably reduced for parents who do not attend full time. (see Methodology for an explanation behind this estimate) That may seem like a lot, but the roughly $1,000 increase in the maximum Pell award provided by mandatory money each year costs about $6 billion—and this provides some recipients with awards three times that amount.
2. Adjust IDR based on family composition
An increasing share of student loan borrowers use an income-driven repayment (IDR) plan for their student loans. These plans tie monthly payments to a borrower’s discretionary income—what their household earns above 150 percent of the federal poverty level.
The discretionary income exemption in IDR plans currently adjusts based on household size but not based on how the household is constructed. In other words, a family of two gets $25,365 exempted, while a single individual has an exemption of only $18,735, because the poverty level grows as family size increases. But the formula does not consider that a household of two comprising two adults is fundamentally different from a two-person household that includes one adult and one child. This holds true even if incomes are the same; in many cases, adults in a household have the potential to get a job at any moment, while a young child does not.
IDR formulas could better reflect household composition by
automatically increasing the discretionary exemption for each child. The
simplest way to accomplish this would be to raise the exemption by 50
percentage points above the poverty line for each child, capped at an
additional150 percentage points in the exemption. In other words, a
family of two with one adult and one child would have 200 percent of
their income exempted. If a household has two children, the exemption
would increase to 250 percent and so on—up to a 300 percent exemption.
For a two-person household, one of whom is a child, that means
protecting almost $8,500 in additional income, with even greater
benefits for larger families.
be fair, this change would not have an effect on a very low-income
family who does not make enough to require a loan payment. But it could
provide a meaningful benefit for middle-income families. For example, a
family of three making $50,000 per year would have their payments on IDR
fall from $150 per month to $61 per month—savings of more than $1,000
3. Give student-parents special priority under the FSEOG
The Federal Supplemental Educational Opportunity Grant (FSEOG) is another college grant program distributed to colleges and then awarded to students. Because the federal money is allocated to institutions, financial aid offices have significant discretion in choosing who receives the funds and how much they get. The most restrictive legal requirement is that aid officials are must prioritize students with the lowest expected family contributions who also receive the Pell Grant; it has no requirements related to student-parents.
In the 2015-16 school year, about 10 percent of student-parents received the FSEOG, compared with 7 percent of nonparents. But the FSEOG could better support student-parents in two ways. The first step is rewriting the formula that determines how much money institutions receive; it has not meaningfully changed in decades and thus provides disproportionate help to Northeastern colleges and private institutions that serve fewer students and have higher prices. While a broader formula rewrite should consider factors such as how well a school serves Pell recipients, it should also include bonuses for institutions that successfully serve student-parents. Doing so would create incentives and rewards for placing a greater emphasis on this group.
second FSEOG change involves rewriting the rules to require schools to
prioritize undergraduate student-parents who receive the Pell Grant,
followed by those with the lowest expected family contributions who also
receive Pell. This would put student-parents first in line to get help.
America has a desperate need for greater investments in helping parents, particularly in making high-quality child care more widely available and making the tax code more generous for working families. Likewise, higher education must do its part to ensure it is better serving students who are parents and caregivers. These efforts should include innovations such as child care on campus and schedules and supports that work for parents. But it’s long past time for the formulas and calculations that drive the distribution of billions of federal aid dollars to recognize and account for the unique needs of student-parents.
Ben Miller is the vice president for Postsecondary Education at the Center for American Progress.
note: CAP uses “Black” and “African American” interchangeably
throughout many of our products. We chose to capitalize “Black” in order
to reflect that we are discussing a group of people and to be
consistent with the capitalization of “African American.”
of the numbers in this column come from the author’s analysis of data
from national sample surveys produced by the National Center for
Education Statistics (NCES). The author used the online NCES tool
Powerstats to generate these numbers. Because the tool does not provide
for a way to directly link to these results, this piece includes table
numbers that readers can input to look up the figures themselves. The
statistic on the share of students who have dependent children can be
found in Table bchbmded. The number of parents who are single parents
can be found in Table bchbmdbb. The number of parents who are women, by
race and ethnicity, can be found in Table ckhbmdpn04.
The estimate for the costs of the larger Pell award for student-parents comes from author’s analysis of data from the 2015-16 National Postsecondary Student Aid Study. The author calculated the breakdown of Pell recipients by the number of children they have, which can be found in Table bdhbmbh47. The author then multiplied this breakdown by the number of Pell recipients in 2015-16 to get the number of students with one, two, or three or more children. The author then used Table bchbmded to calculate the share of these students that attended full time, half time, three-quarter time, or less than half time. The author then calculated how award sizes would vary based on number of children and attendance intensity. For example, a full-time student with one child would receive $1,000, while one who attended half time would receive $500. This meant the maximum award was $3,000 for a full-time student with three or more children, while the minimum award was $250 for a student with one child who attended less than half time. The author then multiplied the award sizes by the number of students to get an overall cost estimate.
By Katie Hamm, Allegra Baider, Catherine White, Katherine Gallagher Robbins, Cathy Sarri, Megan Stockhausen, and Nina Perez Posted on October 7, 2019, 5:00 am
children deserve to have nurturing, enriching early experiences that
support healthy development. Families—across race, ethnicity, religion,
immigration status, and economic background—want their children to grow
up to be happy and thriving adults. Child care is a critical tool for
families in realizing their children’s full potential. With access to
affordable, quality child care options, families can pursue employment
and educational opportunities that contribute to family stability and
financial security. Children benefit from participating in programs that
support their development and learning, beginning at birth and
continuing through elementary school in the after-school hours and
summer months. Communities prosper because child care promotes economic
growth, racial and economic equity, and child wellbeing. The United
States has yet to realize the benefits of investing in child care for
all children and families and lags behind most other industrialized
countries in this regard. This report explains why our nation’s leaders
must immediately prioritize solutions that make quality child care
affordable and accessible to all families.
This report is released jointly by the American Federation of Teachers, the Center for American Progress, the Center for Law and Social Policy, Community Change, Every Child Matters, MomsRising, the National Women’s Law Center, and the Service Employees International Union.This article was originally published in Case for Child Care.
How Universal Home Visiting Models Can Support Newborns and Their Families
By Cristina Novoa and Simon Workman Posted on September 26, 2019, 9:00 am
Download the PDF here.
matter a person’s background or where they live, the birth of a baby is
a momentous occasion that brings many challenges. All families need
support in the days, weeks, and months following a birth. As new mothers
are still recovering from childbirth, they also face the challenge of
caring for a newborn at a time when financial, mental, and emotional
resources are most limited.
