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112 / Chapter 6 The Care Policy Landscape Janet Gornick, Candace Howes, and Laura Braslow C are policy” is not a common category in American social policy research, which often organizes social policies simply by the characteristics of recipients . The widely referenced congressional publication Compilation of the Social Security Laws (the “Green Book”), for example, categorizes U.S. social policies primarily according to the groups served: the elderly, survivors of deceased workers, people with disabilities, the blind, the unemployed, veterans, mothers, and children. Academic social policy typically disaggregates policies into broad domains such as income support, employment, housing, and health policy (Blau and Abramovitz 2010). In the political arena, public initiatives with budgetary components are often separate from those that do not require direct fiscal outlays. That has the effect of decoupling, for example, child care policies (which generally require public spending ) from family leave policies (which often grant leave rights but not wage replacement and thus do not require direct governmental expenditures). Before we can give care policy the sustained and systematic attention that it deserves, we must develop a clear definition of its content and boundaries. As several contributors to this volume have argued, defining “care” presents an ongoing conceptual challenge; the same is true, of course, with respect to “care policy.” Identifying and assessing care policies is especially challenging in the United States because of the complex, often overlapping divisions of labor between national and state governments. In many aspects of care policy, both federal and state levels of government are key actors in revenue generation, spending, and direct provision of care, as well as in various aspects of rule setting and regulation, from determining eligibility to quality assurance. We begin this chapter by defining the universe and boundaries of care policy, limiting ourselves to policies that directly shape the provision or receipt of care for children or for adults who need personal assistance. The next section provides an overview of early childhood education and care policy, family leave policy, foster care policy, and ” / 113 The Care Policy Landscape services and special education for children with disabilities. The third section provides a parallel description of care for adults, focused on long-term care services and supports . For each of the policy categories, we clarify, in general terms, the nature of the policy, its intended purpose, the size of the population potentially and actually served, and its key components at both the national and state levels. We close each policy section with a discussion of current estimated national and state expenditure levels. We conclude the chapter with some remarks about the care policy landscape as a whole. DefininG Care PoLiCy A large system of policies, regulations, and institutions indirectly affects the nature and adequacy of care provided in the United States. This system includes an array of income transfers and tax expenditures (such as Social Security and the Earned Income Tax Credit [EITC]); near-cash and non-cash supports (such as food stamps, subsidized school lunches, and housing assistance); regulations that shape working conditions (such as minimum wages and overtime thresholds); public education (including investments in primary, secondary, and tertiary education); and institutions of social control (including the juvenile and adult criminal justice systems). These government policies and institutions transfer crucial goods and services and shape the private acquisition of resources in ways that affect individuals ’ and families’ access to care and to resources to be used for care. Under this wide umbrella are a number of policies that more directly shape care provision and receipt for children and adults needing personal assistance. We divide these two overarching categories of care recipients—children and adults—into seven subcategories and map them onto the main care policies that typically or potentially serve them and their caregivers, as shown in table 6.1. Our research suggests that the policies listed there are the largest and most substantial public initiatives related to the direct provision of care, as measured by the number of care recipients (or potential recipients), the level of expenditures, or both. Included are policies that operate through a diversity of mechanisms, such as direct provision, demandor supply-side subsidies, and employment regulation. Also included are diverse governmental structures, from purely national programs to federal-state matching programs, federally funded block grants, state programs that extend eligibility for or benefits from national programs, and autonomous state programs. The first two groups served are children in the early developmental stages who live with their families (a small subset of whom have...

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