The Biden–Harris administration has taken several measures in its first three months to strengthen the nation’s social safety net. Many of these policies will have an outsized impact on women — particularly women of color, who often struggle to access health care and now are bearing the brunt of the COVID-induced economic crisis.
From mandating paid sick leave and shoring up childcare to addressing the maternal health crisis, the new administration clearly recognizes the ways health and economic security are intertwined and how this impacts women.
On the latest episode of The Dose podcast, Debra Ness, president of the National Partnership for Women and Families, makes the case that the pandemic has exposed inequities too difficult to ignore. She believes women will emerge “smarter and stronger” from this crisis.
SHANOOR SEERVAI: In just the first three months, the Biden administration has taken measures to strengthen the social safety net in the U.S. Many of these policies, like pandemic aid and an infrastructure plan, explicitly recognize the links between people’s health and their economic security. How will these policies impact women? And in particular, women of color, who have always had to struggle to have their voices heard? I’m Shanoor Seervai. On today’s episode of The Dose, we’re going to be talking about this with Debra Ness, president of the National Partnership for Women and Families, an organization that works to improve the lives of women. Just a heads-up, we recorded this show in the middle of Black Maternal Health Week on April 14th.
Debra, welcome to the show.
DEBRA NESS: Thank you very much. It’s a pleasure to be here.
SHANOOR SEERVAI: So let’s get started talking about the Biden–Harris campaign platform, which included a series of large, sweeping objectives when it comes to women’s health. Could you give us the bird’s-eye view of what the administration has planned?
DEBRA NESS: So I think what is so exciting about this Biden–Harris administration is that we for the first time see an administration that is looking at the ways in which both health and economics intersect in people’s lives, and particularly how those intersections impact women and women of color. It so happens that we live at a time now where the pandemic has really brought these intersections into very sharp relief. And one of the huge tragedies is that it’s women of color, Black women in particular, who are dying at the highest rate of any other population group, other than Black men. And a lot of it is a result of the combination of both economic and health inequities that they have suffered throughout their lives. So what the Biden–Harris administration is essentially doing is saying, “We’re going to step back and we’re going to take a look at rebuilding our economy, but not building it back the way it was, but building it back in a way that makes it better. And that makes it work for everyone.”
SHANOOR SEERVAI: When we look at the starting point where things were before, what had the Trump administration been doing that was undermining women’s access to health care?
DEBRA NESS: Well, the Trump administration sought to undermine women’s access and access generally to health care in so many different ways. So for example, we all know about the court fight to decimate the Affordable Care Act. We also know that he was against the expansion of Medicaid that was made possible by the Affordable Care Act. So this administration imposed work requirements in Medicaid that made it harder for women, particularly women of color, to get access to coverage that they needed desperately and would have been eligible for.
So for example, if a woman is working at the kinds of odd jobs, picking up a job here and there, while trying to deal with caregiving at home, you can imagine that the amount of hours she works or how she documents that could be very different from month to month and could be very cumbersome. So sometimes women who were struggling to take care of their families and string together odd jobs were just left out of being eligible for Medicaid, simply because they couldn’t either figure out or meet those work requirements.
Another thing the administration did was it really decimated the Title X Program, which is our national family planning program. And Title X is the way a lot of women, poor women in underserved communities, women in rural communities get entry into the health care system, and it provides a lot more care than just family planning. But as a result of the Trump administration rules, many of those clinics were decimated. They had to close down because they could no longer provide the services or the full information that women are entitled to.
SHANOOR SEERVAI: So the Biden–Harris administration is coming in at a time when, at the baseline, access for women on so many fronts had been restricted and limited. And then of course the pandemic has made the deep inequalities of this country more marked than ever. Against this backdrop, what do you think is at the top of the new administration’s agenda?