During this important transition for parents and infants, additional community and social supports can help families adjust to their new lives and promote healthy child development in the process. A number of evidence-based models have been developed to provide such support, often referred to as “home visiting.”1 Many of these models provide specialized support to parents and children in high-priority families, such as families with low incomes or young parents, or to individuals serving in the military. However, others take a universal approach, supporting all families. One such model is Family Connects, which combines engagement and alignment of community service providers with short-term nurse home visiting beginning in the first month after birth. While many other universal home visiting models exist—including Welcome Baby in Los Angeles County2 and the First Born Program in New Mexico3—Family Connects has been most widely adopted.4
issue brief explores the positive impacts that universally available
family support programs such as Family Connects have on communities by
serving all families and connecting those most in need to additional
What is Family Connects?
Family Connects is an evidence-based voluntary program that “bridges the gap between parents and community resources” and is available to all parents of newborns.5 It employs registered nurses to visit parents in their homes shortly after their baby’s birth. These nurses are trained not only to deliver the model protocols, but also to build trust, offer supportive guidance, and navigate difficult situations in culturally responsive ways. By meeting with every family with a newborn, regardless of income level or background, Family Connects helps boost all parents’ knowledge and confidence around caring for their baby while also linking families who need additional services to community resources based on their individual needs and preferences.6 These services can range from helping a family select a child care arrangement to helping a parent find stable housing or address a substance abuse problem. The services may also include referral to a longer-term home visiting program. The idea is to engineer a system of care around the birth of a child that ultimately has a positive impact on health at a population level; the nurse connects with a family and identifies needs, the nurse connects the family to community resources, and the parents connect with their infants.7
Family Connects’ origins can be traced to 2001, when the Duke Endowment asked the Duke Center for Child and Family Policy to improve community-level outcomes for children in Durham County, North Carolina.8 After convening a broad array of community partners spanning research, health care, and social services, the team agreed that the best way to achieve its goal was to support all families with a newborn through a free, voluntary program. Since its initial 2008 pilot program in Durham, the Family Connects model has been studied through randomized control trials and successfully expanded to more than two dozen communities.9
Universally available family support programs such as Family Connects resemble the health care system’s practice of universal well-baby visits.10 In the United States, most young children attend regular well-baby visits for preventive services such as immunizations and referral to specialists when an issue requires follow-up. Importantly, these regular visits are not triggered by a medical crisis or perceived demographic risk factors such as family structure; instead, they are designed to prevent illness and promote all children’s development and well-being. Similarly, a universal family support program helps families avoid significant challenges, such as severe and unaddressed maternal depression, and promotes families’ ability to flourish. Just as the health care system requires a strong system of referrals and support from specialists, a universal home visiting program works best when there is a strong network of community services available for families.
How does Family Connects work?
Family Connects aims to reach each and every family with a newborn in the community, regardless of income, marital status, or family size. Participants receive one to three in-person meetings, as well as follow-up phone calls during an infant’s first 12 weeks.11 This approach helps keep costs low—between $500 and $700 per infant—and allows programs to reach a large number of families.12 The program is most effective when combined with a robust suite of targeted services so that families who require more intensive assistance can be referred for additional support as needed.
The program rests on three pillars:
Alignment with community agencies: Family Connects staff actively recruit local agencies and community programs that serve families with young children—for example, child care facilities, parent groups, and other home visiting models. Information including program eligibility, service capacity, waitlist times, and evidence of effectiveness is collected and entered into an annotated electronic database. This single portal allows nurses to quickly access information on community resources when they visit families who need additional services such as child care.13
Home visits: Parents are typically greeted by nurses or program staff at the hospital or birthing center, welcoming the new baby into the community and introducing the family to the program. If parents decide to participate—previous studies show that more than 70 percent agree to join—the nurse schedules an in-home visit about three weeks after birth.14 This initial visit lasts between 90 and 120 minutes, during which time the nurse conducts a structured clinical interview and standardized screening to assess the family’s risk levels in key domains such as child care, safety, parental mental health, and health care needs. Nurses score each domain on a scale of 1 to 4, from least to greatest risk.15 Data from a pilot study of Family Connects demonstrated that 94 percent of parents needed support in at least one area.16 After the interview, nurses and parents together develop a course of action, which can include additional visits or phone calls from the nurse, physician follow-up visits, and/or referrals to more intensive services such as targeted home visiting programs.17 This collaborative approach promotes parents’ engagement and empowers them to develop a plan that fits their needs.
Data and monitoring: Family Connects staff maintain an integrated data system that documents their work with all families. Each record includes information on attempts to schedule a home visit; parents’ responses to interview and screener questions; referrals to community services; services received; and parents’ overall satisfaction with the program. To address privacy concerns, all information-sharing requires families’ consent, and staff scrub identifying information from case records when developing summaries about community agencies. This system provides valuable data that allow the community to identify gaps in the services that are available in the community, recruit new programs to fill those gaps, and track the community’s progress toward meeting the needs of all families.18
Why the program is successful
Family Connects has been shown to increase families’ connections to community resources and improve parenting behaviors, such as comforting an infant; it has also been found to improve parents’ mental health, enhance the quality of home environments, reduce infants’ emergency medical care, and increase parents’ utilization of higher-quality child care for their children.19 For example, a study of the Family Connects program in Durham, North Carolina, using a racially diverse sample, found that participating infants had 59 percent fewer visits to the emergency room and two fewer overnight stays in the hospital during their first six months. In addition, participating mothers were 28 percent less likely to have signs of clinical anxiety, and nearly 80 percent of families made a community connection—such as connecting with a local child care program—as a result of participating in Family Connects.20 Preliminary findings also show a reduction in investigations by child protective services.21
Combined, these impacts make investing in a universal program such as Family Connects a smart choice for policymakers who want to maximize the return on investment of public dollars.22 However, the power of a program such as Family Connects is in its combination of targeted, specialized interventions and services within a universal program that reaches the entire community. This makes it more likely that programs will identify hard-to-reach families and connect them to community resources that fit their needs. It is therefore important for policymakers to assess the full scope of services available to support the needs of infants and new parents in their community and to center a universal program within the context of targeted supports that can meet the specific needs of all children and families.
