Those are supports and services for elderly and disabled people who need help with daily living to stay out of nursing homes or other types of congregant care settings. In practical terms, that means everything from personal attendants who help seniors with bathing to counselors who help people with intellectual impairments find jobs so they can live on their own.
More proposals are on the way. The second half of the Build Back Better agenda, which Biden plans to introduce later this month, is likely to include major new initiatives to make child care and preschool more widely available, as well as some kind of paid leave program.
And these do not appear to be token gestures. Wednesday’s home care proposals envision $400 billion in new federal spending, accounting for nearly one-quarter of the $2 trillion package Biden unveiled. A meaningful initiative on child care and preschool would likely require hundreds of billions of dollars more.
Medicaid, the government health insurance program that states operate using federal funds and under federal guidelines, already pays for nursing homes and other forms of institutional care. And there’s no pre-set limit on that spending. The more people who need the help, the more funding Medicaid provides.
The lack of open-ended funding forces states to cut off enrollment and put everybody else on waiting lists. Nationwide, about 800,000 people are now on those lists, and some have been for years. It’s a well-known fact that deters many others from even trying. Most experts think the actual unmet demand for home- and community-based services is closer to 1.5 million.
For decades, advocates have proposed putting home-based care on an equal footing with institutional care. That way, the choice between whether to stay at home or to go into a congregant living setting would be about the preferences and needs of individual people and their families ― not because of a financial disparity rooted in a decision lawmakers made half a century ago.
Biden’s caregiving proposals, by contrast, would likely become ongoing expenditures. His proposal for home- and community-based services doesn’t formally call for any new spending beyond the 10-year budget window, but as a practical matter, it would be difficult to end funding and cut off services once people and families are using them. The same would be true for a new child care initiative.
But the economic benefits of caregiving initiatives are real. For one thing, caregiving is literally an investment in making individual human beings more productive. This is most obviously the case when it comes to early childhood programs. Research has shown repeatedly that, when infants and toddlers get good care, they are more likely to stay in school, remain employed and stay physically healthier as adults.
Doing this all at once ― helping more people to pay for caregivers while simultaneously requiring that caregivers get higher pay ― makes the project a lot more expensive. The price tag for the full care agenda is likely to be in the high hundreds of billions of dollars, at least, and could be even bigger depending on how ambitious Biden gets with the elements he has yet to unveil.
That’s bound to be a hard sell politically among Republicans, and perhaps even among some conservative Democrats wary of big government and the spending that goes with it. That is undoubtedly one reason why Biden and his allies are talking about these proposals in the context of their potential to create a more dynamic economy.
This content was originally published here.