RAISING A CHILD IS WORK. SO IS KEEPING SOMEONE ALIVE.

JUSTICE · SOCIAL JUSTICE

Published by | Langhorne P. Breedlove

MONDAY, NOVEMBER 9, 2026 · 12:31 AM ET

Tags: Maternity · Childcare · Paid Family Leave · Disability · Eldercare · Caregiving

Dear fellow American proletariat: We have built an economy in which the arrival of a baby is treated as a workplace scheduling problem, the deterioration of a parent's health as a personal inconvenience, and the person who holds the entire family together as somebody who apparently has nothing better to do. The baby has no invoice department. The nursing home certainly does.

American Proletariat proposes a connected national system of maternity and postpartum services, affordable or publicly funded childcare, paid family and medical leave, disability support, eldercare and caregiver protections. Care should not require a family to choose between a paycheck and a person.

THE MANDATE

Guarantee access to medically necessary pregnancy, birth and postpartum care; create a reliable pathway to affordable, quality childcare; establish paid leave for childbirth, adoption, foster placement, serious illness and family caregiving; and expand appropriate home, community and residential supports for disabled and older Americans. Protect individual choice, informed consent and the rights of people receiving care.

AP proposes a coordinated entitlement and service system, not the immediate abolition of existing Medicaid, Social Security, Head Start, disability programs or state family-leave arrangements. Its architecture must distinguish medical services from daily assistance, job-protected leave from paid income replacement, and professional care from voluntary family caregiving. None of those distinctions should become an excuse for abandoning the person who needs help.

ROOTS & HISTORY

President Bill Clinton signed the Family and Medical Leave Act on February 5, 1993. For eligible workers at covered employers it provides up to 12 workweeks of job-protected leave in qualifying circumstances, including childbirth, adoption or foster placement, serious illness and care for certain family members. The federal requirement is generally unpaid; it is not a universal paid-family-leave benefit. (Sources 01, 02)

Public childcare funding has its own legislative lineage. Congress established the Child Care and Development Block Grant in 1990, and the 2014 reauthorization strengthened health, safety, quality and continuity requirements. States and territories administer federal childcare assistance under differing eligibility rules rather than providing one universal entitlement to every household. (Sources 03, 04)

Medicaid home- and community-based services became an option under section 1915(c) in the early 1980s, allowing states to support qualifying people outside institutions. Such waivers can include personal care, respite, adult day services and other support, but states may target populations and cap enrollment. A service existing somewhere in Medicaid law does not guarantee that it is available to every eligible-looking person who needs it. (Source 05)

TODAY · THE PRICE OF BEING NEEDED

A May 2026 Census Bureau working paper analyzing the 2025 Current Population Survey found that 23.9% of households with children age 13 or younger reported paying for childcare in 2024; among paying households, average annual expenses were $10,520, equivalent to 5.6% of household income on average. The study does not say that all households paid that amount. (Source 06)

The same survey analysis found 3.7% of households reporting difficulty obtaining adequate childcare, and households reporting that problem lost an average of 65.8 days of work time. The denominator matters: the lost-time estimate applies to affected households, not to every American parent. (Source 06)

In 2025, AARP and the National Alliance for Caregiving estimated 63 million U.S. adults provided ongoing care to an adult or a child with a complex medical condition or disability in the preceding year. Their survey found that nearly half experienced at least one adverse financial effect. That estimate includes both paid and unpaid family caregivers under the study's methodology; it should not be described as 63 million unpaid workers. (Source 07)

The CDC's final 2024 vital statistics recorded 649 maternal deaths, or 17.9 per 100,000 live births, a decrease from 18.6 in 2023 that was not statistically significant. The rate for non-Hispanic Black women was 44.8 per 100,000, compared with 14.2 for non-Hispanic White women. A maternity policy that ignores unequal outcomes is incomplete, but reducing those disparities requires evidence-based care improvements rather than slogans. (Source 08)

This is the landscape in which families are told to be responsible. They are responsible. The question is whether the institutions governing employment, childcare, disability and healthcare intend to share any of the responsibility with them.

THE LEGAL PATH

Congress would need to authorize and finance a federal paid-leave benefit, expand or redesign childcare assistance, and determine the relationship between new caregiving entitlements and Medicaid, Medicare, Social Security and employment law. The Department of Labor could enforce appropriate leave and workplace provisions, while HHS and state or Tribal partners could administer care programs under explicit statutory authority. (Sources 01, 04, 05)

States continue to regulate many childcare and healthcare providers, and existing state paid-leave systems would require coordination rather than accidental displacement. Tribal governments must have meaningful control over services provided through their own institutions. Protections must extend to kinship caregivers, adoptive and foster families, people with disabilities, and diverse family structures without requiring officials to invent one acceptable model of family life.

THE PLAN · CARE ACROSS A LIFETIME

01 · MATERNITY & POSTPARTUM CARE

Guarantee access to prenatal visits, evidence-based delivery care, postpartum follow-up, lactation support where desired, appropriate mental-health treatment and emergency services. Fund provider capacity in underserved regions and establish transparent measures of maternal complications, continuity and respectful treatment. Coordinate with the Universal Comprehensive Healthcare proposal rather than counting the same medical bill twice.

02 · CHILDCARE THAT PARENTS CAN ACTUALLY USE

Finance an expanded choice of licensed centers, family childcare homes, early learning and appropriate after-school services. Establish minimum health and safety rules, transparent quality measures, fair reimbursement and adequate staffing. Publicly supported care must work for parents with evening shifts, rural commutes, disabilities and irregular schedules—not just those whose workday fits a municipal brochure.