The universal approach expands the scope of the program, removing the potential stigma that could be associated with targeted programs. In Durham, 99 percent of participating families would recommend the program to new mothers,23 and in Oregon, a recent bill to expand Family Connects statewide passed with overwhelming bipartisan support.24 Over time, this increased popular support could also translate to more sustainable funding for programs and greater investments in community resources overall.
As policymakers and advocates seek to give all children and families a strong start in life, a universally available family support model should be part of their agendas. Family Connects provides an example of such a model, and its promising outcomes and potential for cost savings make it broadly appealing to communities ranging from large cities such as Chicago—which recently began a pilot program in four hospitals—to midsize cities such as Durham to small rural communities. It even appeals to states: In June 2019, the Oregon Legislature approved a bill to expand Family Connects throughout the state over the course of several years, becoming the first state in the country to expand home visiting to all families.25
As communities consider how best to serve families with newborns, it is critical to recognize that all families could benefit from additional help. Stakeholders should use the myriad resources available to help communities understand families’ needs, the different models available, the costs and returns on investments, and the potential outcomes of investing early.26 While the results of statewide implementation of Family Connects remain to be seen, the model’s strong track record of improving child outcomes for entire communities is certainly promising.
Novoa is senior policy analyst for Early Childhood Policy at the Center
for American Progress. Simon Workman is the director of Early Childhood
Policy at the Center.
The authors would like to thank Steven Jessen-Howard for his assistance with this brief.
National Collaborative for Infants and Toddlers, “Increased Availability of Evidence-Based Home Visiting Models,” available at https://www.thencit.org/measure-impact/select-metrics-for-success/increased-availability-of-evidence-based-home-visiting (last accessed September 2019). ↩
First 5 LA, “Home Visiting Programs,” available at https://www.first5la.org/home-visiting-programs/ (last accessed September 2019). ↩
First Born Program, “About,” available at https://firstbornprogram.org/about/ (last accessed September 2019). ↩
Ron Haskins, Kenneth A. Dodge, and Deborah Daro, “Achieving Broad-Scale Impacts for Social Programs,” The Future of Children (2019): 1-8, available at https://futureofchildren.princeton.edu/sites/futureofchildren/files/media/foc-policy_brief_spring_2019.pdf. ↩
Family Connects, “About,” available at http://www.familyconnects.org/about (last accessed September 2019). ↩
Haskins, Dodge, and Daro, “Achieving Broad-Scale Impacts for Social Programs.” ↩
Family Connects, “Why It Works,” available at http://www.familyconnects.org/evidencebase (last accessed September 2019); Durham Connects and Duke Center for Child and Family Policy, “Right From the Start: The story of Durham Connects” (Durham, NC: 2015), available at https://childandfamilypolicy.duke.edu/wp-content/uploads/2015/02/Durham-Connects_CCFP_FINAL-Online.pdf. ↩
Kenneth A. Dodge and others, “Implementation and Randomized Controlled Trial of Universal Postnatal Nurse Home Visiting,” American Journal of Public Health 104 (2014): S135–S143, available at https://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2013.301361; Family Connects, “Why It Works”; Kenneth A. Dodge and W. Benjamin Goodman, “Universal Reach at Birth: Family Connects,” The Future of Children 29 (1) (2019): 41–60, available at https://futureofchildren.princeton.edu/sites/futureofchildren/files/media/foc_vol_29_no_1_0.pdf. ↩
Haskins, Dodge, and Daro, “Achieving Broad-Scale Impacts of Social Programs.” ↩
Dodge and Goodman, “Universal Reach at Birth.” ↩
Ibid. Early randomized control pilot programs and field trials showed that between 77 and 80 percent of families offered the program agreed to participate. Because the program is designed to address a family’s needs holistically, all parents should be present during the initial visit. However, insisting on both parents’ participation led to some mothers’ withdrawal from the program during pilot testing. Nurses are now encouraged to listen to mothers’ preferences and schedule visits to accommodate family situations (e.g., extended stays by relatives) and prior appointments (e.g., standard well-baby visit schedules). ↩
Family Connects, “FAQ,” available at http://www.familyconnects.org/faq (last accessed September 2019). ↩
Family Connects, “About.” ↩
Dodge and Goodman, “Universal Reach at Birth.” ↩
Family Connects, “Why It Works”; Dodge and others, “Implementation and Randomized Controlled Trial of Universal Postnatal Nurse Home Visiting.” ↩
Dodge and others, “Implementation and Randomized Controlled Trial of Universal Postnatal Nurse Home Visiting.” ↩
Dodge and Goodman, “Universal Reach at Birth.” ↩
Mary Ann Barton, “County saves $3 for every $1 spent on ‘Durham Connects’ program,” National Association of Counties, February 19, 2018, available at https://www.naco.org/articles/county-saves-3-every-1-spent-%E2%80%98durham-connects%E2%80%99-program. ↩
Haskins, Dodge, and Daro “Achieving Broad-Scale Impacts for Social Programs” ↩
An Act Relating to Home Visiting, Oregon S.B. 526, 80th Leg., 1st sess. (August 8, 2019), available at https://olis.leg.state.or.us/liz/2019R1/Measures/Overview/SB526; Julie Sabatier, “Oregon Lawmakers Want To Offer Home Visits To All New Parents,” Oregon Public Broadcasting, February 7, 2019, available at https://www.opb.org/radio/programs/thinkoutloud/segment/oregon-home-visits-new-parents-bill/. ↩
Oregon House Democrats, “Legislature Approves New Program Providing Registered Nurse Home Visits for Newborns,” Press release, June 19, 2019 available at https://www.oregonlegislature.gov/housedemocrats/Documents/PRESS%20RELEASE%20Legislature%20Approves%20New%20Program%20Providing%20Registered%20Nurse%20Home%20Visits%20for%20Newborns.pdf. ↩
National Collaborative for Infants and Toddlers, “Implementation of a Universal Family Connection and Referral Strategy,” available at https://www.thencit.org/measure-impact/select-metrics-for-success/implementation-of-a-universal-family-connection-and (last accessed September 2019). ↩
Author’s note: CAP
uses “Black” and “African American” interchangeably throughout many of
our products. We chose to capitalize “Black” in order to reflect that we
are discussing a group of people and to be consistent with the
capitalization of “African American.”
