Jay Inslee's Plan to Put Families First

The engine of America’s prosperity is its people, and that engine functions best when any American, no matter their race, gender, sex, or wealth, can achieve their dreams. But this fundamental truth has been ignored in recent decades — as have the hopes and dreams of working-class and middle-class American families. This situation would be bad enough were it only the product of disinvestment in workers and families. But our politics have ensured that the burden is borne unequally: austerity policies for the families most in need and struggling to build for the future, but ever-larger tax giveaways for CEOs, corporations, and the wealthiest among us. The result: in 1982, the United States had the highest standard of living of any industrialized nation; today, the U.S. ranks 10th.

In human terms this growing income disparity is measured in the impossible burden that working families face today: multiple jobs to make ends meet, even as they go to school to advance their careers; paying more for child care than college tuition; or leaving the workforce to care for aging parents or a sick loved one.

Our country has failed in its responsibility to the well-being of our people, and American families are being left behind. America must ensure the economic security of its people — and to do so at every stage of life. A middle-class lifestyle should never be out of reach because of the ZIP code that someone lives in, generational poverty that they cannot escape, or because of catastrophic health care costs that wipe out a lifetime of hard work meant to build a better future. Shared prosperity requires a clean and safe environment, the opportunity for a good job, and investments in social supports that help people build a foundation for economic security. This is how we will, and how we have historically, fulfilled the mandate of our Constitution’s preamble: to “...promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity.”

That is what Governor Inslee is proposing in his Putting Families First plan: a comprehensive standard of universal care in the United States that makes investing in working families the priority, at every stage of life — from birth to childhood, adulthood to working life, retirement to old age — to increase prosperity for everyone, help families afford the cost of the care and support that they need and deserve, and build a foundation of prosperity for workers and families alike.

Republicans say that if you do this - invest in families, workers, and people - that it will somehow damage your economy. But in Washington state, we are putting many of these policies in action, and because of that, not despite of it, we have one of the strongest economies in the nation.

Since 2013, Governor Inslee has signed into law: an expansion of early learning for 48,000 children; full funding for all-day kindergarten; the nation’s best Paid Family and Medical Leave program; the nation’s most comprehensive free and low-cost college program; the nation’s first public option for healthcare; and the nation’s first publicly-funded long-term care benefit. These programs, as well as numerous other innovations that help Washingtonians of every income level and background, improve the health, education, and career outcomes of everyone, and save taxpayers billions of dollars in downstream costs. These are the very investments — in children, students, workers, families, and seniors — that have built made Washington state the best state in the country and built the nation’s fastest growing economy.

Governor Inslee’s Putting Families First plan is the roadmap for making the economy work for everyone, built from what’s worked in making Washington state great.

Investing in Successful Outcomes from the Beginning of Life

National Paid Family and Medical Leave for America

No one is immune from life events that impact their ability to provide for themselves, whether planned or unplanned, happy or unhappy: welcoming a new child into the family; caring for a loved one who has unexpectedly become sick or injured; dealing with one’s own illness; or honoring a solemn obligation. But America is the only advanced industrial nation that leaves its people vulnerable to these life events, conditioning the ability to cope with them on your ZIP code, the size of your paycheck, or the generosity of your employer. Bearing the burden of these events alone places enormous financial stress on families at their most vulnerable moments, drives talented employees from the workforce, and is estimated to cost working families nearly $21 billion annually. It’s long past time to close this gap for American families by providing National Paid Family and Medical Leave.

National Paid Family and Medical Leave will benefit every member of every family. It will allow both mothers and fathers to be able to stay home with new infants and children to provide needed nurture and support; allow employees to stay home when sick or caring for a sick family member; and honor their obligations to their country when called to service. In the absence of federal action, many of America’s largest employers as well as seven states and Washington, D.C. have implemented or will implement a state-level paid family and medical leave program. But even so, as of March 2018, only 17% of American private sector workers have access to paid family and medical leave — and only 11% among the smallest private employers. Closing this gap for families requires federal action.

Governor Inslee proposes a National Paid Family and Medical Leave program based off the nation-leading program that he signed into law in Washington state in 2017, and that will begin issuing some of the most generous benefits of any program in the country in 2020. Governor Inslee’s proposal for National Paid Family and Medical Leave is built on the following pillars:

Strong Coverage: The program will provide up to 12 weeks of paid family or medical leave per year, with eligibility beginning immediately upon welcoming a new child into the family, or to care for their own illness or the illness of a family member, including a covered service member. Additional weeks of paid leave will be available for people facing specific circumstances, such as complications of pregnancy.
Strong Benefits: Workers who earn income 50% or less of the national Average Weekly Wage (AWW) will receive wage replacement of 90% of their wages. Workers who earn income above 50% of the AWW will receive 90% replacement for that part of their income below 50% of the AWW and 50% replacement for income above that level, up to a maximum of $1,000 per week. Other state and employer benefits can be used to augment this program. This approach ensures that every family has access to the leave they deserve, with the strongest wage benefits directed to the families and workers that need it most.
Accessibility and Eligibility: The program will be available to all employees who have worked a set number of hours in the previous calendar year, and who experience a qualifying event. The funds would be collected nationally and administered through appropriate state agencies. Additionally, the program will be structured to ensure eligibility for public employees, including employees of school districts, in a manner consistent with strong collective bargaining rights.
Sustainably Financed: National Paid Family and Medical Leave will be funded through a payroll tax of 0.4% of wages, with employee contributions capped at 50%. This approach provides a sound financial footing, and ensures that no other program is cut in order to provide this paid family leave benefit, in contrast with Republican proposals that rob other critical social safety net programs of needed funding.
Inclusive Definition of Family: Governor Inslee’s National Paid Family and Medical Leave program is inclusive of all the forms that family takes in America today, especially same-sex families. This approach honors that reality with strong supports, and rejects attempts by conservatives to define down the meaning of family. Leave will be available in the event or injury and illness to children — meaning biological children, adopted children, and foster children — as well as parents, spouses, domestic partners, grandchildren, grandparents, and siblings.
Protections Against Discrimination: National Paid Family Leave will be supported by statutory and regulatory protections against discrimination and retaliation, whether against employers seeking to exercise their paid leave earned benefit, or against minority and LGBTQIA+ employees, who are particularly vulnerable to health or employment disparities, as well as individuals in need of leave as a result of intimate partner violence or assault.
Compatible with State Programs: National Paid Family and Medical Leave will represent a floor for benefits, not a ceiling. States with new and existing programs may offer a higher level of benefits, funded through state-level financing, and employees who receive benefits from qualified employer-provided plans will continue to enjoy them.

