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Congress Should Permanently Strengthen Economic and Health Security for Front-line Workers and Millions More

The pandemic brought short-lived national attention to many low-paid workers who had previously been overlooked, as the public recognized more broadly that people like grocery clerks, bus drivers, and home health aides do work with life-and-death importance. Millions of these so-called “front-line” and “essential” workers — and millions more who aren’t labeled as such — do critical work for little pay and would benefit from congressional action, including to expand the Child Tax Credit and Earned Income Tax Credit (EITC), close the Medicaid coverage gap, extend temporary premium tax credit increases, and expand access to affordable child care and preschool.

While the precise definition varies across states and studies, the term “essential workers” generally refers to people and industries whose work is necessary to provide critical goods and services including groceries, health care, and transportation. A Brookings Institution report estimated that 90 million people work in essential industries in the U.S., and within that group, 50 million are “front-line” workers who must report to job sites. Of course, work technically termed “essential” isn’t the only important work. Teachers, for instance, have not consistently been designated as essential workers.

Millions of front-line and essential workers have financially precarious lives. “These are people who work very, very, very hard, and who make very, very, very little,” hospital unit secretary Tony Powell told Brookings. Brookings found that in 2018, “22.3 million essential workers were in occupations with a median wage of less than $15 an hour,” including nursing assistants, home health aides, retail salespeople, and cashiers. One in three essential workers lived in a household that earned less than $40,000 a year, The Atlantic reported in 2020. In addition to low wages, essential service sector workers have long faced unstable and unpredictable hours.

People who cannot work from home are also less likely to have health insurance or a college degree, and more likely to be renters, immigrants, and people of color, according to University of Chicago researchers. Many also have little or no easily accessible savings. Among households headed by an essential worker who could not work from home, the median household in 2016 (the latest available data at the time of the study) held about $3,100 in liquid assets, and a household at the 25th percentile had just $700. Health issues or job losses can be catastrophic for these families.

Public policy and some companies offered temporary aid during the pandemic. Federal fiscal legislation — including relief checks, the American Rescue Plan’s temporary expansions of the Child Tax Credit and Earned Income Tax Credit, and access to less expensive health coverage through the Affordable Care Act (ACA) marketplace — provided significant temporary support for front-line and essential workers. As these workers faced disproportionate COVID-19 infections and deaths, some states and companies also offered hazard pay or “hero bonuses,” but those were limited and have largely expired.

Congress should make more lasting improvements in the economic and health security of essential workers and millions of others who do important work to keep our communities functioning. A range of concrete reforms would make a meaningful difference:

  • Expand the Child Tax Credit to include permanent full refundability (ensuring that children in families with low or no income get the full credit) and issue it monthly. The American Rescue Plan’s expansion of the Child Tax Credit, which included these provisions as well as an increase in the credit amount and eligibility for children through age 17, is benefiting families of more than 1.5 million elementary and middle school teachers, over 1 million truck and delivery drivers, and over 800,000 nursing, psychiatric, and home health aides for tax year 2021 (see Table 1). Gains from an expanded credit would accrue to essential workers’ children for decades to come.
  • Extend the Rescue Plan’s expanded EITC for workers not raising children in the home. Cashiers, home health aides, and food preparers are among the essential workers who would benefit from such an extension (see Table 2). More than 1 million cashiers would see a lasting income boost if the American Rescue Plan’s temporary EITC expansion were made permanent.
  • Close the Medicaid coverage gap. Some 5 million essential workers get their coverage through Medicaid; another 558,000 who are currently uninsured would benefit from closing the coverage gap.
  • Extend the temporary American Rescue Plan premium tax credit increases, which expire after 2022. This would give people with low incomes access to affordable health coverage through the ACA marketplace.
  • Provide substantial funding for states to offer free preschool education to 3- and 4-year-olds and to make child care affordable to families with low or moderate incomes.

Congress should craft economic legislation that includes these and other advances to promote the well-being of people working for low pay and their families, including those who were heralded as heroes during the pandemic and whose work will be no less important as the pandemic recedes.

People in Selected Essential Occupations Whose Families Would Benefit From Expanding the Child Tax Credit, as in the American Rescue Plan
Relative to without the expansion
Occupation Number of workers
whose families would gain
Workers whose families would gain as a share of all workers aged 18 and older in occupation
Elementary and middle school teachers 1,544,000 39%
Truck and delivery drivers 1,069,000 27%
Cashiers 1,048,000 30%
First-line supervisors/managers of retail sales workers 994,000 29%
Nursing, psychiatric, and home health aides 801,000 35%
Janitors and building cleaners 682,000 27%
Cooks 661,000 29%
Personal and home care aides 497,000 31%
Child care workers 474,000 36%
Miscellaneous agricultural workers 381,000 38%
Teacher assistants 375,000 32%
Secondary school teachers 348,000 32%
Food preparation workers 315,000 28%
Preschool and kindergarten teachers 305,000 42%
Other teachers and instructors 300,000 25%
Medical assistants 292,000 46%
Health practitioner support technicians 219,000 31%
Bus drivers 186,000 29%
Hand packers and packagers 173,000 26%
First-line supervisors/managers of food preparation and serving workers 164,000 26%
Special education teachers 133,000 40%

Source: CBPP estimates based on U.S. Census Bureau’s March 2019 Current Population Survey, using 2021 tax parameters and incomes adjusted for inflation to 2021 dollars. Estimates reflect a pre-pandemic economy.

Working Adults Not Raising Children in the Home in Selected Essential Occupations Who Would Benefit From Expanding the EITC, as in the American Rescue Plan
Relative to without the expansion
Occupation Number of workers who would gain Workers who would gain as a share of all workers aged 19 and older in occupation
Cashiers 1,074,000 33%
Retail salespersons 673,000 20%
Cooks 660,000 30%
Janitors and building cleaners 537,000 21%
Laborers and freight, stock, and material movers, by hand 534,000 24%
Personal and home care aides 468,000 29%
Truck and delivery drivers 412,000 10%
Nursing, psychiatric, and home health aides 385,000 17%
Stock clerks and order fillers 384,000 26%
Food preparation workers 315,000 30%
Child care workers 304,000 24%
First-line supervisors/managers of retail sales workers 253,000 7%
Teacher assistants 205,000 18%
Hand packers and packagers 204,000 32%
Miscellaneous agricultural workers 182,000 19%
Postsecondary teachers 162,000 11%
Other teachers and instructors 152,000 13%
Dishwashers 105,000 51%
Preschool and kindergarten teachers 75,000 10%
Bus drivers 71,000 11%

Note: Workers without children counted as benefiting from expanding the EITC as in the American Rescue Plan are those aged 19 and older (excluding students under age 24 attending school at least part time).

Source: CBPP estimates based on U.S. Census Bureau’s March 2019 Current Population Survey, using tax year 2021 tax rules and incomes adjusted for inflation to 2021 dollars. Estimates reflect a pre-pandemic economy.