Introduction and summary
first few years of a child’s life are profoundly consequential in terms
of brain development and growth. In a matter of a few months, a
typically developing infant or toddler will move through milestones fast
enough to make their parent’s head spin—if it isn’t already spinning
from the turmoil of financial stressors that come with a new addition to
the family. Many young parents are just starting out in the workforce,
hoping to give their children a bright future while struggling to afford
the very immediate costs of raising a baby. This presents an
exceptional opportunity for public policies that can support young
families during this critically important stage.
By increasing public investment in child care from birth to age 5, the early care and education system can be made more equitable for parents and children. Today, families with greater resources have many more choices when it comes to child care. For most parents, child care choices are constrained by the high cost of providing care for an infant or toddler. With few affordable options, some parents leave the workforce out of necessity rather than choice, which can have a compounding effect on lifetime earnings and savings.1 This circumstance disproportionately affects women and has been identified as one of the primary reasons that the United States now trails other economically developed nations when it comes to female labor force participation.2
Currently, child care is most expensive and hardest to find when children are in their first few years of life, making infant and toddler care a promising investment in the financial security of families and the well-being of young children. The price of infant care today is higher than public college tuition in most states.3 Accordingly, the supply of infant and toddler care is three times scarcer than child care for preschool-age children.4 Together, these linked factors of cost and scarcity are cited by 3 in 5 parents as the primary challenge to finding infant or toddler care.5
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The tendency of many states and cities has been to invest in preschool, since they can link these programs with the public education system. While preschool is an excellent public investment, child care policy should begin at birth rather than in the year or two before kindergarten.6 In fact, a preschool-only approach can have unintended consequences on the price and supply of infant and toddler child care;7 many providers use revenues from larger classes of older children to subsidize the high costs associated with infant care.8 When public preschool crowds out the market for private tuition preschool, providers can no longer cross-subsidize the cost-intensive care of infants and toddlers, leading to fewer slots and higher prices.
report analyzes the economic effects of access to child care for
families with children under the age of 3. The author uses the U.S.
Census Bureau’s Survey of Income and Program Participation (SIPP) to
understand the challenges facing families with very young children and
the opportunity to improve their lives by investing when children are
young. This dataset contains information on what families report
spending on child care, the types of care arrangements that they use, as
well as the dynamics of income and debt for parents with very young
The key findings from this analysis include:
with an infant or toddler spend about 50 percent more on child care
than families with a preschooler. If their child care expenses were
capped at 7 percent of household income, as is recommended by federal
guidelines, low-income families paying for infant or toddler care would
save, on average, nearly $450 per month.
families with an infant and toddler are more cost constrained than
those with a preschooler, there are fewer infants and toddlers in
licensed child care—27 percent compared with 46 percent, respectively.
This analysis finds that within this rate, there are large disparities
by income and by race and ethnicity. High-income families use licensed
child care at nearly four times the rate of low-income families—52
percent compared with 14 percent—while Hispanic or Latinx infants and
toddlers are only half as likely as other children under age 3 to be in
average, parents see a significant reduction in income following the
birth of a child, leading to increases in household credit card debt.
Moreover, new parents increase their spending on major expenses such as
housing and transportation. This supports the idea that public
investments in child care would be particularly beneficial to parents
with very young children, who experience heightened financial stress.
Results of a child care analysis of families with infants and toddlers
report considers the particular challenges that face families seeking
child care for their infants or toddlers. These challenges include the
higher cost of care, inequality of access to licensed child care, the
temporary income loss following the birth of a child, and the rise in
household debt from an increase in expenses. These dynamics play out
differently for different types of families and affect mothers and
fathers differently, so the report profiles various trends by the race,
ethnicity, and gender of the parent. Finally, this report places these
findings in the context of a broader economic policy system that makes
few accommodations for young parents and families, identifying
opportunities for greater and more sustainable economic growth and
reduced inequality among families with young children.
Family spending on infant and toddler child care
One of the persistent challenges in studying the economic effects that child care has on families is in figuring out what families are paying for child care. The most frequently cited statistics tend to be from surveys of child care providers, which provide an insight into what prices licensed providers charge but do not capture how much parents spend.9 That being said, the average price of child care varies by state and type of setting, with infant care in a child care center topping $20,000 per year in many states.10 However, relatively few families can afford center-based infant care.
This report, which uses a nationally representative household survey of income and expenses, finds that among families who pay for child care, those with an infant or toddler spend about 50 percent more on child care than families with only preschoolers, spending an average of $265 per week.11 (see Table 1) This amounts to more than 12 percent of the average income for a family with an infant or toddler, nearly twice what the U.S. Department of Health and Human Services (HHS) has benchmarked as affordable.12 Children under the age of 3 are much less likely than preschoolers to attend licensed child care, with about one-quarter of infants and toddlers going to child care centers or family child care homes.13 However, parents with a child under age 3 are just as likely to pay for child care as those with a preschooler, while about half of families use unpaid child care, such as parental care or care provided by a grandparent, relative, or close friend. In general, these facts suggest that when children are under the age of 3, most parents cannot afford licensed care, nor can they afford to leave the workforce entirely. Families seem to be paying what they can, although the care that they are able to afford is unlikely to be with a licensed provider.
low-income families—those who make less than 200 percent of the federal
poverty level—who pay for infant or toddler child care, the share of
income that is spent on child care rises to 28 percent, which is four
times HHS’ affordability benchmark. If these low-income families spent
only 7 percent of their income on child care, they would see their
monthly child care spending reduced by $450 dollars, which comes out to
more than $5,000 over the course of the year—effectively a 10 percent to
20 percent income boost for a family of four. For these families
especially, affordable child care would equate to greater economic
security, due in part to savings on child care expenditures but also
because families may be able to work more hours or pursue better jobs or
educational opportunities. This could help equalize the playing field,
as families with the highest incomes are currently spending only 7
percent of their income on infant and toddler care and accessing
licensed child care at greater rates.
Only higher-income families currently access licensed infant and toddler child care
Since licensed child care for infants and toddlers is so costly, it is accessed much more freely by higher-income families, since they are able to pay the full price of care.14 Families in the top 20 percent of the income distribution use licensed infant and toddler care at rates that are nearly four times higher than low- and middle-income families, with 52 percent of children under age 3 attending licensed child care.15 (see Figure 1) Consequently, lower-income families are more likely to use grandparent care or other relative care than those with more financial resources.16
is an even more stark divide than the trends seen in preschool-aged
care. While only a third of infants and toddlers are in licensed child
care, it appears to be the norm for children from high-income
households. These statistics show that those with relatively more
resources can access licensed child care in higher numbers. Perhaps this
is due to the fact that high-income families’ child care spending meets
the 7 percent threshold of affordability.
have many different preferences when it comes to the type of child care
arrangement for their children. While unlicensed child care by a
relative or neighbor is not necessarily poor quality, there is a
significant range when it comes to quality in the unregulated child care
market. These differences in access to child care by income are
important, because they suggest that at least some low-income families
are selecting child care based on cost constraints rather than their
true preferences. Policies that make child care affordable for all
families are likely to increase access to licensed care for low- and
middle-income families. If these families can afford to make the same
choices as higher-income families, it should help reduce the educational
and economic inequalities that arise from a system that is largely
based on families’ ability to pay for child care.