Investing in Healthy Mothers, Babies, and Children

One of the most shocking examples of the decline in living standards in America is the sharp increase in maternal mortality and infant death. The U.S. has one of the worst maternal mortality rates in the developed world, and is one of only a handful of countries where maternal mortality is rising. At least half of these deaths are preventable, and the maternal mortality rate for African American, Native American, and Alaskan Native women is an appalling three times higher than average. Infant mortality also remains too high, even as the rate has fallen since the mid-2000s; the U.S. ranked 30th of 40 countries measured by the Organization for Economic Cooperation and Development in 2014.

When we invest in home-based support before, during and immediately after birth, maternal and infant mortality outcomes are improved, children are better prepared for school, abuse and neglect are less likely and parent-child bonds are stronger. There remains much work to do to improve outcomes and eliminate racial disparities in mortality. We must support new mothers to protect the health and economic vitality of families. That’s why Governor Inslee’s plan calls for major new investments in protecting mothers, infants and children by:

Expanding the availability of home visits by doubling funding for the Maternal Infant and Early Childhood Home Visiting (MIECHV) program. Governor Inslee would also double the percentage of MIECHV program funding dedicated to tribal community home visits. In February 2018, Congress reauthorized the MIECHV for five years, but held funding flat at $400 million. Governor Inslee will also explore ways to leverage Medicaid to pay for home visiting in order to attain universal voluntary home visiting for families and increase access for low-income families. Additionally, Governor Inslee will improve flexibility options for states seeking to expand home visits through technical billing assistance, innovation grants and waiver templates, and more. Home visits have dramatic impacts that prevent adverse childhood experiences, including child abuse, neglect, and mortality — Governor Inslee is committed to providing home visits for all that need them.
Expanding availability of maternity supports like doula services through Medicaid, and incentivize states to allow Medicaid-covered doula services. Governor Inslee’s proposed 2019-2021 budget included millions to add doula services through the state’s Maternity Support Services program. Doulas and certified midwives help mothers have healthy pregnancies and babies and provide culturally competent care and reduce health disparities for women of color.
Eliminating barriers to essential medical care for new mothers, including: expanding the length of eligibility for Medicaid benefits from 60 days postpartum to one year; identifying and dismantling barriers to maternal mental health; expanding education and tools to navigate care systems for minority mothers; and addressing the growth of maternity care “deserts” throughout the country.
Increasing supports and services for parents with disabilities who are vulnerable to discrimination by social services agencies and providers in how they provide care for their children.
Support grants to train doulas and midwives in languages where there are health disparities, higher rates of maternal mortality, or disabilities to ensure language barriers are not an obstacle to important information and services.
Providing doula and midwifery services to incarcerated pregnant women, consistent with legislation signed by Governor Inslee in 2018.
Expanding the Affordable Care Act’s provisions requiring workplaces to provide breaks and private areas for breastfeeding mothers to pump from one year to two years, consistent with legislation signed by Governor Inslee in 2019, and protect the requirement for insurers to cover breast pumps. Additionally, a recognition program would be created that is similar to the Breastfeeding Friendly Washington program established by the Inslee administration which identifies and rewards hospitals, care clinics, and similar facilities that provide information and training on how to effectively breastfeed.
Supporting and protecting from adverse rule changes the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program that supports over 7 million infants and women nationwide with nutrition and breastfeeding support.

Providing Children and Parents the Best Start Possible

A child’s success depends on the support and investments they receive at the very beginning of their lives. Childhood early learning is one of the most powerful tools available to promote positive outcomes. A Harvard Graduate School of Education study found that students in quality early education programs were “less likely to be placed in special education, less likely to be retained in a grade, and more likely to graduate from high school.” A separate study found students who benefited from preschool-to-third-grade interventions attained associate's and bachelor’s degrees at a rate nearly 50% greater than those who did not. Early education programs are also associated with improved outcomes in health, thanks to medical screenings and other benefits wrapped into educational access, as well as reduced delinquency and involvement with the criminal justice system. One 2005 study found that every dollar of investment in early education generated up to $17.07 of return investment. These impacts are so powerful that the children of young students who received early education also benefit.

Under Governor Inslee’s leadership, Washington state has vastly expanded its commitment to high-quality early education. Governor Inslee signed legislation eliminating eligibility gaps and income barriers for children to participate in Washington’s Early Childhood Education and Assistance Program (ECEAP), which serves students from low-income families most in need of assistance, and Inslee’s state budget invests over $50 million in new funding for early learning. ECEAP students have demonstrated improved academic performance in grades 3-5 compared to non-enrollees, with scores nearly twice those of students enrolled in similar programs in other states. In 2015, Governor Inslee also signed the Early Start Act, which expanded early learning opportunities for 48,000 children in Washington state — part of the largest investment in early education in state history. Importantly, the Early Start Act also invested in educators to ensure teacher preparation and high-quality early learning and child care throughout Washington state. While there is more work to do, Washington is making the investments in students at the point in their life when it makes the most difference — as president, Governor Inslee would make the same investments in every child in the country.

Investing in Early Learning And Childcare

Governor Inslee believes working families deserve high-quality child care so that parents can go to work or attend school — regardless of ZIP code or income level. The sad fact is, early learning and child care supports are out of reach for too many families. For single parents the costs are crushing, the average cost of child care — between $9,000 and $9,600 annually — exceeds 37% of income for single parents, thirty percent higher than the allocation recommended by the Department of Health and Human Services (HHS). In 28 states, child care costs exceed the cost of tuition at four-year colleges. Without affordable child care, parents are likelier to drop out of the workforce at the expense of long-term economic security. As is so often the case, the burden of these runaway child care costs and lack of access hits lower-income families the hardest, whose children are 27% less likely to be ready for school by age 5 and more likely to experience a range of negative impacts due to the lack of access to early learning and child care.

