Lingie Chiu, a pediatrician in Hawaii, sees a lot of families struggle when their children are hospitalized. 

There’s the parent’s emotional burden of not knowing what will happen, and the anxiety of children who may not understand what’s going on. But there’s another element too — the fact that many parents can’t afford to stay with their kids in the hospital.

Chiu has sometimes had to tell parents that they can’t leave their children alone. Those are difficult conversations, Chiu says, where parents often cry knowing that they can’t afford to miss work.

Sometimes, even if the hospitalization only lasts a few weeks, parents will be forced to quit work to take care of their kids. That’s one reason why Chiu is hopeful the Senate will approve President Joe Biden’s proposed paid family and medical leave plan, part of a bigger social spending bill that he’s trying to get through Congress.

To Chiu, something like that feels long-needed.

I’m surprised that there are so many pukas or holes still in the system,” she said. 

Left to right, Thomas Gill, Liza Gill and baby Ryan Olivia Gill with their dog named Hoku.
Thomas Gill and Liza Gill have struggled to find child care in Kapolei for their baby Ryan Olivia Gill. Cory Lum/Civil Beat/2021

The House version of the bill called for 12 weeks of paid medical and family leave, with a broad definition of family that would enable a range of people to take paid time off to care for their loved ones, including but not limited to parents, spouses or siblings.

It’s still unclear whether legislation guaranteeing paid family leave will actually pass, and if it does the length is likely to be reduced to four weeks or less. On Wednesday, the New York Times reported that the provision was likely to be dropped from the bill due to opposition from Democratic Sen. Joe Manchin III of West Virginia, but that Democrats are fighting to keep it in.

Still, Hawaii parents and advocates for children say even a scaled-down version of Biden’s proposed programs for children and families would be instrumental in helping Hawaii families stay afloat given the state’s high cost of living.

The U.S. Senate has been tangled up in negotiations since the House passed a $3.5 trillion version of Biden’s Build Back Better plan, which also included universal pre-kindergarten, subsidies for child care and a provision to make the refundable child tax credit permanent.

The New York Times reported the plan was originally envisioned as the greatest expansion of the social safety net since President Lyndon Johnson’s administration created Medicare and Medicaid.

But the combination of opposition from Republicans and moderate Democrats has forced Democrats to carve out huge aspects of the bill, eliminating free community college and key climate change provisions and reducing the estimated cost to between $1.5 trillion and $2 trillion.

Kathleen Algire from Hawaii Children’s Action Network Speaks says the federal funding proposed for universal pre-K would give Hawaii the boost it needs to expand its small program and meet the state’s ambitious enrollment goals.

Research shows that access to pre-K benefits child development.

“It is not a hyperbole when we say this is a once-in-a-lifetime opportunity to improve people’s lives,” Algire said of the family-related proposals in Biden’s plan. “It would benefit not just our current generation but generations to come.”

To Algire, this moment recalls the 1970s, when then-President Richard Nixon vetoed a bill that would have provided universal child care.

“We don’t want to wait another 50 years to have something like this,” Algire said.

Paid Family Leave

The United States is one of only a handful of countries that doesn’t offer paid family leave. And despite the dominance of the Democratic Party in Hawaii, the state, like most others, doesn’t have a family leave insurance program.

Jing Guo, an associate professor at the University of Hawaii who specializes in comparative family policy, says even though the U.S. policy already requires large companies to offer three months of unpaid family and medical leave, many people can’t afford to take that time off.

Jing Guo, of the Thompson School of Social Work and Public Health at the University of Hawaii University of Hawaii

The lack of paid leave creates a huge disparity between high income workers who have access to such programs and low income workers who don’t. Establishing a paid leave program that enables all mothers to take time off when their child is born — which Guo noted is the norm in other developed countries — would start to bridge that gap.

“It would be great to have up to 12 weeks, but four weeks still will be revolutionary for the U.S. because for so long we don’t have paid family leave,” Guo said. 

But there are a lot of potential hurdles. Currently, many employers don’t offer paid leave because of the cost.