Gaps in access to licensed infant and toddler child care by race and ethnic origin
equity concern on which the SIPP data can shed light are differences in
access to licensed care by race and ethnic origin. Considering the fact
that there are persistent and large racial wealth and racial income
gaps, it is not surprising to find gaps in access that correspond with
the large access gap associated with family income. This analysis does
find differences by race and ethnicity in the rate at which infants and
toddlers attend licensed child care. White children under age 3 have
access to licensed child care at the highest rate, 36 percent, with
Black or African American children accessing licensed care at the
slightly lower rate of 34 percent. (see Figure 2)
than 3 in 10 Asian infants and toddlers were in licensed care. However,
Hispanic or Latinx children were by far the group with the lowest
access to licensed infant and toddler care. Merely 1 in 6 Hispanic or
Latinx children under age 3 were in licensed child care, which makes
this group only half as likely to be in licensed care as the overall
population of infants and toddlers.
Research shows that Hispanic or Latinx parents have similar attitudes toward child care as white and Black or African American parents, and Hispanic or Latinx parents are no more likely to report having relatives available as caregivers than their non-Hispanic peers.17 However, the National Research Center on Hispanic Children and Families did find that a larger share of Hispanic or Latinx children needed care during nontraditional hours, such as during the evenings, on weekends, or overnight.18 Its research suggests that approximately one-third to two-thirds of low-income Hispanic or Latinx children need care during these off hours, which may partially explain these much lower rates of licensed care use.19 A properly designed public investment in the child care sector should build up the supply of care outside of daytime business hours, as many parents work during the early morning, evening, or on weekends.
Families are especially cost constrained when their children are very young
author also reviewed monthly changes in income and debt in the year
before and after the birth or adoption of a baby. The trends that emerge
reflect what many parents frequently describe as a difficult financial
transition. In the absence of any meaningful public policy to support
families during this period, parents face a combination of three
Reductions in household income, particularly for mothers who do not have access to paid parental leave
in household expenses that are directly attributable to having a baby,
such as formula or feeding supplies; diapers and clothes; and equipment
or furniture such as car seats and cribs
in major expenses that accompany family expansion, such as greater
housing debt, vehicle debt, and, of course, child care expense
As shown in Figure 3, the median parental income drops by about 10 percent just before and after the arrival of a baby. The median income returns to its prebirth level after about six to nine months as parents scramble to make up for lost income. But after this brief spike, parental income then settles back to a slightly lower level than before the birth of the child. This rollercoaster trend is mostly driven by steep declines in the earnings of mothers, since fathers, on average, experience increases in their personal income following the birth of a child. (see Appendix) This so-called motherhood penalty stems from mothers leaving the workforce due to a lack of paid leave and child care; mothers reducing their work hours to accommodate greater child-rearing duties than fathers; and mothers being discriminated against in hiring and pay negotiations.20 This penalty is greatest for low-income mothers, who are less likely to have flexible work schedules or access to paid parental leave.21
Within the group of mothers analyzed for this report, there are differences by marital status and race or ethnicity.22 Single mothers increase their labor force participation and income following the birth of a child, while married mothers become less likely to remain in the workforce. Corresponding with this decline in labor force participation for married mothers, the median income for married mothers only returns to about 80 percent to 85 percent of the income before the birth of their baby.
Meanwhile, Black mothers increase their labor force participation and income following the birth of a child. Black mothers have historically had higher labor force participation rates than mothers of other races or ethnicities, as they are much more likely to be their family’s breadwinner.23 Conversely, due to a drastic decline in labor force participation, Hispanic or Latinx mothers see their median earnings drop to almost zero following the birth of a child. While many of these Hispanic or Latinx mothers eventually return to the labor force, their labor force participation rate remains below 50 percent one year after the birth of their child. (see Figure A3)
this report shows that household debt, particularly credit card debt,
increases when parental income is falling. Figure 4 shows the monthly
change in average credit card debt for parents before and after they
have a child. Credit card debt increases just before childbirth, when
many parents lose a portion of their income but need to purchase the
supplies, furniture, and clothes that they will need for their baby. The
average level of debt then declines over the course of the following
year as parents pay off the debt that they accrued around the birth of
Finally, the SIPP data show a steady increase in the average spending on rent or mortgages, as families seek better or larger housing following the birth of a child. Figure 5 shows that the average rent or mortgage payment rises by about 15 percent in the first year after childbirth. The data also show increases in average vehicle debt and unsecured debt, such as private loans for which there is no collateral offered. For Black families, overall household debt increases at tremendous rates after the birth of a child, driven by large increases in housing and vehicle debt. Considering the fact that a racial wealth gap has been engrained in American society through decades of structural racism in American policymaking and implementation, this uniquely large increase in household debt deserves closer examination.24 Research has shown that college-educated Black households have 30 percent less median wealth than noncollege-educated white households, so Black families may be more burdened with debt as their families grow.25 (see Figure A2)
These interrelated dynamics put economic stress on parents during what is already an emotionally and physically draining period—adjusting to life with a new baby. Sleep deprivation, postpartum depression, and maternal health challenges place even more stress on mothers, with effects that are especially dangerous for women of color, particularly Black women.26 The current generation of new parents, who are typically Millennials, also has much higher levels of student debt than previous generations.27
A recent survey published by The New York Times found that 1 in 5 parents reports going into debt to pay for child care.28 In the context of the economic forces at play for new parents, this should hardly come as a surprise. But this information obscures that for many families, additional debt is not a viable option. Confronting the pressures and constraints from their existing debts, such as credit cards, mortgages, car loans, and student loans, few can justify or even manage the sky-high expense of infant child care. Those who can afford to pay are often families who are already high-income earners. This is why large public investments in child care from birth to age 5 can be seen as an equity and economic security policy. These are investments that can put millions of families on firmer financial footing during a time of great economic precarity.
care is an important aspect of economic policy, for both the short-term
labor force attachment of parents facing the economic shocks that
accompany a growing family and for the long-term health of the economy
in the face of widening income and wealth inequality. It is a matter of
gender and racial equity, since mothers face larger income shocks than
fathers and are more likely to leave the labor force out of economic
necessity instead of by choice. It is also an issue that affects racial
and ethnic groups differently, leading to discrepancies in rates of
access to licensed infant and toddler child care, making it harder for
families of color to get ahead.