03 · PAID FAMILY & MEDICAL LEAVE

Design wage replacement for qualifying childbirth, parental bonding, personal recovery and family caregiving, accompanied by job protection, anti-retaliation rules and coordination with employers' existing paid leave. Determine benefit duration, wage replacement rates, small-employer administration and self-employed eligibility through legislation. The purpose is to make taking necessary leave financially possible without presuming every family has identical needs.

04 · DISABILITY & ELDERCARE SUPPORT

Expand person-centered home and community services, respite options, accessible transport, caregiver training and appropriate residential care. Respect the individual's preference and safety, independent living rights and available medical evidence. Support family caregivers who choose to provide care without treating relatives as a compulsory free workforce.

05 · WORKFORCE & QUALITY

Recruit and retain childcare professionals, home health aides and direct support workers with adequate training, safe staffing and enforceable workplace rights. Build apprenticeship paths through Government-Paid Apprenticeships & Credentials. A society that calls care essential must account for the people who actually deliver it.

THE TEN-YEAR LEDGER

The federal baseline already includes Child Care and Development Fund assistance, Head Start, Medicaid long-term services and supports, federal employee benefits and other relevant programs; states, employers and households finance additional care. These overlapping funding streams must be mapped by payer and service before calculating new federal obligations. (Sources 04, 05)

For the first-year forecast, specify the number of births and eligible leave episodes, paid weeks, wage-replacement formula, childcare places, average reimbursement, provider expansion, home-care service hours, staffing costs, technology, administration and enforcement. Identify capacity constraints separately from financial outlays. A promised childcare slot does not materialize merely because an appropriations table contains enough zeros.

The ten-year model must distinguish gross program expenditures, existing federal and state spending shifted into the new system, employer contributions, household out-of-pocket costs displaced, caregiver wage effects, labor-force participation assumptions, administrative savings and uncertainty. It must avoid double-counting maternity care in the Universal Comprehensive Healthcare proposal and income support in any Switchboard or Social Security expansion.

Because AP has not yet fixed eligibility rules, duration of paid leave, replacement rates, childcare reimbursement or the covered caregiving service hours, no reliable first-year net cost or ten-year fiscal balance can presently be asserted. Fiscal estimates will be required before a financing claim is made.

WHAT COULD GO WRONG?

A broad subsidy can increase demand faster than childcare providers or care workers can expand, raising prices or creating waitlists. Overly prescriptive national standards could close small family childcare operations, while weak standards could expose children and disabled adults to unsafe care. Paid leave must protect workers without creating unmanageable compliance costs for the smallest employers.

Paying family caregivers may improve financial stability but can also create difficult questions about assessment, conflicts of interest, unpaid contributions and whether recipients genuinely choose family care. Institutional care must remain available when home-based support is unsafe or unsuitable. Cost controls should not be disguised denial systems; access rules should not become blank checks for fraud.

Alternatives include refundable childcare credits, targeted means-tested subsidies, employer mandates, social-insurance paid leave and direct public services. They differ in reach, predictability, administration and effects on household income. AP should compare the options against consistent measures instead of assuming that the most expansive promise is automatically the most effective design.

MEASURING SUCCESS

Publish maternal mortality and severe morbidity, prenatal and postpartum access, childcare cost relative to household income, provider vacancies, childcare waitlists, paid-leave take-up, job retention after leave, disability service coverage, home-care delays, caregiver financial strain, care quality, complaints, and net public cost per person served. Present results by geography and affected population with privacy safeguards.

The point is simple enough to fit on a refrigerator magnet: people need care throughout life, and people who provide it need time, income and support. The birth of a child is not an economic misconduct allegation. A parent's illness is not a scheduling error. And nobody should have to become a financial casualty because somebody they love needs help.

SOURCES & FURTHER READING

01 · U.S. Department of Labor — Family and Medical Leave Act of 1993, Public Law 103-3, enacted February 5, 1993. https://www.dol.gov/agencies/whd/fmla/law

02 · U.S. Department of Labor — FMLA Frequently Asked Questions, eligibility, 12-week entitlement and unpaid leave. https://www.dol.gov/agencies/whd/fmla/faq

03 · U.S. Department of Health and Human Services, Administration for Children and Families — FY2025 Congressional Justification, Child Care and Development Fund history. https://www.acf.hhs.gov/sites/default/files/documents/olab/fy-2025-congressional-justification.pdf

04 · Childcare.gov / U.S. Administration for Children and Families — Child Care Financial Assistance Options and state eligibility. https://www.childcare.gov/consumer-education/get-help-paying-for-child-care/child-care-financial-assistance-options

05 · Centers for Medicare & Medicaid Services — Home & Community-Based Services, Section 1915(c) Waivers, coverage and state rules. https://www.medicaid.gov/medicaid/home-community-based-services/home-community-based-services-authorities/home-community-based-services-1915c

06 · U.S. Census Bureau — Child Care Challenges and Adaptations: Findings from the 2025 CPS ASEC, Ani R. Silwal and Adrienne DiTommaso, May 2026. https://www.census.gov/library/working-papers/2026/demo/sehsd-wp2026-08.html

07 · AARP and National Alliance for Caregiving — Caregiving in the U.S. 2025, July 24, 2025. https://www.aarp.org/press/releases/2025-07-24-new-report-reveals-crisis-point-for-americas-63-million-family-caregivers/

08 · Centers for Disease Control and Prevention, NCHS — Maternal Mortality Rates in the United States, 2024, Donna L. Hoyert, March 2026. https://www.cdc.gov/nchs/data/hestat/hestat113.htm

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WE ARE ONE.  ·  E PLURIBUS UNUM.