DEBRA NESS: I think recognizing the realities that women and particularly women of color face, I think the best way to illustrate this is maybe to talk about an average woman. Let’s say Rosa, who is working in a frontline job. She’s a cashier. She gets close to minimum wage. She doesn’t have health benefits. She has no paid sick days and she has no paid leave. Because she’s dealing with the public every day, she’s exposed at a much higher risk level to getting COVID. She’s worried sick every day about bringing that home to her family.
And she’s got young kids at home and she’s got an elderly mom she’s taking care of, and her employer doesn’t provide any protection, no masks, et cetera. When she gets sick finally, she succumbs. She gets COVID. She now has no paid sick days. She has no paid leave. So what happens? Well, she loses her job and she struggles to get to whatever health care that she can. When she does, she faces a lot of the challenges that many women and women of color face in our health care system, which is the structural ways that it’s hard to access care sometimes. She doesn’t have a primary care doc. She doesn’t have a nearby clinic. She has to take two buses just to get to the nearest hospital clinic.
And then there’s all of the implicit bias she faces in the way she is treated by the health care providers. And there’s no income coming in while she’s sick. So she goes back to work even before she’s feeling better. And probably she makes it through, struggles through, if she’s lucky enough to be able to go back to work. Or she has by now lost her job and she is struggling to figure out how to make the unemployment system work for her. So the Biden administration has been realizing is that for the most part, women are the primary holders of jobs in our care sector. None of us can actually go to work and thrive. If there isn’t somebody who’s doing that caregiving work, whether it’s paid caregiving or unpaid caregiving, we all need it. We all have some kind of family, or we all sometimes get sick. So if you don’t have caregiving, it’s hard for the rest of the economy to work.
SHANOOR SEERVAI: What have they done so far to support caregivers, to make it possible for people to work, but also for families to have what they need.
DEBRA NESS: So the first step of the Biden–Harris administration has been to pass the American Rescue Plan, which is really an extraordinary boon to women and women and families in particular. It provides some immediate financial assistance to the most hard-hit families, number one. Number two, it starts to address the fact that our childcare infrastructure just collapsed during this time. So shoring up our childcare system, increasing the child tax credit, increasing the earned income tax credit, are ways to immediately begin to address the fact that women can’t get back into the workforce if there isn’t somebody who can help them with that home caregiving.
The other thing the Biden administration did was push very hard on and put money into getting schools reopened more quickly. Again, that will help women get back into the workforce. And then finally, another really important piece of what Biden did in the rescue plan. He put money into a program called the Home and Community-Based Services, which is a Medicaid program which supports home-care workers and allows there to be an expansion of home care to people who are elderly or disabled or sick and need care at home. Many women leave the workforce or are forced out of their jobs because not only do they not have childcare, but they also don’t have care for other kinds of loved ones, who they are taking care of.
SHANOOR SEERVAI: Mm-hmm. And as we think about women having to leave the workforce, you mentioned that a couple of times, I’m curious about what the long-term or lasting impact of that will be. Are the women who have had to leave the workforce, for the reasons you’ve just described, going to be able to get back on their feet quickly?
DEBRA NESS: So one of the worries we have is that women were the first to lose their jobs. They have lost their jobs in much greater numbers than men, and they are likely to be the last to get those jobs back. It will probably take much longer. In addition, if we really want to solve the problems that we saw were at the heart of why this pandemic so disproportionately hurt women, we need to make sure that the jobs that they go back to are decent-paying jobs with basic benefits like health care and paid leave and paid sick days. Otherwise, all we’re doing is building back the same inadequate system that we had before the pandemic.
And if you think about the solutions to this, we have to get beyond the band-aids. We have to get beyond a one-time influx of money into childcare or a temporary paid sick days program. These need to be permanent programs. We need permanent investment in childcare. We need permanent comprehensive paid leave and paid sick days for everybody. We need Home and Community-Based Care. And really importantly, we need those to be good jobs because if we keep creating jobs for women that are low paid, where they can’t build any savings, where they have no economic security, no benefits, then all we’re doing is perpetuating the economically insecure communities that we say we’re trying to rebuild.