But thoughtful public policies can counter these inequities, with the goal of providing more families with a broader set of choices than they currently have, leading to greater economic security for families with young children. States and the federal government should spend much more supporting access to high-quality child care for children under the age of 3. Businesses and employers would benefit greatly, as nearly 9 in 10 primary caregivers say that problems with child care reduced their productivity at work.29 In the aggregate, this productivity loss is estimated to cost employers around $13 billion every year, which is a steep price to pay for a system that virtually no one says is working for them.30
Congress can immediately increase federal investment in child care by passing the Child Care for Working Families Act, which would cap child care expenses at 7 percent of family income for approximately 85 percent of children under age 12. Congress can also increase funding for the Child Care and Development Block Grant, which currently provides several billion dollars to states to defray the cost of child care for low-income families.31 With recent increases in the size of the block grant, states should dedicate additional dollars to addressing the bigger issue of poor child care availability and affordability for infants and toddlers.
But child care should just be one part of a holistic, inclusive public policy approach to helping families with young children. This can include any number of research-driven programs with very high returns on each dollar spent, such as maternal and infant home visiting programs, high-quality preschool and pre-K, early interventions for children with disabilities, and direct cash support for families with young children. Another federal policy action that would greatly benefit families with young children is the passage and implementation of the FAMILY Act, which would allow most workers to take paid time off when they have or adopt a baby or when they or their close family members are seriously ill.32 Paid family and medical leave has been shown to improve women’s attachment to the labor force after birth and generally helps workers and families maintain better economic security when welcoming a new child, recovering from a serious medical condition, or caring for a loved one with a serious injury or illness.33
the United States is starting from such a low level of public
investment in infant and toddler child care, this policy area is a great
opportunity to positively affect the lives of children and their
families. Without such an investment, the licensed child care market
will continue to serve primarily the families with the highest incomes.
Moving away from a system that is reliant on parental private spending
toward recognizing child care as a public good will lead to more
equitable access, and hopefully outcomes, for communities of color and
low- and middle-income families.
public investments would also help combat the motherhood penalty that
many women pay, reducing lifetime earnings and contributing to the
gender pay gap. Along with other important policy options, such as paid
family and medical leave, a child benefit paid to families, expanded
home visiting programs, and public pre-K, the United States can build a
prenatal to age 5 policy structure that would relieve the tremendous
burden that is shouldered by young families in this country. This would
benefit the overall economy through greater labor force participation
and higher productivity from parents of young children. Ultimately,
greater public investment in early childhood can help to reduce
inequality of opportunity by helping parents when they most need it, so
that they can find success and happiness for themselves and their
About the author
is a senior policy analyst for Early Childhood Policy at the Center for
American Progress. His work focuses on the economic benefits of child
care, child care infrastructure and supply, and bias and discrimination
in early childhood policy. His research has been featured in or cited
by The New York Times, Vox, The Washington Post, NPR, Slate, CNNBusiness, and CNBC, among
others. Malik holds a master’s degree in public policy from the Gerald
R. Ford School of Public Policy at the University of Michigan and a
bachelor’s degree in public affairs from Baruch College.
author would like to thank Diana Boesch, Katie Hamm, Connor Maxwell,
Shilpa Phadke, Danyelle Solomon, Taryn Williams, and Simon Workman for
their helpful review and feedback. The author would also like to thank
the Art and Editorial teams for making these findings comprehensible and
for their help visualizing monthly income and debt dynamics. Finally,
the author would like to thank Holly Fee and Matthew Marlay at the U.S.
Census Bureau for their work leading a SIPP training and for their
expert review of the data analysis contained in this report
Data and methodology
data analyzed for this report come from the 2014 panel of the Survey of
Income and Program Participation. For the estimates of household
spending on child care and rates of usage of licensed child care, the
author used the most recent data, which come from Wave 3 of the SIPP and
cover the 2015 calendar year. Interviewers asked the reference parent
about child care expenses from a typical week in the previous December.
Thus, for Wave 3 data, the interviews took place in early 2016, and the
respondents shared how much their household spent on child care in a
typical week in December 2015 for all children in the family under the
age of 13. Since this report aimed to isolate expenses for just infants
and toddlers, the author limited the sample to just families in which
there were no children over the age of 3 in December of 2015. This
resulted in an infant-toddler family sample size of 486 families
(N=486). For the comparison group of families with only children of
preschool age, the author constructed a subsample of families in which
there were no children under the age of 3 nor over the age of 5. This
resulted in a preschooler family sample size of 362 families (N=362).
the analysis of licensed care use, it is important to note two
characteristics of the data. First, the interviewer asks the reference
parent about care arrangements for each child under age 13 in the
household, but they do not assign any type of care as the primary care
arrangement. Most parents report using multiple care arrangements for
their child, between family, themselves, child care centers, siblings,
and other types of care. Unfortunately, it was not possible to determine
which care setting was the most common care arrangement. Second, the
interviewer did not verify whether the type of care that the parent
indicates using is licensed. For this report, the author assumed that
the following types of child care are likely to be licensed and are
therefore a kind of proxy for licensed child care: daycare or child care
center; Head Start; preschool or pre-K; and family child care home.
the event-study research design section analyzing the income and debt
dynamics of parents before and after their baby was born, the author
appended all three waves of interviews, covering the calendar years of
2013 through 2015, into a single 36-month panel. The author tagged the
initial observation for each member of every household in the SIPP
panel, then identified the cases in which this new household member was
coded with the age of zero. Since household composition can change in
January with each new interview wave, the author also made sure that the
babies tagged as being born in January were coded as zero years old for
every month in that calendar year. This removed more than 200 infants
who were new to the household for that interview wave but were not born
in January as the data might suggest. Ultimately, the author constructed
a sample of 1,599 births. The author next used the relationship
variable epnpar1 and epnpar2 to identify who the parents of the baby
were in the household. Not every baby lived in the same household as
both parents. Approximately 200 babies did not live with their mother
from birth and were excluded from the sample. Another approximately 300
babies lived with their mother but not their father. Ultimately, this
results in a sample of 1,382 infants, the same number of mothers, and
Additional findings and figures
all of the findings from the section analyzing parental finances before
and after the birth of a baby are included in the body of this report.
