This is the third blog in a series detailing the panels and discussions that took place at the recent 2024 Care Conference hosted by the Institute for Women’s Policy Research (IWPR) and American University’s Program on Gender Analysis in Economics (PGAE).

There is general agreement that there is a crisis of care in the United States, but how do we measure the gaps between what is needed and what is available, and what revenue sources could close such gaps? These questions were addressed in a workshop on the care infrastructure moderated by American University Professor Mieke Meurs.

The session began with Saniya Jilani, a doctoral student at Colorado State University and IWPR research consultant, presenting her and IWPR’s Martha Susana Jaimes’ work analyzing the gap between the demand for and supply of care. Jilani began by acknowledging the work on measuring care by Nancy Folbre and colleagues and noted that any indicator would reflect a compromise between the ideal and the possible. Using American Community Survey data, Jilani and Jaimes propose using the number of children, disabled persons, and persons 65 years and older to calculate state-level demand. That would then be compared to the number of full-time workers in care occupations (as an estimate of supply) to identify states with the largest care gaps. Jilani noted that the presentation reflects work in progress—the next steps will focus on understanding the reasons behind the temporal and spatial variation in care infrastructure and developing a more precise categorization of demand and supply subcategories.

Sarah Nolan, deputy policy director for healthcare at SEIU, shifted the discussion to policy initiatives supporting a robust home care infrastructure for elder and disabled care. She began by stressing the importance of the American Rescue Plan (ARP) Act of 2021, which gave states the option to strengthen home and community-based services (HCBS) under the State Medicaid program—an option taken up by all 50 states and the District of Columbia. This was followed by an executive order on increasing access to high-quality care and supporting caregivers, increasing Medicaid reimbursement rates, establishing worker and consumer advisory groups, and developing and reporting on new access and quality metrics. Despite this progress, Nolan highlighted ongoing challenges. While ARP funding was substantial, it is not continuing, and state budget constraints—and the fact that many of these initiatives are optional for states—make some of these gains precarious. Mechanisms to ensure adequate provider payments, efficient allocation of resources to workers, and sufficient state funding are needed to sustain any progress going forward.

Jon Whiten, deputy director at the Institute on Taxation and Economic Policy, focused on revenue to fund care infrastructure and the need to shift our mindset from financial scarcity (and having to “fight for a tiny slice of a tiny pie”) to one of abundance (and focus on growing the pie). At the federal level, past tax cuts benefited those who needed it the least, cutting corporate and estate taxes and top personal income tax rates. But, as Whiten pointed out, the current administration is arguably more focused on tax fairness than any recent administration, as illustrated by the President’s budget, released in March, which includes many detailed proposals for raising revenues in an equitable manner.

Whiten also noted that there are greater constraints on growing revenues at the state level because most states have balanced budget mandates. And while federal taxes are modestly progressive, state taxes typically display “a reverse Robin Hood effect,” taking from the poor to give to the rich. In 44 states, the tax code makes income inequality worse rather than better, and 41 states tax the top 1 percent less than any other income group. Strategies for raising revenue are highly state-specific but broadly speaking, red states’ priorities are often to prevent further cuts by closing corporate loopholes and increasing personal income tax rates. In contrast, in blue states, there has been a greater focus on increasing taxes on the very wealthy.

Whiten concluded by pointing to two states that recently identified new revenue sources: New Mexico now has a permanent funding source for early childhood education, and in Massachusetts, the Fair Share Amendment of 2022 is generating millions for transportation and public education through increased taxes on those with incomes of $1 million or higher.

The workshop reminded everyone that discussions of public funding and taxation are crucial for any efforts to fix the broken care infrastructure. Beyond that, it pointed to several efforts that are already underway and that can inform future advocacy and policymaking on building the care infrastructure.

Rida Hameed is a PhD economics candidate at American University.

Watch the full workshop here and download the presentations here.