Governor Inslee will make sure affordable child care is available for every family. He would establish a child care system that would cap child care spending for lower-income families at the HHS target of 7%, and builds on systems and principles implemented in Washington state. A roadmap for doing so is the Child Care for Working Families Act, sponsored by Senator Patty Murray (D-WA) and Representatives Bobby Scott (D-VA), which Governor Inslee supports and would sign into law as president of the United States. Governor Inslee’s plan would expand access to early education, improve program quality, as well as support workers. Investing in the child care workforce is essential to improve quality, expand capacity and access, and increase retention of child care workers. Governor Inslee will invest in workers through increased wages, benefits, and training. Essential impacts of the Child Care for Working Families Act include:

Eligibility For Families in Need Throughout Childhood: Child care costs for families earning up to 150% of state median income would be capped at 7% of their income, and would cover costs relating to infancy, toddlerhood, preschool, and summer and after school care. For families earning up to 75% of state median income, child care would fully subsidized. These investments would increase the number of children receiving assistance by a factor of thirteen, and add 2.3 million jobs between additional providers and parents — from primarily lower-and-middle-income families — participating in the workforce thanks to newly available care.
Expanded Preschool and Full-Day Kindergarten: Funding would be provided to states investing in high-quality early education, including by expanding preschool for 3-4 year olds for eligible families across the country and expanding access to full-day kindergarten. Working families must be able to access safe, quality child care environments while they work or advance their careers, including in circumstances that reflect the changing nature of work, such as during non-traditional hours outside of a predictable eight-hour schedule or during swing and overnight shifts. The need for high-quality child care will only grow as more and more Americans benefits from career-technical education and expanded apprenticeships that will be available in the transition to a clean energy economy.
Increase Access and Affordability for Families with Disabilities: While the Americans with Disabilities Act and Section 504 of the Rehabilitation Act do apply to child care centers, families do often find themselves unable to find accessible daycare. Governor Inslee will increase funding to remediate physical and programmatic accessibility barriers to increase access for families with disabilities.
High-Quality and Standards: Federal grants will be utilized to improve program quality through a tiered system similar to Washington state’s. Governor Inslee has led the full-scale implementation of Washington state’s Quality Rating and Improvement System, known as Early Achievers. Participation in Early Achievers became mandatory for all state-subsidized child care providers thanks to the Early Start Act, which Governor Inslee signed in 2015.
Lifting Up Children Experiencing the Greatest Need: Funding will be increased through the Individuals with Disabilities Education Act (IDEA) to better serve children with disabilities, and place special focus on meeting the needs of children in foster care, experiencing homelessness, or are vulnerable to racial discrimination.
Investing in Child Care Providers with Strong Wages and Benefits: Child care workers hold one of the most important jobs in our nation, but are among the lowest paid workers in the U.S., resulting in high turnover. These circumstances are the result of a failure of political will to do what is necessary — pay child care providers and early educators a living wage and strong benefits that reflect the vital role they play in supporting working families and the development of our children. By passing the Child Care for Working Families Act, Governor Inslee will support child care workers by creating 700,000 new jobs and increasing average wages by 26% for child care workers and educators. These investments will ensure that child care professionals and preschool teachers receive wages commensurate with elementary school teachers with similar credentials.

In addition to the provisions of the Child Care for Working Families Act, Governor Inslee will take action to expand the right to organize across the country for child care workers. Just as Governor Inslee proposed in his Evergreen Economy Plan, access to federal funds would be contingent on employers not only complying with existing labor laws, but also demonstrating neutrality amid labor organizing drives and allowing access to employee trainings by union representatives. Governor Inslee also supports the repeal of the Taft-Hartley Act provisions that permit so-called “right to work” states, as well as amending the National Labor Relations Act to recognize the establishment of a represented collective bargaining unit when a majority of workers vote to form a union or a majority of workers sign authorization cards to join a union, and to set standards for swiftly establishing first contracts between employers and bargaining units. Ensuring that child care providers are able to collectively bargain and fight for fair compensation is an essential component of recognizing the extraordinary and essential work that they do every day.

America’s Healthiest Generation Initiative

In 2014, Governor Inslee launched the Healthiest Next Generation initiative in Washington state to coordinate state agency efforts to address declining life expectancy for children. The initiative focuses on early learning facilities and schools, and invested millions of dollars in health-related grant funding. The Inslee Administration will launch a federal version of this successful program, America’s Healthiest Generation Initiative, that will take an interagency, evidence-based approach to learning readiness challenges across America, including nutrition, physical fitness, nursing supports, health improvement metrics, and more. Efforts include:

Ending student hunger. In Washington state, Governor Inslee signed legislation expanding “Breakfast After the Bell” programs for hungry students and ending “lunch shaming” in Washington state so every student who needs a hot meal at lunch has one. Governor Inslee will ensure these students’ needs are met nationally.
Improving physical fitness. Getting kids ready to learn requires that they are not only well-fed but that they also have access to physical education (PE) and physical activity. Governor Inslee will expand funding for, and access to, grants that support PE and recess in schools across America. Physical exercise is closely associated with improved academic performance. In Washington state, the Healthiest Next Generation initiative helped establish health and physical activity standards integrated into K-12 standards, and Governor Inslee was also a steadfast supporter as a Member of Congress of the Fitness Integrated with Teaching (FIT) Kids Act to increase physical activity and nutrition in schools.

Higher Education Opportunity for All

Access to higher education means the opportunity to achieve a student’s hopes and dreams — in whatever field they choose. That opportunity must be available to everyone, whether their interest is in attending a four or two-year public institution, community college, career technical education, or working in an apprenticeship. Equitable access to career advancement opportunities is the key to meeting America’s workforce challenges in the high-demand fields throughout our economy.

The problem is: opportunity to pursue higher education is increasingly a fantasy for many American families. Four-year collegiate institutions have become less and less affordable. America’s community college system has been persistently neglected despite its role as an essential pathway to career advancement for millions. College degrees have become vital credentials to find employment in our country, but due in large part to state disinvestment in higher education, acquiring a degree is inaccessible to many and often requires those who are able to access it to take on life-altering debt. Our underinvestment in higher education extends to higher education professionals, who struggle under their own debt burdens, poor wages and benefits, and weak labor standards.

Our system reserves career advancement for the few and privileged when it should be opening the door for all, and affording college is a source of anxiety and stress instead of hope. Fundamental reform is needed. The election of President Trump dashed the hopes of those seeking federal higher education reform, setting higher education down an even more inaccessible, more expensive path. In response to high demand, the need for reform, and the vacuum of leadership created by Trump, it has been left to states to provide model policies and student and educator protections.