For the sake of explaining some of the findings in the report in greater
detail, this section of the Appendix contains several figures and a
discussion of the trends observed in the analysis.
are three additional analyses presented here for reference and brief
discussion. The first is a comparison of the income dynamics of women
before and after the birth of a child with the income dynamics of men
during this same time frame. Second is a comparison of changes in
overall household debt by the race and ethnicity of parents. Finally,
the author presents a comparison of maternal income dynamics by race and
shown in Figure A1, there are distinct trends in personal income for
men and women in the year before and after the birth of a baby. Fathers
experience what has been described as a “fatherhood bonus” in the year
after a child is born. Some of this may be associated with a small
increase in paternal labor force participation, as the few
nonparticipating men join the labor force to help support their child.
The bigger influence on this increase in income comes from more hours
worked by fathers, after a brief dip in average hour worked in the first
two months after a birth. On the other hand, mothers experience a huge
drop in median earnings—approximately 50 percent—in the months just
after a baby is born. The median personal income for women does rebound
somewhat from this low but only recovers to about 85 percent of where it
had been one year before the baby was born. The incomes for both groups
have been indexed to their level one year before the birth of a child.
A2 shows differences in the total debt held by parents before and after
the birth of a child. The graph shows white parents increasing their
overall debt by a relatively small amount before beginning to pay it
down in the final month of the baby’s first year. Overall, there is only
about a 1 percent increase in average total debt over the two-year
period. Hispanic or Latinx parents display a very different trend, with
the average total debt for these parents decreasing by about 18 percent
after bouncing up and down in the six months before and after the
arrival of a baby. Finally, Black or African American parents show a
very large increase in their average total debt, which grows by nearly
50 percent during the year a child is born. The total debt for all three
groups has been indexed to their level one year before the birth of a
Figure A3 shows the dynamics of female labor force participation in the
months before and after childbirth, by the race and ethnicity of the
mother. White women’s labor force participation drops from about 75
percent to 60 percent in the months after childbirth, recovering to
about 64 percent one year after childbirth. Hispanic or Latinx mothers
start from a lower level of labor force participation, at just under 60
percent, which then drops to less than 45 percent after the birth of a
child and staying in the range of 40 percent to 50 percent for the first
year of their child’s life. Lastly, Black or African American women
display a different trend altogether. While they do experience a decline
in labor force participation prior to childbirth, within six months,
this group’s labor force participation is higher than it was one year
before childbirth. This analysis finds that the labor force
participation rate for Black or African American women one year after
the birth of their child tops 75 percent.
Michael Madowitz, Alex Rowell, and Katie Hamm, “Calculating the Hidden Cost of Interrupting a Career for Child Care” (Washington: Center for American Progress, 2016), available at https://www.americanprogress.org/issues/early-childhood/reports/2016/06/21/139731/calculating-the-hidden-cost-of-interrupting-a-career-for-child-care/. ↩
Francine D. Blau and Lawrence M. Kahn, “Female Labor Supply: Why Is the United States Falling Behind?”, American Economic Review: Papers & Proceedings 103 (3) (2013): 251–256, available at https://pubs.aeaweb.org/doi/pdfplus/10.1257/aer.103.3.251. ↩
Meghan Cornwell, “Child Care Aware of America’s 12th Annual Cost of Care Report Shows Child Care Outpaces Nearly All Other Family Expenses Nationwide,” Child Care Aware of America, Press release, October 22, 2018, available at https://usa.childcareaware.org/2018/10/child-care-aware-americas-12th-annual-cost-care-report-shows-child-care-outpaces-nearly-family-expenses-nationwide/. ↩
Steven Jessen-Howard and others, “Understanding Infant and Toddler Child Care Deserts” (Washington: Center for American Progress, 2018), available at https://www.americanprogress.org/?p=460128. ↩
Leila Schochet, “The Child Care Crisis is Keeping Women Out of the Workforce” (Washington: Center for American Progress, 2019), available at https://www.americanprogress.org/issues/early-childhood/reports/2019/03/28/467488/child-care-crisis-keeping-women-workforce/. ↩
William T. Gormley Jr., Deborah Phillips, and Sara Anderson, “The Effects of Tulsa’s Pre‐K Program on Middle School Student Performance,” Journal of Policy Analysis and Management 37 (1) (2018): 63–87, available at https://onlinelibrary.wiley.com/doi/full/10.1002/pam.22023; Rasheed Malik, “ The Effects of Universal Preschool in Washington, D.C.: Children’s Learning and Mothers’ Earnings” (Washington: Center for American Progress, 2018), available at https://www.americanprogress.org/issues/early-childhood/reports/2018/09/26/458208/effects-universal-preschool-washington-d-c/. ↩
Jessica H. Brown, “Does Public Pre-K Have Unintended Consequences on the Child Care Market for Infants and Toddlers?” (Princeton, NJ: Princeton University, 2018), available at https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3360616. ↩
Simon Workman and Steven Jessen-Howard, “Understanding the True Cost of Child Care for Infants and Toddlers” (Washington: Center for American Progress, 2018), available at https://www.americanprogress.org/issues/early-childhood/reports/2018/11/15/460970/understanding-true-cost-child-care-infants-toddlers/. ↩
Child Care Aware of America, “The US and the High Cost of Child Care: A Review of Prices and Proposed Solutions for a Broken System” (Arlington, VA: 2018), pp. 25–27, available at https://cdn2.hubspot.net/hubfs/3957809/COCreport2018_1.pdf. ↩
The SIPP collects data on child care expenditures regardless of setting, although it does not break down the spending by each child in the household. Nonetheless, the panel is large enough that for this study, the author was able to isolate a subsample of families whose oldest child is still under 3 years of age. The spending and child care choices of these families were then compared with a similarly sized subsample of families whose child or children are between the ages of 3 and 5, whom this report will refer to as “preschool-aged” or “preschoolers.” In order to identify a large enough subsample for reliable estimates, 5-year-olds have been included in this preschool-aged group, even though many 5-year-olds would have been in kindergarten during the survey period. This brings down the average child care expenditure for parents of preschoolers by a small amount, as well as the share that report paying for care—since in most places, kindergarten is public and free. See the Appendix for more information. ↩