The government faces the same price tag. Outreach and education about the program alone would cost $150 million, according to the House version of the bill.

Then there’s the cost of wages. The House proposed reimbursing businesses for providing paid leave, which The Hill reported could cost as much as $225 billion over 10 years, funded by tax hikes on wealthy people.

Those proposed tax increases have received pushback from Republicans as well as centrist Democrats.

Child Care Deserts

Compared to families in many other states, Hawaii families have a particularly large need for child care support given the high cost of living in the islands.

About 9% of Hawaii households are living below the federal poverty line, but an analysis by Aloha United Way found an additional 33% are living just above that line and at risk of falling into poverty if they hit any financial snags, such as sudden unemployment. These are individuals living on about $31,000 a year, or families of four earning around $90,000 a year.

That salary might be a lot in another state, but in Hawaii, where housing prices are sky-high compared to most states and food is taxed on top of being expensive to begin with, paying for child care for two children on $90,000 annually can be difficult.

The average annual cost of sending a kid to a child care center in Hawaii exceeded $14,000 per child in 2019, according to Child Care Aware of America. Costs can rise significantly for infants.

Jerome Stone and his family smile in a photo they took after moving to Hawaii island. Stone says the child tax credit helped the family afford food after his wife lost her job during the pandemic. Courtesy: Jerome Stone

Even when families can afford child care, it may not exist. More than two-thirds of Hawaii residents live in child care deserts, according to the Center for American Progress. Only families in Nevada and Utah have less access to professional child care, according to the center’s analysis.

That’s one reason why the proposed child care subsidies in the Build Back Better plan sound like a good idea to West Oahu resident Liza Gill, who hasn’t been able to return to work full time since having her daughter in March.

As a consultant, she didn’t have access to paid family leave but decided to take off unpaid time to take care of her daughter. That meant the family relied on the income of her husband, who was working as an emergency room physician and couldn’t afford to take unpaid paternity leave.

By June, Gill was ready to return to work. But when she called child care facilities in Kapolei, the next opening wasn’t until April 2022.

Her daughter is now on the waitlist, and Gill has only been able to squeeze in 20 hours of work each week in between caring for her. She may have found another spot in town, but it didn’t make sense to spend 10 hours in traffic every week when both of their jobs were in Kapolei.

Not being able to return to work full time has meant the family has taken a much larger financial hit than expected.

“I can’t really not be working any longer, but I also don’t have child care,” Gill said. Other local families might rely on family to help but that’s not an option for them. “We can’t rely on our grandparents because they’re still working.”

She is hopeful that the federal support for child care proposed by Biden would help expand their family’s options.

Paying For Food

Another aspect of the proposal — to make the refundable child tax credit permanent — will likely be reduced to only a year-long extension, if it passes. Jerome Stone, 63, hopes that element makes it through.

Stone moved to Hilo with his family of three in October 2020 after getting priced out of Boulder, Colorado. His wife had been a massage practitioner for 27 years when the pandemic shutdowns and fears of Covid-19 brought her business to a grinding halt.

Stone, a hospice nurse, became the family’s sole breadwinner. Then the monthly checks from the child tax credit started coming in. Stone was relieved and gratified, and said the money helped pay the grocery bill.

“Food is very expensive and our son has celiac disease so we have to buy everything gluten-free,” Stone said.

Buying groceries is also how Kaneohe resident Jamie McOuat partially spent the child tax credit she received for her son. The 59-year-old mother got laid off in June from a nonprofit job and suddenly found herself part of the low-income community that she used to serve.

The child tax credit helped enable her family to keep her 7-year-old in his sports and violin programs that they wouldn’t have been able to afford otherwise.

The biggest benefit for us has been social emotional growth of our child,” she said of the tax credit. McOuat, who is from Canada, is still shocked and amazed at how the U.S. lacks paid family leave and other social support programs for children and families that she once took for granted.

Every other country or culture I lived in, it’s obvious that it’s always prioritized,” she said. 

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