Party of Five
Or, How We Can Have the Biggest, Liberal-est Paid Leave We Want
I’ve spent most of the day holding a tiny newborn infant in my arms, my third baby in six years. And here’s a fun fact about this one: it’s my most expensive child by far. That’s because in between baby #2 and baby #3, I left full-time employment to start my own business. I’m no longer part of any type of employer-paid leave program.
Rather than having some set of weeks in which I’m paid my usual salary, this maternity leave is really just a matter of how long I’m willing and able to forego earning money. I run on an “eat what you kill” business model: I bill for work performed, with a lag. I’ve had months where no money comes in, and months in which I’ve netted a quarter of my income for the year.
No performing means no billing means no income.
So here’s a question: What would need to happen for me—not tethered to an employer, taking home an erratic amount of gross, pre-tax income month-to-month—to have a paid maternity leave?
Honestly, not much.
Paid Family and Medical Leave in 90 Seconds
That’s It?
What Am I Missing?
The Question (and Distraction) of Duration
The Question (and Battle) of Coverage
What Leave Means
Paid Family and Medical Leave in 90 Seconds
Expand Social Security to cover paid family and medical leave. Right now, the program covers 1) Retirement 2) Disability and 3) Death of a Worker (aka Survivors).
Add 4) Paid Family and Medical Leave.
Everything you need for a universal leave program is there:
the administrative infrastructure,
coverage of virtually all W2 employees (whether they are full-time, part-time, in one job, in five jobs, or hopping between jobs),
all self-employed workers,
a method for collecting taxes,
and field offices for processing claims located throughout the US.
Paid family and medical leave would require a new payroll tax that the worker and employer contributes to, a new trust fund that receives those tax deposits, and an investment in field offices to handle leave claims. Those leave claims would be more complicated than retirement or survivors claims but less complicated than disability claims.
Done.
Really, done!
Congress just needs to fill in the details, like how generous benefits are in terms of replacing wages, how long benefits last, and what the appropriate tax rate is given the generosity and length of coverage. They aren’t flying blind: 13 states have already designed a similar system.
When a worker needs to go on leave because of illness or caregiving for an ill family member, they’d submit a claim to their local Social Security office and then, based on some combination of how much they earn and how much time they need on leave, the worker would get a weekly amount from Social Security that replaces all or a portion of their paycheck.
Boom! Paid leave.
That’s It?
Yes. In fact, expanding Social Security to include Paid Family and Medical Leave has been proposed in every Congress since 2013. It’s called the FAMILY Act. You can read about it here.
What Am I Missing?
The problem isn’t with Paid Family and Medical Leave—we know exactly how to set up the most efficient, effective, fair system with universal coverage—the problem is with Social Security.
Congress needs to reform it to address long-term shortfall in the retirement program. For decades, Social Security collected more in taxes than it needed for benefits and saved the rest. But starting in 2010, Social Security started collecting less in taxes than it needed for benefits and dipped into that savings. The savings account, called the Trust Fund, will be depleted by 2033-ish (it’s a projection and so it can move around). At that point, benefits will automatically be cut.
Congress could act now. I mean, let’s be real: they could have acted when they first learned about this long-term shortfall back in the early 1990s, or when tax collections fell during the Great Recession fifteen years ago. But they won’t act now or even soon. They will likely wait until the last possible moment to address it.
(I’d put my money on New Year’s Eve 2032, where Andy and Anderson’s usual CNN coverage is split between Andy merrily and tipsily awaiting the ball drop in Times Square while Anderson is planted at the capitol in DC counting down time until a Social Security benefit cut or reform.)
TO BE CLEAR: There’s no practical reason why Congress couldn’t pass the FAMILY Act and start a paid family and medical leave program—Social Security’s long-term shortfall presents no impediment or obstacle—it’s just a political issue. We could have this system up and running in a matter of months.
While we are forced to wait, let’s think about what we want paid family and medical leave to look like. I think there’s two big questions: duration and coverage.
The Question (and Distraction) of Duration
How long should paid family and medical leave be? Depends. Paid Family and Medical Leave covers:
You getting sick
A family member (like child, spouse, or parent) getting sick
Newborn care
We’ve kind of inherited the “Family and Medical Leave” moniker from the 1993 Family and Medical Leave Act, which established unpaid leave via job protection. But the program we need is really: Medical leave, family leave, and newborn leave, the three areas of coverage enumerated above.
