Industrial policy program manager Audrey Stienon argues that before increasing federal investment in child and elder care, measures should be taken to prevent large corporations from dominating these markets and compromising service quality for working-class families.

During the tense negotiations over his “Build Back Better” bill, President Joe Biden fought hard to include a $400 billion provision that would have dramatically lowered the cost of child care and expanded access to pre-kindergarten. He did not succeed, thanks to opposition from Senate Republicans and one key Democrat, Joe Manchin. But the effort signaled a new level of commitment among most Democrats to address what policy wonks often refer to as “the care economy.” During her campaign, Kamala Harris stressed her support not just for increasing public funding for child care but also for another urgent issue: the lack of affordable long-term care for the elderly and people with disabilities.

Though elements of the MAGA movement have advocated for more federal support for families with children, today it seems unlikely that the Trump administration will do much. Another federal push to fund the care economy is likely years away.

That delay, however, could be a blessing if those who are committed to helping families use the time wisely to address a growing problem with social service delivery: its capture by corporate interests. Experience has demonstrated that when the federal government steps in to provide more public support for different facets of the care economy, too often the unintended consequence is to attract new players to the sector who are motivated by greed. Examples include a vast corporate ecosystem of privately owned, publicly subsidized, and massively predatory providers that range from dental chains specializing in the overtreatment of children on Medicaid to abusive, monopolistic dialysis centers gorging on Medicare dollars.

Before more spigots of federal money get opened, advocates need to figure out how to corporate-proof the care economy. The way to do that is to focus their energies at the state and local levels. That’s not only where reform actions will be possible over the next four years—it’s also ground zero for the care economy itself. After all, child care facilities, hospitals, nursing homes, and most other health care providers operate almost exclusively in local or regional markets, and they have long been subject to regulation, and subsidy, by state and local governments.

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