Here, Washington state has once again led the way.

Governor Inslee signed into law the Washington College Grant program that provides free-and-low-cost college education for 110,000 students from families at or below the state’s Median Family Income, sets aside hundreds of millions of dollars for investments in public and community colleges, creates pathways to connect degree holders with careers in high-demand industries, and is progressively funded with a dedicated revenue source drawn from businesses that most directly benefit from these investments in the state’s workforce. The program has been called “pretty much the most progressive state higher [education] funding bill...at the state level in years”. The vision at the heart of this program is simple: the cost of higher education must go down so that it is once again a realistic option for everyone, and higher education must be invested in at every level so that career advancement is available to everyone, not just those with a four-year degree.

The next president must use the power of the federal government to restore the promise of higher education for everyone in America.

A Higher Education Promise for America

Governor Inslee’s approach will include making attendance at public college and community college tuition and debt-free for students from lower-income and middle-class families. America’s higher education system must move away from a system that relies on students asking how much debt they can afford to advance their careers and pursue their dreams, to one that makes quality higher education available without impoverishing both themselves and their families. To help achieve this goal, Governor Inslee’s proposal will create a state-federal matching program that will incentivize states to enact or expand college promise programs that meet this goal. Under Inslee’s plan, states will have options for structuring programs to qualify for the federal match. This will allow states to convert existing programs to “first-dollar” programs that allow students to utilize other financial aid funding to address the complete cost of college, including books and other essentials, and establishing affordability benchmarks for tuition-free and debt-free options. Washington state’s plan is already a first-dollar plan, and Inslee will encourage other states to adopt that student-friendly model. The program would support families earning up to $150,000, with the most generous benefits available to families in the greatest need.

The federal-state partnership structure would incentivize states to maintain or increase their levels of funding support for higher education, and the match rate would be variable to both accommodate differences been states and help states maintain funding during periods of recession. To truly reinvest in higher education, states must do their part. Nationwide, state funding for higher education in 2018 remained $7 billion below the 2008 levels, as adjusted for inflation. Inslee’s higher education investments will require state reinvestment and will act as a funding floor — states may adopt options that extend grant funding more broadly, as Governor Inslee has done in Washington state.

Federal support will also be conditioned upon states making needed investments in wages and benefits for education professionals, as well as offering stable working conditions, and a pathway to join a union without interference for all institution staff. Of particular note, the Inslee administration will require states to address the dramatic under-compensation of adjunct professors, who represent nearly two-fifths of faculty at America’s colleges and universities, but are woefully underpaid. The trend of institutions balancing budgets on the backs of professionals and students must stop.

Additional features of Governor Inslee’s plan include:

Dedicated funding supports to connect students at community and technical colleges with career opportunities, and helping students identify the majors and concentrations early that are likely to lead them to career opportunities after graduation. Governor Inslee launched a program called Career Connect Washington and signed the Workforce Education Investment Act that made investments to connect students to today’s careers and ensure the higher education system’s curriculum provides students with high demand skills to qualify them to compete for high paying jobs. Governor Inslee will recreate this effort federally.
Simplifying the Free Application for Federal Student Aid (FAFSA), including a transition to a one-time FAFSA submission that allows students to apply for aid once over their collegiate career, rather than annually as is presently required.
Expand funding support for wraparound services to help students pay for the true cost of college, including options such as expanding eligibility for the National School Lunch Program to qualifying students in higher-education settings and working to ensure there is child care available to parents who take evening classes to further their careers.
Tripling the number of people participating in apprenticeships by 2030, to 1.5 million. In his Evergreen Economy Plan, Governor Inslee calls for the creation of a new White House-led national partnership with labor unions, community and technical colleges, and K-12 public schools, along with educators, to develop programs that bring workers from schools to job sites with skills that improve work product and expertise while raising pay and benefits. Apprenticeship and training programs will be established in a way that connects workers with jobs and unions so they can get the skills and support they need.
Dramatically strengthen enforcement mechanisms to hold collegiate institutions, and particularly for-profit institutions, accountable for the protection of students. This includes the creation of an enforcement arm within the Office of Student Financial Aid and a restoration of rules that require for-profit institutions draw 15% of their revenue from non-federal financial aid sources, rather than 10%. The PROTECT Students Act, introduced by Senators Dick Durbin (D-IL) and Maggie Hassan(D-NH) provides a detailed roadmap for this and other critical enforcement steps.
Reinstitute the Gainful Employment rule that was repealed by Secretary of Education Betsy DeVos, which held for-profit institutions accountable for providing meaningful career skills to enrollees and withheld federal financial assistance to those that failed to do so while leaving students with crushing debt. DeVos’ repeal of these regulations is expected to cost $6.2 billion over 10 years, and gives free reign to institutions whose “singular focus is gobbling up federal grants and loans for their investors”. Reinstituting the rule will be a first step; Governor Inslee will also seek legislation enshrining strong standards defining Gainful Employment into law.
Similarly, Governor Inslee supports fully implementing, and enshrining into federal law, the borrower-defense rules promulgated by the Obama Administration, allowing students defrauded by for-profit institutions to pursue legal action to eliminate their remaining debt burden.
Work with Congress, and use federal rulemaking authority, to expressly clarify that federal law does not preempt states from using consumer protection authority to hold student lenders to account. In Washington state, Governor Inslee has signed legislation responding to the Trump Administration’s dereliction of duty, both protecting students at for-profit institutions in need of borrower defense and creating a student loan bill of rights. The Trump Administration is now targeting these protections in federal court. Both federal courts and the Department of Education have repeatedly recognized that state consumer protection authorities have an important role to play in protecting students.
Toughen enforcement and standards, both within and without the Department of Education structure, for student loan servicers to be fully transparent with borrowers and take all possible measures to help prevent borrowers from entering into default, as well as investing in meaningful enforcement against loan servicers engaging in unfair, deceptive, and abusive practices.
Taking steps to reduce the burden of student debt, including extending forgiveness for outstanding student debt on a sliding-scale basis for individuals earning up to $150,000 annually. Governor Inslee also supports fixing the dysfunction of the Public Service Loan Forgiveness program that rejects 99% of applications for relief, including by moving towards a system of auto-enrollment for eligible graduates, as well as annual renewal of income-based repayment plans and allowing for the refinancing of federal student loans. Additionally, Governor Inslee will also propose a new program supporting STEM education and scientific and technical career paths through a student loan debt-forgiveness program for graduates, including but not limited to those entering clean energy, sustainability, and climate science-related jobs in the non-profit and public sectors.
Repeal provisions of law authorizing states to deny in-state tuition to undocumented students, and amend the Higher Education Act of 1965 to extend federal financial aid programs to DREAMers, as proposed in the Higher Education DREAM Act of 2019 by U.S. Rep. John Lewis. This is a necessary step that can be taken as Congress considers comprehensive immigration reform. Governor Inslee signed legislation extending in-state tuition to undocumented immigrants through the Real Hope Act in 2014, and the recently signed Workforce Investment Act expands financial aid to eligible families regardless of immigration status. To give DREAMers a shot once they graduate, the Inslee Administration will also work with Congress to pass the DREAM Act and complete comprehensive immigration reform.
Repeal the ban on access to Pell Grants for incarcerated persons. Washington state participates in the Second Chance Pell Pilot Program at correctional facilities across the state. The governor understands that access to higher education can be transformative for people in prison, both while they are incarcerated and as they prepare for reentry.
Allow students with disabilities the opportunity to retain their financial aid and suspend enrollment in order to seek treatment for a mental illness or a disability. Currently, students lose access to Pell Grants and other aid if they take longer to graduate, but these provisions penalize disabled students or students who want to get help for mental illness.

