Aging in America News

Indivar Dutta-Gupta on How Not to Support Family Caregivers—And What Care Infrastructure Could Look Like

In late October 2024, candidate Trump declared, “I am announcing a new policy today that will support a tax credit for family caregivers who take care of a parent or a loved one. It’s about time that they were recognized, right? They add so much to our country, and they are never spoken of ever, ever, ever, but they are going to be spoken of now.”  A new Roosevelt Institute report by Indivar (“Indi”) Dutta-Gupta, Direct Spending on Care Work: Thinking Beyond the Tax Code for Caregiving Infrastructure, tackles the premise of supporting caregivers through tax policy. This conversation has been edited for length and brevity.

What became of Trump’s campaign promise to family caregivers?

We’ve seen no follow-through on it, and we’re worried that we might see even some efforts moving in the other direction. The scale of the cuts being proposed to Medicaid is unprecedented, and there is no way for states to fully make up for cuts in federal support. So we’re already facing this silent crisis of caregiving. And if people don’t speak up and make their voices heard, it could get a lot worse this year.

Do you have recommendations for readers to make their voice heard? Are there advocacy groups that you think are really taking the lead on this?

There’s Coalition to Protect America’s Healthcare, and there are groups like Caring Across Generations and National Alliance for Caregiving. If folks have their own care stories to share, they can find those groups online or directly share those stories with policymakers. There’s still a lot of opportunity to prevent some of the worst possible outcomes here, especially for Medicaid and long-term care. But people need to make very clear how valuable these programs are to them and their community.

What happens when policymakers default to tax incentives to solve problems?

There has been a lot of effort on a bipartisan basis, and certainly among conservatives, to essentially rely upon tax incentives to expand access to care, both early learning and care and long-term supports and services. But in fact, when we look at these efforts, we see pretty consistently that while there are some mild benefits—especially the reduction of stigma in applying for benefits—tax-based approaches to building the care infrastructure we need are going to be grossly insufficient.

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Could you expand on the report’s assertion that “current tax expenditures for care are often regressive and inefficient”?

A lot of tax-based subsidies disproportionately go to upper-middle-income and higher-income people. Many of them outright exclude people with low incomes, and others restrict the level of benefits for people with low income. The tax-based subsidies that go to families and are intended to subsidize care generally require people to spend money upfront and then get reimbursed just once a year, at tax time.

Direct investments like Medicaid constitute our care infrastructure.

When we rely too heavily on the tax system, not only do we not achieve the scale or the reach and the access that we want, but we do very little to invest in quality care, which requires substantial investments in the workforce.

What happens if we fail to act?

If we continue to fall short of investing adequately in our care infrastructure or, worse, go backwards and reduce our investments, as unfortunately we seem to be doing, you’re going to see fewer people able to work and families making different decisions about their lives, including how many children they have and whether they remain in the workforce.

And there’s a downward spiral from there, because once you’re out of the workforce for a considerable amount of time, it’s hard to get back.

Yeah, very hard to get back in, especially in a well-aligned position relative to your experience and skills.

Conversely, what’s the upside of investing?

Financial security and stability are usually higher in response to expansions of care investments. So there’s really a lot of upside and even some evidence that some programs could pay for themselves.