Child Care is Already in Crisis — We Need to Take Action to Improve Child Care, Not Make it Worse.

Amanda McDougald Scott, Ph.D.
7 min readOct 3, 2022
Amanda McDougald Scott speaking at the podium at the JCLCC hearing.

Testimony given September 29, 2022 at the Joint Citizens and Legislative Committee on Children (JCLCC) hearing in Greenville, SC.

During the 2020 and 2021 JCLCC hearings, I shared about a Medicaid Waiver 1115 for child care workers. I am here again to talk about similar issues, but with updates related to current events in South Carolina.

Medicaid access up to 200% of the Federal Poverty Limit would benefit not only child care workers, but also other South Carolinians who are earning low wages. Research indicates that when caregivers for children have access to healthcare, they are able to provide a better environment in which children can thrive…this is applicable to child care workers, parents, guardians, grandparents, and others who care for children1–12.

Agnes, one of the child care professionals from my Participant Action Research study, summed up her thoughts on the importance of benefits, especially health insurance, as the most important thing we talked about and that others needed to know with a very simple statement: “I say the most important is helping ’em with insurance…” 7.

Medicaid access would provide much-needed relief for patients, families, and healthcare systems. In the child care workforce, lack of employer-provided healthcare is a top reason for turnover — a problem that has been worsened by the pandemic7.

However, many child care centers cannot afford to provide access to health care. Child care professionals who must provide their own insurance usually sacrifice access to health care due to the high cost, in favor of using that money to pay for other life necessities (i.e. housing, transportation, food, student loans, unexpected costs)13,14.

Some shared that “getting sick was not an option,” due to the expense of health care, absence of sick days, having to pay illness-associated costs, reluctance to take sick days because of inadequate backup staffing, lost wages from missing work and going into debt as a result7. This frequently leads to leaving the child care workforce in favor of higher-paying or better-benefitted jobs that they liked less7. Turnover in child care is estimated to be between 26–40%15.

For the sake of our children, families, and economy — Medicaid access must be provided for child care professionals16.

Another often-overlooked reality is that child care workers are likely to have caregiving responsibilities both at work and in their homes17. National data shows that 24.3% of child care workers had children at home between 6–12 years of age, while 20.2% had children ages 5 and under at home18. These child care workers need child care for their own children while they work — and the ability to pay for basic living expenses without sacrificing their own health7.

Child care as an industry continues to be in a worsening crisis — one that requires a systemic response from our State and Federal governments.

Currently, the cost of child care in South Carolina (for one child) is estimated to be about $1,138 a month19 — which is a 128% increase in just two years- from $500 in 2020! This rate is higher than the inflation rate.

Inflation increases the cost of living, which further burdens workers being paid unlivable wages. Child care workers’ wages remain unlivable at a median of $22,310 annually. That’s $1,859 a month, which means that 61% of a child care professional’s monthly wage is consumed by child care costs alone — and that is for just one child. Additionally, you may not know that many child care centers also cannot offer the benefit of free on-site tuition for workers’ children — a policy that would lower turnover rates7. Considering these rates and costs are untenable for many families with young children, and especially the child care professionals who support the rest of the workforce, it is logical to conclude that if there is also a sudden increase in the number of children, there will be an exacerbated child care and economic crisis in South Carolina.

Increased costs mean that more children are kept at home, which, due to the pandemic, we already know has had a staggering economic impact. The estimated cost of the current and future loss of U.S. women’s working hours, wages, and economic activity due to the pandemic is estimated to be $64.5 billion 22. What increase in cost should we expect if there is a sudden increase in the number of children needing care?

Although the Senate and House have not been able to concur on how restrictive they would like to be on banning access to quality, safe reproductive care in South Carolina, as many of you are aware, there are many lawmakers who continue to push for bans.

I am asking you to please address the child care-related problems we already have in South Carolina, not exacerbate them. The pre-existing fractures in our society and system must be addressed. We can start to make a change moving forward NOW by

1- Providing access to health care through expanding Medicaid, with access up to 200% FPL.

2- Improving the South Carolina economy by systemically funding child care. Grants and other temporary stipends requiring applications, therefore additional work burden, are not sustainable. We must add the cost of state child care to the South Carolina budget- permanently.

3- Take care of the workforce, families, and children who are already here.