SHANOOR SEERVAI: Mm-hmm. Do we have any of what you just described yet? Any of the permanent changes to sick days, paid leave, decent jobs? Unfortunately, we do not have a $15 federal minimum wage, but at least it is part of the conversation.
DEBRA NESS: The $15 minimum wage, the elimination of the tipped wage, which is only $2.13 an hour, federally, those at least are conversations and the fight is very robust. And I believe this country is moving in that direction. The same is true for paid sick days and paid leave. We don’t have those guarantees right now. They are not in this first rescue package, but we are looking forward to seeing them in the next package that the administration puts out there, the American Family Plan. And there we should see a permanent comprehensive paid leave program for everyone.
SHANOOR SEERVAI: So we’ve talked about how the pandemic has forced women out of the workforce and also about how women are overrepresented in caregiving roles. Can you tell me about current job opportunities in caregiving and why these are so important?
DEBRA NESS: These jobs are pretty much people-ready. Unlike a lot of the infrastructure jobs that go more toward employing men and can take some time to get up and going, care jobs are easy to get up and running. And if Congress does the right thing, we can see those jobs get into play very quickly. And the numbers being crunched now show that that money invested has a terrific return. Economists have shown that if women in the U.S. were participating at the same rate in the workforce as women in Western Europe, where they have paid leave and paid sick days, we would be gaining $500 billion a year in GDP.
SHANOOR SEERVAI: We’ve been discussing the links between a woman’s economic opportunities and her health. We see this playing out when it comes to reproductive health care, which has been more difficult for women to access at home and abroad over the past four years. For example, the global gag rule or the Mexico City policy bans foreign NGOs that receive U.S. government funds from performing or promoting abortion as a method of family planning. The way the previous administration applied this policy, it barred the federal government from supporting really important global health efforts like those on maternal and child health, malaria, and HIV/AIDS simply because the organizations providing those services also offered information on abortion. The Biden administration has reversed the Mexico City policy.
Mary, what is currently happening on the issue of funding for foreign NGOs?
DEBRA NESS: We are now fighting for legislation that would permanently make clear that our funds would not be restricted in that way. It’s called the Global HER Act. And it would be nice to not have this be a political football, because it has been going back and forth between different presidents now for decades. Second thing, I’m really pleased to report they’ve taken some big steps on Title X, and just today they announced a proposed new rule that would actually undo the damage that was done during the Trump administration and invest a record amount of money in the Title X program to get it back up and running. So those vital services would be available to women again. And so that women could go to a Title X clinic, get the cancer screening, the STD screening, the family planning guidance without being worried about whether they were getting full, truthful information from their health care providers.
So that’s really terrific news. And we would love to see more dollars poured into Title X over time, but what a terrific start. And then I would say that yesterday was another big day because for the first time we had an administration issue the first-ever proclamation calling this Black Maternal Health Week. And that is in recognition of the extraordinary work that we need to do to improve maternal health care generally in this country, but also to close the terrible gap between women of color and Black women in particular and white women.
Black women right now have maternal mortality rates that are two to three times higher than white women. And this new proclamation, together with concrete actions that the Biden administration is taking, could make a huge difference. So for example, they have already made it possible for states to expand Medicaid coverage for pregnant women instead of just six weeks postpartum to a full year. And they just issued their first waiver to the state of Illinois that will now put that into effect.
SHANOOR SEERVAI: Let’s take a minute to talk about what that means. Why is it so important for a woman on Medicaid to have coverage for more than six weeks after she’s had her child?
DEBRA NESS: So one of the things that is really troubling about our health care system is that women’s health continues to be one of those areas where there is often insufficient research, evidence, attention, and often women are not taken seriously in the kinds of questions they ask or the kinds of information they provide about their own status. And as a result, we have pretty suboptimal results when it comes to maternal health outcomes and birth outcomes. And one of the weird things is that after a woman gives birth, there’s very little attention paid to her health.