Medical leave and family leave have duration dictated by the nature of the illness, so leave would be dependent on a doctor’s assessment. This is how private short-term disability insurance, unpaid leave (through FMLA), and paid leave in states that set up a program currently operate. Your wife needs a hip replacement, recovery is expected to last 6 weeks, so the doctor recommends that she get 6 and you, caregiver, get 4.
So the only open question of duration—a duration that Congress would determine—is newborn leave. How long should new parents have paid wages to be at home with their kid? There’s a medical answer to that question, surely, but a social and economic one that encompasses what we think parents and newborns deserve and how we value that time.
I’m maybe a bit too realistic here: so long as health insurance is provided by employers, our hands are tied. Leave will be fairly short, probably 12 weeks, maybe 16. Much longer than that though, and it invites a host of pretty nasty incentives and steep costs borne by employers.
And before you say, “I don’t care, soak ‘em! Employers should bear costs!” Think about how this plays out.
Let’s say we want one year of paid leave for newborn care. Paying for wages through a public leave system is easy—it’s just a matter of setting the tax contributions high enough. But
Should the year of leave also have a year of job protection? And if so,
Should the year of leave also have a year of employer insurance coverage maintained?
If the answer to both is ‘yes,’ employers are essentially on the hook for a year of health insurance coverage for an employee who isn’t working, who they can’t fire, and who they probably need to replace at least on interim basis until they come back. That’s an enormous costs. Employers would pass it on: women of childbearing age would be assumed to be more expensive in the long-run, meaning they’d be hired, promoted, and paid less.
^That’s what happened after the Pregnancy Discrimination Act of 1978 prohibited the differential treatment of pregnancy in employment, which meant employers had to start covering prenatal, postnatal, and labor and delivery in their health insurance plans.
Is there a way around this? Eh, no path is great.
One alternative:
Have paid leave, job protection, and health insurance coverage around a newborn be different lengths. So a worker can get a year of paid leave through Social Security, but only (say) two months of health insurance from their employer and four months of job protection. Well, paid leave de facto becomes two months long for everyone who needs health insurance from their employer, four months for anyone afraid they won’t be able to find a job, and a year for whatever few people remain.
Leave can very easily generate incredible inequality, if not designed with inequality in mind.
Another alternative:
Expand Medicaid so that the newborn is covered for the length of leave of the parents. If the employer ends private coverage, or even if the parent no longer has a job, they at least have some income from paid leave and health insurance from Medicaid.
This is truly the “mouse a cookie” scenario because if you are covering postnatal care through Medicaid, you should cover prenatal care too. And if you’re covering the infant, you should cover the mom too and probably any siblings. And if you’re covering the newborn and mom and siblings for 1-2 years anyway, you should cover both parents. And depending on sibling birth distance, you might have random gaps in Medicaid coverage between pregnancies or encourage pregnancy timing based on Medicaid coverage, so you should extend the Medicaid coverage for something like the length of mom’s fertility. And if a worker is eligible for Medicaid, then employers would be much less likely to offer private coverage to them.
I should say, I kind of love this scenario because I think all children should be eligible for Medicaid from -1 to 18 years old so they never have a gap in health insurance or any costs in accessing health care. But, from the perspective of paid leave, this is an even bigger hurdle than reforming Social Security.
In sum:
It’s a tangled web of incentives to work around employer sponsored health insurance, and I don’t think Congress will take it on. I think they’ll design newborn leave of a short length to avoid it. It’s why I think the duration question about what new parents deserve is kind of a distraction. A long duration requires a fundamental change in how health insurance is provided in the US.
So if we’ve got to make due with a shorter newborn leave in the meanwhile, let’s focus on
The Question (and Battle) of Coverage
If the US faces some roadblocks for having generous newborn leave duration, then let’s go big where we can: coverage. Y’all, I want the most liberal paid leave program we can get. Liberal in the truest sense of the word. There’s three big asks:
1 Medical Leave That Prioritizes Health
Medical leave is fairly straightforward: if you get sick or injured and need to be home from work longer than what would typically be covered by sick days or paid time off, you take medical leave. Rather than being paid by your employer for work performed, you are paid by the medical leave program.
Your employer may offer a similar benefit for you right now; in the private sector it’s referred to as short-term disability insurance. This insurance is structured to kick in on, say, the 8th day after an incident. So you get in a car accident on a Monday, you’re expected to use sick days (if you have them) for 7 days, disability coverage starts on the following Monday. It’s often tiered—the first two weeks of disability coverage you are paid 100% of your prior wage, the next 6 weeks you are paid 70%, the next 12 weeks you are paid 50%, and so on.
So let’s design medical leave so that the north star is health and recovery.