I appreciate your time and attention to these urgent matters, and welcome any questions.


1. Center on the Developing Child at Harvard University. 8 things to remember about child development. 2016.

2. Field T, Hernandez‐Reif M, Diego M, et al. Still‐face and separation effects on depressed mother‐infant interactions. Infant Mental Health Journal: Official Publication of The World Association for Infant Mental Health. 2007;28(3):314–323.

3. Field T, Healy B, Goldstein S, et al. Infants of depressed mothers show” depressed” behavior even with nondepressed adults. Child development. 1988:1569–1579.

4. Hamre BK, Pianta RC. Self-reported depression in nonfamilial caregivers: prevalence and associations with caregiver behavior in child-care settings. Early Childhood Research Quarterly. 2004;19(2):297–318.

5. Institute of Medicine, National Research Council. Transforming the workforce for children birth through age 8: A unifying foundation. Washington, DC: The National Academies Press; 2015.

6. Institute of Medicine. The early childhood care and education workforce: Challenges and opportunities: a workshop report. Washington, D.C.: National Academies Press; 2012.

7. McDougald Scott AM. Examining the Everyday Life of Child Care Workers: How Low Wages and the Lack of Benefits Affect Daily Life, Decisions about Employment, and What They Need You to Know.Clemson University, Clemson, South Carolina; 2021.

8. Otten JJ, Bradford VA, Stover B, et al. The culture of health in early care And education: Workers’ wages, health, And job characteristics. Health Affairs. 2019;38(5):709–720.

9. Russell SD, Lyons JD, Lowman BC. The early childhood system in Greenville, availability, quality, and affordability of child care in the year 2001. Chapel Hill, NC: Child Care Services Association; 2002 2001.

10. Whitaker RC, Becker BD, Herman AN, Gooze RA. The physical and mental health of Head Start staff: the Pennsylvania Head Start staff wellness survey, 2012. Prev Chronic Dis. 2013;10:E181.

11. Thomason S, Austin LJE, Bernhardt A, Dresser L, Jacobs K, Whitebook M. At the wage floor. Center for the Study of Child Care Employment (UC Berkeley)

Center for Labor Research and Education (UC Berkeley)

COWS (UW-Madison); May 22, 2018 2018.

12. Whitebook M, Phillips D, Howes C. Worthy work, STILL unlivable wages: the early childhood workforce 25 years after the National Child Care Staffing Study. University of California, Berkeley: Center for the Study of Child Care Employment; 2014 2014.

13. Garfield R, Orgera K, Damico A. The uninsured and the ACA: A primer- key facts about health insurance and the uninsured amidst changes to the Affordable Care Act. Kaiser Family Foundation; January 25 2019.

14. Schlieber M, Whitebook M, Austin LJE, Hankey A, Duke, M. Teacher’s voices: Work environment conditions that impact teacher practice and program quality — Marin County. Berkeley, CA: Center for the Study of Child Care Employment, University of California, Berkeley; February 6, 2020 2019.

15. Buffett Early Childhood Institute. Early childhood teacher turnover in Nebraska. Buffett Early Childhood Institute;2018.

16. McDougald Scott AM. Benefits for Child Care Workers: How the State Could Help through a Medicaid Waiver. Journal of Working Class Studies. 2021;6(1).

17. South Carolina Department of Social Services. COVID 19 Vaccination Dashboard. 2021; Accessed September 30, 2021.

18. National Survey of Early Care and Education Project Team. 2019 National Survey of Early Care and Education (NSECE) Preliminary 2019 Workforce data-file and documentation. In. Office of Planning R, and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services, trans. Washington, DC2020.

19. Center for American Progress. South Carolina. 2022; Accessed September 29, 2022.

20. The cost of child care in South Carolina. Economic Policy Institute; 2020. Accessed February 2021.

21. Patricia Cohen, Eddy M. Eurozone inflation sets another record, hitting 10 percent in September. 2022. Accessed September 30, 2022.

22. Kashen J, Glynn SJ, Novello A. How COVID-19 sent women’s workforce progress backwards. The Century Foundation and Center for American Progress; October 30, 2020 2020.



Amanda McDougald Scott, Ph.D.

Advocate for social justice, mom to a 5-year-old, partner, friend. Political, child care, early childhood, psychology, and health care wonk.