U.S. Department of Health and Human Services Administration for Children and Families, “Child Care and Development Fund (CCDF) Program,” Federal Register 81 (190) (2016): 67438–67595, available at https://www.gpo.gov/fdsys/pkg/FR-2016-09-30/pdf/2016-22986.pdf. ↩
Due to the nature of the SIPP data, the author was unable to identify a primary care arrangement. ↩
The SIPP does not collect information on whether a family is using licensed child care. However, the survey does record what type of care each child is in. The author selected the following categories to stand as proxy for licensed care: daycare or child care center; Head Start; preschool or pre-K; and family child care home. ↩
Author’s analysis of U.S. Census Bureau, “Survey of Income and Program Participation: 2014 Panel Wave 3,” available at https://www.census.gov/programs-surveys/sipp/data/datasets/2014-panel/wave-3.html (last accessed September 2019). ↩
Lina Guzman and others, “Hispanic Children’s Participation in Early Care and Education: Parents’ Perceptions of Care Arrangements, and Relatives’ Availability to Provide Care” (Bethesda, MD: National Research Center on Hispanic Children and Families, 2016), available at https://www.childtrends.org/wp-content/uploads/2016/11/2016-60HispECEParentPerceptions-1.pdf. ↩
Danielle Crosby and Julia Mendez, “How Common Are Nonstandard Work Schedules Among Low-Income Hispanic Parents of Young Children?” (Bethesda, MD: National Research Center on Hispanic Children and Families, 2017), available at https://www.hispanicresearchcenter.org/wp-content/uploads/2017/11/Hispanics-Center-parental-work-hours-Brief-11.1-V21.pdf. ↩
Claire Cain Miller, “The Motherhood Penalty vs. the Fatherhood Bonus,” The New York Times, September 6, 2014, available at https://www.nytimes.com/2014/09/07/upshot/a-child-helps-your-career-if-youre-a-man.html. ↩
This analysis identified 1,599 births in waves 1 through 3 of the 2014 panel of the SIPP. Mothers are directly identifiable within the dataset using relationship variables that identify all parents in the household. ↩
Daniella Zessoules, Annie McGrew, and Michael Madowitz, “The State of the U.S. Labor Market for Mothers: Pre-May 2018 Jobs Release,” Center for American Progress, May 30, 2018, available at https://www.americanprogress.org/issues/economy/news/2018/05/30/451414/state-u-s-labor-market-mothers-pre-may-2018-jobs-release/; U.S. Department of Labor Women’s Bureau, “Labor force participation rate by sex, race and Hispanic ethnicity: 1948–2015 annual averages,” available at https://public.tableau.com/profile/women.s.bureau.department.of.labor#!/vizhome/LaborforceparticipationratebysexraceandHispanicethnicity1948-2015annualaverages/LFPRbysexraceandHispanicethnicity1948-2015 (last accessed September 2019). ↩
Angela Hanks, Danyelle Solomon, and Christian E. Weller, “Systematic Inequality: How America’s Structural Racism Helped Create the Black-White Wealth Gap” (Washington: Center for American Progress, 2018), available at https://www.americanprogress.org/issues/race/reports/2018/02/21/447051/systematic-inequality/. ↩
Jamila Taylor and others, “ Eliminating Racial Disparities in Maternal and Infant Mortality: A Comprehensive Policy Blueprint” (Washington: Center for American Progress, 2019), available at https://www.americanprogress.org/issues/women/reports/2019/05/02/469186/eliminating-racial-disparities-maternal-infant-mortality/. ↩
Megan Leonhardt, “Feeling the squeeze, American parents struggle to afford child care and student loan debt,” CNBC, August 13, 2019, available at https://www.cnbc.com/2019/08/13/21percent-of-student-loan-borrowers-struggle-to-pay-for-child-care.html. ↩
Christina Caron, “The Costly Burden of Day Care and Preschool,” The New York Times, August 14, 2019, available at https://parenting.nytimes.com/work-money/day-care-cost-yougov-survey. ↩
Sandra Bishop-Josef and others, “Want to Grow the Economy? Fix the Child Care Crisis” (Washington: Council for a Strong America, 2019), available at https://strongnation.s3.amazonaws.com/documents/602/83bb2275-ce07-4d74-bcee-ff6178daf6bd.pdf?1547054862&inline;%20filename=%22Want%20to%20Grow%20the%20Economy?%20Fix%20the%20Child%20Care%20Crisis.pdf%22. ↩
U.S. Office of Child Care, “Child Care and Development Block Grant Act (CCDBG) of 2014: Plain Language Summary of Statutory Changes,” available at https://www.acf.hhs.gov/occ/resource/ccdbg-of-2014-plain-language-summary-of-statutory-changes (last accessed October 2019). ↩
FAMILY Act of 2019, S.463, 115th Cong., 1st sess. (February 12, 2019), available at https://www.congress.gov/bill/116th-congress/senate-bill/463/text. ↩
Tanya S. Byker, “Paid Parental Leave Laws in the United States: Does Short-Duration Leave Affect Women’s Labor-Force Attachment?”, American Economic Review 106 (5) (2016): 242–46, available at https://www.aeaweb.org/articles?id=10.1257/aer.p20161118. ↩
Tips to help you prepare your child for child care.
Before starting care
Visit the child care provider with your child to meet the
caregivers and the other children to help them become more familiar with
their new setting
For older children, talk about the child care program, the people there, and what they’ll do throughout the day
If attending child care requires a new schedule (e.g., waking up
earlier, eating breakfast at a different times), begin this new routine
several days before starting care, to make the transition easier for
During first days
Work with your child care provider on a plan for your departure when dropping off your child during first few days/weeks
If you can, begin care gradually (e.g., on the first day, take your
child for an hour or so and then leave together; over the next few
days, stay for several hours)
As your child becomes more comfortable, gradually increase their time in care until your child reaches a full day
Let your child know ahead of time that you will be going to work and when you will be back (e.g. after nap time)
To help comfort your child, some programs suggest bringing a familiar item from home or a photo of family members
Call your child care provider to see how your child is doing (this can help alleviate your own worries)
Do your best to pick up your child at the time you said you would
Transitions may also be stressful at pick-up time, and your child
may express different emotions when you arrive (this is a normal part of
getting used to child care)
Updated: March 22, 2019
Published: February 13, 2015