America’s broken child care system deserves a permanent fix

Editor’s note: This piece was updated to clarify relationships between organizations. We regret the error.

Last fall, voters in New Mexico — a state that ranks at or near the bottom for children’s health — took the unprecedented step of enshrining the right to early child care in their state constitution and established a permanent funding mechanism to ensure that right exists not just on paper, but in practice. 

The voters’ message was clear: Every child — regardless of their background, family income level or neighborhood — deserves the healthiest possible start in life, and we intend to give it to them. After all, caregiving makes everything else we do possible: living stable and secure lives, helping children grow up healthy and thrive and making ends meet. 

As a nation, however, we have not lived up to this pledge. The 2021 American Rescue Plan provided a major infusion of federal funding for early child care — but those funds are set to expire on Sept. 30, putting that pledge even further out of reach. It is now incumbent upon Congress to move quickly to reinstate these critical funds, without which 70,000 child care centers may close and 3.2 million children may suddenly be without formal care options. But we should also take this moment, as New Mexico has done, to reimagine our approach. 

Child care in the United States ought to be accessible in every community, reflect the diversity and unique needs of families, prioritize both home-based and formal child care centers and be informed by equitable policies crafted by those who depend on care alongside those who provide it.  

As a mother, pediatrician and public health official, I have seen firsthand how affordable and accessible child care sets children up for lifelong success: improved physical, mental, social and emotional health and well-being, stronger academic performance and greater lifetime earnings potential. Few supports have such a profound impact on families.  

A sudden halt to that support will have a devastating impact on children, families and the child care workforce. The Century Foundation projects that one-third of formal child care programs supported by the American Rescue Plan — which helped stabilize a child care system decimated by and still struggling to recover from the COVID-19 pandemic — will close. If that happens, children in every state will lose spots in licensed facilities, from more than 6,000 in Wyoming to more than 300,000 in Texas. Nearly a quarter-million child care providers will lose their jobs. 

The consequences of inaction would be staggering. Parents will face impossible tradeoffs between care, food, housing and utility bills. Family, friends and neighbors — people often already overburdened — will be forced to pick up even more of the slack. Facilities could raise tuition for families and/or cut their employees’ wages just to stay open. Home-based providers — which serve significantly more children with fewer staff members than formal care centers — will have no choice but to shut down. Children will again experience major disruptions to their care and routines. 

Congress can avert this impending catastrophe. But we need more than a band-aid approach. For generations, largely due to structural racism and sexism, our child care approach has failed those who depend on it for either help with raising children or earning a living. Families and providers have paid a heavy price for this neglect. 

While most families across the country struggle to find child care, Latino and rural households, as well as families with low incomes, experience the most severe shortages. Those families rely more on providers outside the formal care system, such as family and friends, who shoulder significant caregiving burdens for little to no compensation. Working families with the lowest wages spend up to one-third of their income on child care, a significantly higher percentage than families at other income levels. This leaves less for food, rent, medication and other necessities. 

With respect to the child care workforce: The vast majority of child care providers are women, approximately 40 percent of whom are women of color. The median wage for a child care worker is less than $12 an hour, consigning many to poverty and food insecurity. Child care workers are also less likely to receive critical benefits such as health insurance or access to a retirement plan, which contributes to high turnover rates and affects the quality of relationships and continuity of care that are so crucial to children’s overall development. 

These outcomes, entrenched as they may be, are not inevitable. 

The Raising Child Care Fund, an initiative of the Early Childhood Funders Collaborative (a grantee partner of my organization, the Robert Wood Johnson Foundation), is backing efforts led by parents, caregivers and advocates in 16 states to change the paradigm. Thanks to their efforts, we’ve seen in recent years not only the constitutional amendment in New Mexico but also successes like 1,000 new child care slots for families with low incomes in Louisiana and a long-overdue salary increase for child care providers in Washington, D.C.  

The Child Care for Every Family Network, another grantee partner of the Robert Wood Johnson Foundation, is doing the important but often overlooked task of educating organizers across the country about the structural discrimination embedded in the child care system and how policymakers both locally and nationally can create a new system that ensures care for all children. 

Our national leaders should do their part as well. Congress can ensure that home-based providers are eligible for federal funding and build child care priorities into a broad array of legislation — as it did recently by making federal grants authorized by the CHIPS and Science Act available only to companies that provide child care support for their employees. As the nation’s largest employer, the federal government should fully implement a recent White House executive order directing executive branch agencies to expand access to child care. The Department of Health and Human Services should move quickly on proposed regulations to cap or eliminate child care copayments for families below certain income thresholds.    

When New Mexico residents joined together to repudiate an unacceptable status quo and forge a path to a future full of opportunities, they set an example for the rest of us. America’s child care system may be broken, but the fixes needed to repair and transform it are well within our reach. Let us embark on that critical work now, and together. 

Julie Morita, MD, a pediatrician, is executive vice president of the Robert Wood Johnson Foundation and former commissioner of the Chicago Department of Public Health.