Healthy Families, Healthy Communities for All

The use of public action to expand healthcare is as old as the Republic itself. President John Adams signed the first public health law in the country, assessing sailors arriving at U.S. ports 20 cents to cover the costs of hospitals and ill mariners. Since then, almost every generation of Americans has taken up this cause. The Affordable Care Act represented the most substantive expansion of healthcare since Medicare and Medicaid were established in 1965, reducing the number of uninsured by 20 million and saving an estimated $2.3 trillion in healthcare-related spending since its passage. Nearly a decade later, states continue to expand Medicaid so that they may provide coverage to the uninsured.

In Washington State, Governor Inslee implemented the Affordable Care Act efficiently and effectively: providing over 800,000 people with health coverage through the Washington Health Benefit Exchange and Medicaid expansion, and cutting Washington state’s uninsured rate from 14% to 5.5%. Today, Washington state is leading the nation to new frontiers for providing affordable health insurance by passing the nation’s first state-level public option for healthcare. Washington state’s public option program — “Cascade Care” — will be available to all Washingtonians regardless of income by 2021 and is expected to reduce costs for consumers as much as 10% compared to private insurance plans.

New frontiers are exactly what’s needed after two and a half years of the Trump Administration's war on healthcare coverage in America, which has caused 1.4 million Americans to become uninsured since 2016. Now, the Trump Administration is pursuing numerous regulatory changes that further threaten Americans’ health coverage, and its efforts to have the Affordable Care Act declared unconstitutional will eliminate existing coverage gains and throw the American healthcare system into chaos. The next president must not only provide immediate relief from President Trump’s assault on healthcare, but also recommit the American government to achieving universal coverage as quickly as possible.

Healthcare Reform for America

Governor Inslee’s administration will achieve universal healthcare coverage within five years — but immediate steps will be taken to reduce the percentage of uninsured Americans by 60% within two years and lower the cost of prescription drugs. The combined approach will make healthcare more affordable for millions of currently-insured people who nonetheless struggle with out-of-control medical bills, ensure that enrollees enjoy choice of both insurer and provider, and that those who do pay premiums will pay only what they can afford. And, because healthcare begins not at the hospital or at the clinic but with health promotion and disease prevention, Governor Inslee will invest in prevention and supports for mental health, food stability, substance abuse and addiction treatment, home care, and affordable housing that are essential to healthy families and children.

Governor Inslee will achieve universal healthcare coverage by:

Expanding Medicare so that everybody can buy-in, and so that no family’s healthcare costs, including deductibles, co-payments, and premiums, exceed their means. This includes providing subsidies similar to those in the Exchange that make care affordable for middle-and-low-income working families.
Expanding the Federal Poverty Level (FPL) eligibility for Affordable Care Act Medicaid expansion from 138% to 200%. This would ensure eligibility for a family of four making $50,200 per year. If a state decides not to offer this coverage through state Medicaid expansion, a federally administered Medicaid expansion program will provide coverage.
Lowering the Medicare enrollment age to 50, limiting out-of-pocket costs on the Exchanges, and increasing subsidies for Exchange enrollees earning between 200% and 600% of FPL to make care affordable for the middle class.
Under Governor Inslee’s plan, employers will continue providing insurance as long as their offerings meet Affordable Care Act standards. Individuals may continue to buy insurance through the Exchanges. Employer insurance plans will be required to include all Essential Health Plan coverage as outlined in the Affordable Care Act and to ensure costs for employees remain affordable.
Allowing Medicare to negotiate prescription drug prices in Medicare, and allow reimportation of drugs, to help reduce drug costs for everyone.
Developing an auto-enrollment program for individuals reaching Medicare age, and for newborns. All newborn children will be eligible for Medicare for the rest of their lives and auto-enrolled with an opt-out option to private insurance.
Maintaining the role of businesses in providing insurance that is affordable for employees and their families through current private insurance but also allowing them to buy into Medicare for their employees with a payment of up to 8% of payroll depending on employer size.

