Friday, September 18, 2020
Nancy E. Shurtz (Oregon), Tax, Class, Women, and Elder Care, 43 Seattle U. L. Rev. 225 (2019):
Elder care is a large and growing sector in the comprehensive health care system in the United States. It is an issue of particular importance to women because women live longer than men, have higher incidences of degenerative ailments, and are more likely to be institutionalized. Women also face greater financial challenges in funding their health care maintenance. Whereas wealthy individuals enjoy a multitude of elder care choices and can even self-insure to avoid the steep expense and risk of long-term care insurance, most women do not possess the resources to exercise such a wide degree of choice. Middle-income women increasingly feel the squeeze of concurrent rises in medical and housing costs and must often engage in contingency Medicaid planning. Low-income women, particularly those who are single, living in rural areas, or members of an ethnic minority, have few viable health care options and are the most likely to be herded into institutional care facilities. Nursing homes carry high costs and often do not offer high-level or personalized care. Current tax policy, however, is structured to favor institutional care. Conspicuously lacking are adequate subsidies to facilitate home-based options and meaningful support for caregiving labors, both key factors that contribute to the dearth of care options for our poorest citizens. The tax system is in dire need of modification to address this exploding elder care crisis, requiring explicit acknowledgment of the need to generate revenues dedicated to fulfilling our public commitment to the basic welfare of this rapidly growing cohort of the American population.
Long-term care, and how to pay for it, is one of the central issues facing women today. It is a particularly pressing concern given the basic facts that women generally outlive men, experience higher rates of debilitative conditions, and are less wealthy—all factors that increase women’s risk of late-life poverty and/or institutionalization. This Article argues that tax laws should be augmented to elevate the value of care labor while offering greater autonomy for those receiving this vital care. The principles of personal responsibility, including the touted virtues of thrift and industriousness, are given short shrift in a political, legislative, and market matrix that chronically undervalues care labor and process. The tools of tax policy offer powerful potential to open remedial paths for the greater public good. A mix of policy measures can begin to reverse the damage visited upon elderly women, particularly those in rural areas or who already dwell in poverty, doubly inflicted by markets and governments that have denied the true value of this essential care. Efforts aimed at increasing individual autonomy and exercise of choice concurrently reduce outcomes that result in forced institutionalization. A refundable credit for both care-receiver and provider, expansion and liberalization of the dependent tax credit and earned income credit, as well