Chapter 4 | Universal Family Care (UFC)

Executive Summary

Gaps in our care infrastructure make it difficult for many workers to juggle the needs to earn a living and to provide care for family members. Similarly, people needing time off work to recover from an illness or injury, as well as those needing long-term services and supports (LTSS) to cope with a disability (either lifelong or in old age), often find that today’s patchwork of programs falls short.

Our early child care and education (ECCE) and LTSS systems are fragmented and means-tested, limited to serving only a fraction of even poor and low-income Americans. The broad middle class has inadequate care options and support. Paid family and medical leave (PFML)—which makes it possible for workers to care for a family member, bond with a new child, or recover from a medical condition without significantly compromising the family finances—is available in only a handful of states. Providers of ECCE and LTSS are poorly compensated, which limits the size and skills of the care workforce and affects the quality and reliability of care. Against this background, an integrated, holistic approach to family care needs over the lifespan merits consideration; such an approach also could address the needs of care workers, who are disproportionately women and people of color and face their own family care challenges.

Universal Family Care (UFC) is a policy designed to strengthen our care infrastructure to meet families’ changing care needs over time. It would make an affordable, integrated care system available to all. Everyone would both contribute to and benefit from a single “care insurance fund.” National programs including Social Security and state programs such as PFML have successfully used this social insurance model. In this report, we focus on state-level policy options, although such an approach could be adopted at the federal level as well.

The UFC insurance fund would cover ECCE, PFML, and LTSS needs when they arise, and provide benefits to families through a single access point. In crafting a UFC program, states will need to make design choices on a variety of issues including the level of comprehensiveness regarding who is covered and for what, the sources of funding, eligibility requirements, benefit adequacy, and qualifying events. To understand tradeoffs in design choices, we present four illustrative UFC designs, each expressed as packages of ECCE, PFML, and LTSS benefits. The choices vary primarily by their benefit generosity and by whether the program is funded solely by contributions or also by additional revenues to achieve universal coverage. Once a state has decided upon a structural design approach, choices remain concerning the degree of internal UFC integration across its ECCE, PFML, and LTSS components, as well as the relationship of UFC benefits to existing ECCE programs and Medicaid LTSS.

As states weigh how to help families cope with managing work and family, encourage greater labor force participation, improve the quality of jobs in the rapidly expanding care sector, and assist families with care costs, UFC holds the potential to address these challenges in a holistic way.

"Far too many Americans find themselves struggling to cover the rising costs of long-term care, which can wreck them financially or leave their loved ones without much-needed support. This report envisions and details an exciting, new solution: a "universal family care" program that would better finance long-term care, childcare, and paid family and medical leave so that people are able to thrive in good health at any age, without descending into poverty."

Robert Espinoza

"We all depend on caregiving — whether taking care of oneself, taking care of a loved one, or receiving professional caregiving services. Yet, the United States of America falls indefensibly short of ensuring access to high-quality early childcare and education, paid family and medical leave, and long-term supports and services for all. Policymakers now have a comprehensive guidebook for meeting our nation's caregiving needs in ways that advance economic prosperity, gender and racial equity, and value care as the indispensable support that it always has been and always will be."

Indivar-Dutta Gupta

"Our care infrastructure is still predicated on a stay-at-home caregiver, a luxury that few families can afford. Our care supports are targeted at the poor, yet most of the middle class struggles to juggle work and care. We need to rethink how we support families. Universal Family Care, anchored in social insurance, offers a common-sense path forward. This report explores different ways states could implement UFC in accordance with their goals, preferences, and constraints."

Benjamin W. Veghte

"At some point in life, nearly everyone faces the challenge of either needing care, or providing care to others, with few resources available to help. A social insurance program might protect families from having to risk losing earnings to provide care, or pay for expensive caregiving services, as other advanced countries have found. This comprehensive report, developed by a Study Panel of the National Academy of Social Insurance, provides state policymakers with a broad range of policy options to be considered in addressing this growing problem affecting state residents and their communities."