Governor Inslee’s proposal will also offer strong protections for patients against discrimination or exploitative tactics by insurers and care providers, and improvements to healthcare delivery systems. This includes:

Restoring requirements for essential healthcare and ensuring that no patient is denied coverage due to pre-existing conditions or lifetime caps on coverage. The Trump Administration has utilized agency rulemaking to allow insurers to offer “association health plans” or “short term plans” with watered-down coverage of maternity care, mental healthcare, and more, and weakened protections for those with pre-existing conditions. These rules also weaken tools to improve accessibility of care and discourage insurers from raising premiums to pocket the profits. Governor Inslee will reverse these and other Trump Administration rules that undermine the public’s trust and confidence in the availability of healthcare, and once again put patient needs over those of insurers. Governor Inslee has already taken action in Washington state by signing legislation that enshrines the Affordable Care Act’s patient protections into state law.
Protecting women from discrimination against reproductive care by ensuring insurance covers reproductive care and contraception. In 2018, Governor Inslee signed the Reproductive Parity Act, which requires insurance plans to provide coverage for abortion services alongside maternity and childbirth coverage, and covers contraceptives without out-of-pocket costs. Governor Inslee will make that the standard nationwide. Reproductive care and abortion services must be available in every community, no matter where a person lives. This is a moral imperative and a matter of economic security for women and their families.
Banning surprise billing. This practice targets patients exactly when they are at their most vulnerable due to bureaucratic complexity that they have no control over. Governor Inslee signed legislation in Washington state that prohibits surprise billing and establishes arguably the strongest state protections against surprise billing. Governor Inslee will take those protections national so no patient gets stuck with a bill they can’t afford.
Dramatically strengthening protections for consumers against outrageous prescription drug price hikes. Governor Inslee’s plan will require cooperation between the Federal Trade Commission (FTC) and the Food and Drug Administration (FDA) to rein in the costs of pharmaceutical drugs. It will also expand recent rules requiring public disclosure of list prices that require drug companies to offer justification for price hikes exceeding 10% over a period of two years, and empower the FTC and other federal agencies to utilize antitrust and regulatory authorities to hold pharmaceutical companies accountable.
Integrating systems that improve coordination of care, as well as payment systems that support improved health outcomes and innovation. In Washington state, Governor Inslee’s Healthier Washington initiative established the Performance Measures Coordinating Committee (PMCC) to achieve these very goals. Common Measure Set standards have been directly integrated into Washington state’s contracts with insurers and providers to drive the state’s health procurement towards value-for-service rather than volume-for-service. Washington state also implemented models integrating behavioral health and reforming payment methods using a $1 million State Innovation Model (SIM) grant authorized in 2013. Lessons from Washington and other states can be applied federally by developing rules and incentives to ensure records are shared among all providers, payment systems that encourage innovation, and changing public and private incentives to reward quality, innovation, and customer service.
Focusing on increasing workforce capacity in essential fields such as long-term care, mental healthcare, primary care, and community-based care, including strong incentives to have providers train and work in cost-effective teams. Governor Inslee’s administration created the Washington’s Health Workforce Sentinel Network, a program designed to identify needs for workforce improvements and investments in a dynamic healthcare environment so that the legislature and other partners can respond. Effectively addressing workforce challenges will also require raising wages for the workforce, expanding access to training and development opportunities, and ensuring that all workers can come together in a union and have a voice in decisions that affect them.
Improving the state of rural healthcare, which is tenuous in many communities. Despite improvements in coverage and payments, rural services are being asked to do more with less. Rural communities rely on their local hospitals to provide the backbone for expected services like in-patient care, but these hospitals are also the center for many support services ranging from physical therapy to mental health to long term care services. Governor Inslee will empower Medicare and Medicaid to work on payment mechanisms like global budgeting, which is now being tested in Pennsylvania, and other mechanisms to stabilize and support needed services in rural communities.

Investing in Supportive Services that Improve Health Outcomes

Healthcare does not begin or end when someone visits a doctor, hospital, or even the emergency room. The essentials of life — good food, stable and affordable housing, care to cope with chronic illnesses or substance abuse — promote health and prevent people from slipping into poverty and further away from the care they need. Addressing these Social Determinants of Health (SDOH) is a critical component of reducing healthcare costs. This approach to improving health outcomes is at work in Washington state right now. Governor Inslee’s administration launched the Health Homes project in partnership with the Center for Medicare and Medicaid Services to provide highly coordinated care to high-risk patients with at least one chronic illness. This program resulted in gross savings of $67 million for Medicare over its first two demonstration years, generated improved quality of life and reduced emergency room visits, and has been hailed as a national standout. Another Medicaid-based initiative called Foundational Community Supports provides supportive housing and employment assistance for people with mental health needs, who experience chronic homelessness and frequent institutional contacts, vulnerable youth and young adults, and other critical populations. Based on this experience, Governor Inslee will:

Expand authorization for the use of Medicaid to provide “wraparound” supportive services for those experiencing mental illness or struggling with substance abuse. The Inslee Administration will work with states to develop programs that deliver these supportive services in housing locations, both on-site and in community settings with the goal of stabilizing housing and improving health, and provide incentives to develop new subsidized housing — especially in areas where housing is not available.
Expand the availability of affordable housing for vulnerable populations by: increasing availability of Section 8 vouchers; promoting through CMS and Center for Medicare and Medicaid Innovation (CMMI) programs to support, and waivers to test, the implementation of supportive services in elderly and low-income housing; support the expansion of low-income housing by prioritizing communities most in need, including infrastructure improvements in communities not able to ensure adequate safe and clean water, as described in Governor Inslee’s Evergreen Economy Plan; and adequately funding the Federal Housing Trust Fund and the Low Income Tax Credit.
Expand food security and stability by reversing the Trump Administration’s proposed changes to the Supplemental Nutrition Assistance Program (SNAP), which endangers food access for 750,000 people and undermines state authority. Governor Inslee would expand funding for SNAP to improve benefit adequacy and reach eligible communities, like seniors, that persistently miss out on benefits despite the general effectiveness of SNAP in reaching its overall eligible population, and create partnerships with grocery stores to give extra savings to shoppers using SNAP.
Expand services to support at-risk youth, especially foster children. Across America, foster children are at an extreme disadvantage in terms of educational attainment, experiencing much higher rates of expulsion and suspension and much lower rates of obtaining high school or bachelor degrees. During the 2019 legislative session, Governor Inslee signed legislation removing barriers to enroll in extended foster care in Washington state through age 21, and as president would incentive states that have not yet utilized federal authority to extend foster care to do so.

Economic Security at Work and in Retirement

Strengthening economic security doesn’t stop just because someone is employed. Unemployment is at a fifty-year low in the United States, but across the nation Americans are on less secure economic footing than ever. For most, wages have been stagnant for decades; the percentage of Americans working multiple jobs remains steady despite record-low unemployment; one-fifth of Americans have saved nothing for retirement; and 40% of Americans live paycheck-to-paycheck to a sufficient degree that they would need to go into debt or sell possessions to cope with a minor financial emergency. In an economy where real wage growth overwhelmingly goes to the wealthiest in our society, leaving our children better off than we found ourselves becomes harder every day, and harder still for women, minorities, LGBTQIA+ people, the elderly, and others vulnerable to discrimination.