First: Have the tiers of wage replacement be very generous and have them cohere with job protection and health insurance guarantees.
Second: Have coverage include recovery. If you need to go to physical therapy three times a week for 8 weeks after you get out of the hospital, medical leave needs to cover that time as well. Don’t create a gap between <very sick> and <fully recovered>. Recovery includes rest and rehabilitation, and medical leave should cover it.
Third: Include labor regulations that give recovering workers the right to work from home or work asynchronously.
2 Family Leave That Gets “Family”
Family leave is really about caregiving: a sick person needs/deserves a caregiver, so a family leave program pays a family member’s wages for a period of time so that they can give that care.
At some point, when Congress creates a paid family and medical leave program, they’ll have to decide what constitutes “family.” Children, siblings, parents, spouses—sure that’s easy. But what about unmarried partners? In-laws? Friends?
What is the advantage of having Congress put a limit on who that caregiver can be rather than letting the sick person pick who they want? If you have a serious heart attack and need to recover, should you get to pick a caregiver from a) who you know and trust to help you or b) a list of individuals whose relation to you Congress has approved?
Not everyone likes their family. No to mention, being family doesn’t make you a good caregiver, doesn’t mean you are in a convenient place with work to take time off to caregive, and doesn’t mean that you want to caregive.
Don’t waste regulations trying to find people whose proximity Congress approves of. Empower the sick person to choose a caregiver.
3 Newborn Leave That Doesn’t Undermine Maternal Recovery
Here’s something that, if you haven’t had a kid, you might not realize. Paternity and maternity leave is a voluntary benefit that some employers provide (it’s about a fourth of workers in the US who have access to it at all). It’s paid time off specifically for newborn care and bonding.
But, that’s not how most people end up staying home with a kid. About half of workers in the US are covered by short-term disability insurance through their employer. After childbirth, delivering moms make a disability claim through this private insurance program which typically approves 6 weeks for vaginal and 8 weeks for c-section. So the mom has a period of time where she’s paid to stay home, and *technically* it’s to support her physical recovery from childbirth, but in reality, she’s taking care of the newborn.
This disability insurance structure is one reason why moms are so much more likely to stay at home with the baby than dads, why gay parents, adoptive parents, or parents who use a surrogate can have no leave at all, and why leave is so short.
So let’s not replicate any of that in a paid leave program and, while we are at it, let’s be upfront that after childbirth a delivering mom will in fact need time to recover and need a caregiver for herself. No more designing a system that moves her straight from the hospital room into full-time caregiving, alone.
Structure newborn leave so that: 1) up to two parents can take the full amount of leave regardless of whether they delivered and 2) any delivering woman is eligible for her own caregiver. So:
Adoptive/surrogate parents: the delivering woman gets medical leave and a caregiver during that leave, the parents get newborn caregiver leave.
Delivering mom + partner: the mom gets medical leave and a caregiver during that leave, the partner gets newborn caregiver leave.
This design basically says 1) every baby gets two full-time caregivers and 2) every delivering mom gets a caregiver.
It’s a win for non-delivering parents that their access to leave is a right not conditional on delivery, and a win for delivering moms who can get a non-partner caregiver right after delivery (think mom/sister/best friend/cousin).
I’m tempted to put here some pretty horrific stories of what recovery from childbirth can look like even in a routine delivery, but I shouldn’t have to resort to that to make the case that moms deserve help to heal.
What Leave Means
When I talk to fellow moms, I hear a lot about how long they want to stay home with a newborn. For the record, not all of them want six months or a year; some moms want to get back to work. But paid family and medical leave is so inextricably linked to newborn leave, and newborn leave inextricably linked to the question of duration, that we can lose sight of all that’s at stake.
A long newborn leave will be the hardest victory for the US to get, and there’s so much to win in the meantime—universal coverage for all workers regardless of employment type, medical leave that supports health and invests in recovery, family leave that empowers the sick and meets their preferences instead of Congress’, newborn care that doesn’t erase the health of mothers.
So much to win.
For what it’s worth, I look forward to the day when I get to regale younger moms with the “back in my day” stories about having a family before paid leave was a universal right. I can’t wait to see their eyes go wide in a disbelief that we would have to go through all this alone, that’d we risk our income, risk our jobs, risk our health and our infant’s health when the solution was so easy and obvious in front of us. I’ll relish their shaking head as they say “But that doesn’t make any sense—did you all expect babies to take care of themselves? How could you not have paid leave?”
And I’ll be glad to look back on this time before paid leave as backwards and shortsighted and wrong, because it is.
Congratulations!
Congratulations!!!!