There are some guidelines around what you should do for the new baby, but oftentimes women don’t have their first visit with a health professional till six weeks later. It’s almost as though we drop women like a hot rock right after they deliver. And yet we know that a significant number of the complications and the mortality that we see occurs way beyond the six weeks and in that first year. And we know how important now that mental health screening, screening for postpartum depression, screening for opioid use, screening for other kinds of health issues that can occur in the weeks and months that follow pregnancy, is extremely important to closing that gap and improving overall birth and maternal health outcomes.
SHANOOR SEERVAI: Mm-hmm. And just like the way many of our other inequities fall, these problems, these risks hit Black women the hardest. They’re more likely to have low incomes, they’re more likely to be on Medicaid and to really need these supports.
DEBRA NESS: And as a result of all those things, so they’re less likely to have access to the kind of care that they need. They’re also less likely to be believed or to be listened to. And we saw that heartbreaking story that Serena Williams told. She nearly died from childbirth because the doctors were not taking her seriously. Now that’s an experience a lot of women have, regardless of whether you’re white or a woman of color. But it is exacerbated for women of color in a very big way.
SHANOOR SEERVAI: Finally, before I let you go, we’ve talked a lot about equity in this conversation. And one of the things that struck me is that you’ve talked about how this administration is really tying economic security and health care together. It’s not “This is the economics box. This is health care box.” I’m wondering for women today who are fighting for better jobs, are fighting for better access to care. How has their struggle changed from previous generations? And how is it still the same struggle?
DEBRA NESS: Well, I think it is very much the same struggle in that there are too many things we are still fighting for. But I think one of the most heartening changes is that there is so much more of communities and groups working together and understanding that really these are all pieces of a whole. So for example, I’ve talked a lot about how important investing in the care economy is. Well, the force behind that is a combination, a very broad combination of groups that include women who care about the challenges facing caregivers with elder relatives or women who were taking care of people with disabilities or kids with disabilities.
It’s bringing together the communities that work for paid leave and paid sick days. The communities that fight for rights for domestic workers and home-care workers, the unions, the labor movement, the folks who have been working for decades on childcare. All of these different constituencies coming together. In fact, there’s a wonderful coalition that we call Care Can’t Wait. And if ever there was a moment, this is it.
SHANOOR SEERVAI: So I think I know what you’re going to say when I asked this last question, but do you think we are going to come out of this pandemic stronger and that women are going to be better off?
DEBRA NESS: I definitely believe that we are going to come out of this stronger and women will be smarter and stronger and better off because I think this pandemic has really put into very sharp relief how intertwined these realities are and how the way things were before the pandemic are just not acceptable anymore. And this whole recognition that the roots of the problem come from really entrenched racism and sexism. If you really think about why this country devalues caregiving to the extent it does, you have to trace it back to the days of slavery.
You have to trace it back to Jim Crow. You have to look at the ways in which, for centuries, women’s role has been defined as the caregiver, the stereotype caregiver, while men are the breadwinners. And the work that women and people of color did was therefore viewed as acceptably undervalued. And that kind of systemic racism and sexism is what has to be attacked. And I think now that our eyes are open, we’re not going to close them again. And so it’s a different fight. It’s a different day. And I think there’s a lot of energy behind this fight.
SHANOOR SEERVAI: Thank you so much for joining me today.
DEBRA NESS: It’s been such a pleasure.
SHANOOR SEERVAI: The Dose is hosted by me, Shanoor Seervai. I produce this show for the Commonwealth Fund along with Andrea Muraskin, Naomi Liebowitz, and Joshua Tallman. Special thanks to Barry Scholl for editorial support, Jen Wilson and Rose Wong for our art and design, and Paul Frame for web support. Our theme music is “Arizona Moon” by Blue Dot Sessions, with additional music from Podington Bear. Our website is thedose.show. There you’ll find show notes and other resources. That’s it for The Dose. Thanks for listening.