In May 2019, Governor Inslee proposed his Evergreen Economy Plan for a clean energy economy that will create 8 million family-wage jobs. The proposal accomplished this goal, in part, by reviving the labor movement through a vast expansion of the right to organize, strong enforcement of labor law, and a commitment by the federal government to condition federal grant money on respect for workers. Expanding labor membership is essential, but the federal government can and must do more through family programs like Paid Leave and Long-Term Care that allow people to remain in and return to the workplace, as well as direct employee protections that promote worker success.

Ensuring a Fair Day’s Pay, a Healthy and Equitable Workplace, and a Dignified Retirement

We must take much stronger action to ensure people receive both equal and fair pay for their hard work, help Americans contribute more towards retirement, ease the burden on existing retirees, and provide healthy, safe, equitable workplaces free of discrimination, theft, harassment, or anti-worker tactics. To achieve this, Governor Inslee will:

Provide fair compensation for overtime by increasing the federal overtime threshold to $49,000 immediately and to $80,000 by 2026. In 2014, the Obama Administration promulgated a federal rule taking similar action, but this rule was blocked in court and abandoned by the Trump Administration. In June 2016, Washington state proposed a rule updating state overtime thresholds consistent with these figures, providing fair overtime compensation to over a quarter-million workers by 2026. Governor Inslee believes this policy is a model for the nation.
Fight for equal pay and pay transparency in the economy by supporting pay transparency, enacting strong enforcement mechanisms against retaliation and discrimination, and signing the Paycheck Fairness Act to create a national equivalent to Washington state’s equal pay laws. In 2019, the gender pay gap remains stuck at 80 cents for every dollar paid to a comparable male employee, robbing employees not only of immediate wages but retirement savings and Social Security. For Latina women (53 cents), Native American women (58 cents), and Black women (61 cents), and LGBTQIA individuals, the gap is much worse, costing hundreds of thousands or even over a million dollars over a lifetime due to their ethnicity or LGBTQIA+ status. Governor Inslee signed Washington state’s first equal pay legislation in over 70 years, and will take these gender pay protections national so the country reaches pay parity for all workers.
Governor Inslee also supports expanded funding for enforcement of laws banning pay discrimination, as well as rigorous and full enforcement of rules requiring pay data collection via the Equal Employment Opportunity Commission. In May 2019, a U.S. district court ordered the reinstatement of rules requiring certain employers to provide such data — rules that the Trump Administration refused to implement.
Repeal Section 14(c) of the Fair Labor Standards Act that allows for the payment of subminimum wages to people with disabilities. Governor Inslee signed legislation barring state agencies from using certificates that allow people with disabilities to be paid at subminimum wages. Inslee believes this must be the standard for workers nationally.
Establish national Paid Sick Leave. Thirty-four million private sector workers don’t earn a single paid sick day to care for themselves or a loved one, and can’t afford unpaid time off work. Washington state established paid sick leave in 2018, which, along with other worker investments, is part of how the state built America’s fastest-growing economy. Inslee would pass the Healthy Families Act, which provides a framework that would build on Washington and other states’ example by allowing workers to earn 7 paid sick days annually to treat illness and prevent the spread of disease.
Create strong provisions for compensation transparency and worker mobility. Governor Inslee signed legislation requiring disclosure of salary information by employers for listed positions, and barring employers from asking for salary history, as well as legislation heavily restricting the use of non-competition agreements and “no-poach” agreements that limit a worker’s ability to move to different jobs or seek better wages. These policies are a model for the nation.
Fight harassment in the workplace. Twelve million workers, or 10% of the U.S. workforce, including some of the most vulnerable workers in America — including home healthcare workers and janitors, security guards and hotel workers, domestic workers and farm workers, and more — do not enjoy protections under existing anti-harassment laws. That’s why Governor Inslee would sign into law the “Be Heard Act”, sponsored by Senator Patty Murray (D-WA), that provides all workers with protections against harassment and promote safer workplaces.
Reform asset limits relating to public assistance that create barriers for low-and-middle-class families that discourage families from saving, reinforce cycles of poverty, or prevent families from seeking support when facing an economic shock. Eliminating unnecessary limits affecting programs like Temporary Assistance for Needy Families (TANF), SNAP, the Low-Income Home Energy Assistance Program (LIHEAP), and reforming limits for Medicaid and Social Security Insurance will not only enhance the economic security of families in need but create efficiencies for state governments. Governor Inslee signed legislation that increased exemptions from asset limits for access to public assistance programs in Washington state to expand eligibility for these programs.
Robustly protect the rights of workers when employers break existing labor law through swift and consistent enforcement of federal labor and organizing law to force changes in corporate behavior. Workers need protections in their fight to organize and join a union, so Governor Inslee will advance broad organizing protections for workers in every sector. This will include increasing fines on illegal corporate activity, broadening strike rights, giving workers a private right of action when their rights are violated, and expanding misclassification and joint-employer protections. The Protecting the Right to Organize Act proposed by Rep. Bobby Scott and Sens. Patty Murray and Sherrod Brown, provides a detailed road map of the specific actions needed.
Support state efforts to establish state-run retirement options. In 2018, Washington state launched one of the first-in-the-nation retirement plan purchasing exchanges, called the Small Business Retirement Marketplace, that allows employees and small business owners without employer retirement programs to shop for plans on favorable terms. This approach is a model for the nation, yet shortly after the election of President Trump, President Trump signed a resolution passed by the Republican-held Congress to overturn an Obama-era rule encouraging states and cities to offer state-sponsored retirement plans. The uncertainty created by this senseless opposition only reduces options for, and harms, seniors and workers planning for retirement amidst a retirement savings crisis. Governor Inslee would reinstate the Obama-era rule and pursue statutory reforms to enable states and cities seeking to provide this option to workers.
Expand Social Security by eliminating the Social Security payroll tax cap, and institution higher cost-of-living adjustment (COLA) benefits for enrolled seniors using CPI-E, as part of an overall approach to securing the solvency of Social Security over the long-term.

Dignified and Affordable Long-term Care for Seniors and People with Disabilities

Seniors and people with disabilities should be able to stay in their homes for as long as possible. Washington state has earned the AARP’s number-one rating for long-term service supports, in part because of the state’s enormous transition towards home-based care. Since 1992, the population of long-term care recipients receiving care in nursing home settings has decreased 44%, while those receiving home-based care has increased 175%. Funding for home-based care is now a majority of Washington state’s spending on long-term care, after having been less than a fifth in 1993. This approach has saved Washington state over $4 billion in Medicaid costs during that time. In 2019, this approach culminated in Washington state’s passage of a first-in-the-nation publicly-funded Long-Term Care Benefit, which provides financial support for long-term care needs that help people remain in their homes and avoid having to turn immediately to Medicaid to address these needs. The program constitutes a “breakthrough” in how our state handles this critical challenge.

The rest of the country deserves the same investment in our population that Washington state enjoys. As president, Governor Inslee will make Washington’s success national.

Long-Term Care Enabling Seniors and People with Disabilities to Remain at Home

Washington state offers the model for America to tackle the enormous increase in projected aging and related costs in the coming decades. The long-term care benefit signed into law in Washington state ensures that individuals in need of long-term care will be able to access it — whether related to aging, mental or physical disability, or injury. The system is progressively financed and creates a financial support of up to $36,500 annually per person — or a daily benefit of up to $100 per day — to help cover the costs of long-term care. The families and patients in need of care may apply the benefit as befits their needs for a wide range of services: adult day services, in-home personal care, assisted living services, adult family home services, nursing home services, care transition coordination, dementia support, home safety evaluation, adaptive equipment, respite for family caregivers, transportation, home-delivered meals, education and consultation, relative care, professional services, and services to assist family members care for eligible individuals.

Building on his success in Washington, Governor Inslee will propose a publicly-funded long-term care trust benefit for the United States: a social insurance program that provides financial support for services to help people stay in their homes as they receive long-term care, and defray the costs of institutional care as they need it. People should not have to impoverish themselves, leave the workforce, or rely exclusively on Medicaid as the payer of last resort to address these needs. The federal government will establish standards and guidelines, collect the needed funds and administer a national program through the Center for Medicare and Medicaid Services (CMS). This approach will meet the challenge of long-term care costs for patients, families and states, help provide financial security for families and caregivers, and provide peace of mind that patients can receive the long-term care they need and remain in their homes as long as possible.

As a long-term care benefit advances through the legislative process and is implemented during the first term of an Inslee Administration, seniors and people living with long-term disability should not have to wait to experience the financial security and home-based care supports that the national program is intended to provide. Governor Inslee’s plan calls for immediately making improvements to Medicaid funding and payment structures to implement these changes even while the national long-term care benefit structure is established through Medicare. The plan calls for:

Providing financial incentives through Medicaid for states to expand access to home-based and community services (HBCS).
Changing the statutory bias within Medicaid to eliminate the favoritism shown towards institutional care. Currently, nursing home care is a mandatory benefit of Medicaid programs, but home care is an optional program. Home-based care should be the preferred option whenever possible, with the costs of nursing home care supported as appropriate given the medical needs of a particular patient.

Supporting the Home Health Care Workforce and Family Caregivers

The escalating needs of the elderly population in the United States create an ever-growing, and unmet demand for both home healthcare workers and family caregivers. Today, nearly 3 million people are employed as home health aides or personal care aides, and another 1.2 million are expected to enter this field by 2026. Yet over 40 million additional people provide aid to friends, loved ones, veterans, or family members in need of caregiving, providing in 2013 alone 37 billion hours of uncompensated care worth $470 billion — more than the amount spent that year by Medicaid on healthcare and long-term care combined. The caregivers who selflessly provide this vital care often bear a special burden, working full-time or part-time jobs while also providing care. These higher-hour caregivers experience higher levels of stress, and most — 57% — do not have any additional support in meeting their obligation to a loved one in need.

America must invest in the workforce necessary to meet this already tremendous need. Yet home healthcare workers, and the essential services that they provide, have been consistently undervalued. Despite the much-higher than average demand for home health and personal care aides, median pay for these positions in 2018 was $11.50 — or $24,000 per year. Like any position, quality providers of care will be attracted by good family-supporting wages, strong benefits, and strong protections for the right to organize. Investing in a strong home healthcare workforce is key to providing economic security for those workers and their families, as well as their patients, achieving cost savings throughout the Medicaid system, and providing peace of mind for the tens of millions of Americans meeting this need today with little support.

To achieve the goal of access to quality home healthcare from fairly compensated and well trained workers, Governor Inslee’s plan calls for:

A guarantee that all home healthcare workers can join together in a union or other worker organization and have a collective voice in discussions concerning issues that affect them and the people for whom they care. Workers must be allowed to pay dues and be active in organizations without retaliation, regardless of the employer model or program under which they provide services.
Ensure home healthcare workers are paid a minimum $15 per hour by 2024, with increases thereafter pegged to the median hourly wage. Inslee’s plan also calls for home healthcare workers to be protected against workplace harassment.
Partnering with union experts and federally funded workforce providers to create labor-management training and certificate programs that improve worker safety, expand worker skills, and allow for and protect opportunities for workers to join unions. Governor Inslee has helped to create the model for this type of training program in Washington state through the SEIU Healthcare NW Training Partnership — the nation’s largest training provider serving home healthcare workers who provide long-term care for home care recipients. Home healthcare workers participating in such programs can expect commensurate increases in pay to reflect increased training and experience.
Create a national home care workforce board to set national standards, particularly around training, compensation and benefits. The workforce board would advise the Department of Labor and CMS on home care workforce issues and concerns, make rate recommendations, and recommend measures to protect against wage theft and ensure fair labor standards, as well as addressing recruitment and retention issues nationally.
Ensure employment and labor rights for home care and other domestic workers, who have historically been left without the benefit of these essential rights. We must establish these rights where they do not currently exist, and enforce them where they do.
Create and enforce adequate federal nursing home staff minimum requirements to improve quality for home residents and workforce stability, updating federal requirements that have not changed in more than 30 years. A lack of adequate staff leads to high worker injuries, with Certified Nursing Assistants having one of the highest injury rates of all job classifications.
Develop innovative models of representation, including structures that enable sector-wide bargaining for nursing home and other long-term care workers in order to level the playing field among nursing care providers and create mechanisms to ensure that workers at the bottom of the pay scale — who have seen little increase in wage levels over the last decade — can earn a living wage.