Bryce Covert | The Nation

Maria Fernandez, an employee of United Home Care Services. (AP Photo/Lynne Sladky)

It’s pretty well known that while women dominate the fast-growing fields of domestic work and home health work, this is only a partial victory. After all, not only are these jobs low-paid, they come rife with abuse. But women also dominate other quickly growing healthcare jobs such as nursing, making up over 90 percent of that workforce, which are far better paid. Where a home health aide can expect to make just over $20,000 a year at the median, a registered nurse looks forward to nearly $65,000. This should be a great sign. Yet a new report shows that the abuse that plagues those who work in the home follows women even when they work in a hospital.

The report from the Lucian Leape Institute, “Through the Eyes of the Workforce,” reviewed the research and convened roundtables and focus groups to look at the working conditions in the healthcare industry. What it found is widespread abuse. The rate of physical harm for the healthcare workforce, particularly for nurses, is thirty times higher than other industries. In fact, the Bureau of Labor Statistics reports that the injury and illness rate for full-time healthcare workers is 56 percent, compared to 42 percent for all private industries—and remember that this includes dangerous jobs like police officers, construction workers and firefighters. More than three-quarters of nurses surveyed by the American Nurses Association said that unsafe working conditions were interfering with delivering quality care. A third of nurses in a nationwide sample reported back or musculoskeletal injuries in the past year, and 13 percent reported unprotected contact with blood-borne pathogens.

The abuse isn’t just physical, though. The report notes, “Health care has a long history of toleration of disrespectful behavior by physicians, and to some degree by nurses, and evidence indicates that this toleration continues.” Overt abuse such as bullying, sexual harassment and even threats of physical assault are often seen as acceptable, as are other less overt ways of judging and mocking workers. Higher-ups also often assign extended hours and dole out unexpected shift changes, not just degrading the workers but impacting their ability to balance their jobs and their families.

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This should all sound pretty familiar to those who work inside the home. The National Domestic Workers Alliance surveyed the in-home workforce and found disturbingly high levels of abuse. Thirty-eight percent reported suffering from wrist, shoulder, elbow or hip pain, and another 31 percent reported soreness and pain from their jobs. Over 20 percent of nannies and caregivers reported back injuries. A quarter of caregivers and 36 percent of nannies reported contracting an illness while at work. They also endure emotional harm—nearly one in five reported being threatened, insulted or verbally abused.

Remember the “end of men” meme? One of the big data points that supposedly showed women on the brink of winning the economy is that they dominate jobs in industries that are growing the fastest. What this narrative never took into account is what these jobs are actually like. Even a “good” job like nursing may not constitute a win for women.

In Brooklyn, domestic workers often get contracted as day laborers. Read E. Tammy Kim’s story in the April 1 edition of The Nation.

Paul Ryan speaks on the federal budget, Capitol Hill, 2011. (AP Photo/J. Scott Applewhite)

The latest iteration of Paul Ryan’s budget is out today, and while you might expect it to look very different than the one proposed before he was part of a losing presidential ticket, he seems to have dug in his heels on some of his most extreme proposals, like block granting vital programs, voucherizing Medicare and drastically slashing spending. As with the first rounds of Ryan budgeting, this one would be bad for nearly everyone (except perhaps the wealthy), but it would especially take an enormous toll on the country’s women.

Medicaid

Women depend heavily on Medicaid. They make up 70 percent of its beneficiaries, which means 19 million low-income women have access to health care.

Last time around, Paul Ryan wanted to block grant Medicaid. This time is no different. In its current form, Medicaid is a program in which states and the federal government jointly finance health care for low-income people. Because the federal government shares the cost with states, it also requires them to adhere to some guidelines on benefits and eligibility. In a block grant system, however, the federal government sends a lump of cash off to the states with no strings attached. Even if actual spending on the program isn’t reduced (which, given the huge cuts to government spending included in this program, those who are wonkier than I may find it will be), simply changing the structure of the program this way is a very bad plan.

We’ve tried this experiment before: we block granted welfare, now called TANF, and it’s done a terrible job of helping low-income Americans, particularly as demand skyrocketed during the recession. In 2010, only twenty-seven of every hundred families living in poverty received TANF benefits. Some states could decide to increase benefits and eligibility, but given the tight budget constraints they face it’s much more likely that people will be dropped. In fact, somewhere between 14 million and 27 million could lose Medicaid coverage by 2021 under a block grant system. That will have a huge impact on the women who rely on it.

But the picture gets even worse when you consider what else he wants to do.

Obamacare

Ryan also promises to repeal the Affordable Care Act. While he doesn’t want to repeal cuts to Medicare spending included in the act, he does promise to repeal the benefits, perhaps the biggest of which is the Medicaid expansion. Women would reap huge benefits from the expansion of Medicaid, given that 13.5 million were expected to get health coverage that way by 2016.

Other provisions that women have been benefitting from in the ACA: the end to gender rating, which was costing women an extra $1 billion a year; access to preventive care without a co-pay, netting a woman around $11,000 now that she doesn’t have to pay a co-pay for contraception, among other things; getting rid of “pre-existing conditions” like pregnancy and domestic violence; and many other great benefits. All out the window if Ryan gets his way.

Medicare

As with Medicaid, the majority of Medicare beneficiaries are women. Women live longer than men, but they also are far more likely to live in poverty in their old age, with twice as many women over age 65 in poverty compared to men.

Ryan still wants to voucherize Medicare, even though the electoral trouncing he and Romney took last year seemed at least in part a rejection of messing with this program. Currently, taxpayers are on the hook for any increase in healthcare costs or premiums that are higher than expected. But with the voucher program, seniors get a coupon of sorts to buy insurance coverage—in its current form, Ryan’s budget allows for them to buy private insurance or Medicare insurance—and will have to make up the difference if the coupon doesn’t go far enough. Meanwhile, Medicare currently guarantees what services will be covered, but in Ryan’s program seniors will be responsible for determining what services they need depending on which insurers they pick. That’s a pretty difficult job in such an opaque market.

On top of this, last time around the coupons increased so slowly that spending on the average 67-year-old would have dropped by 35 to 42 percent by 2050. Elderly women would see less and less support for buying the insurance they need.

Food stamps

Women rely on food stamps to feed themselves and their families. They are more than 60 percent of adult SNAP (the food stamp program) recipients and over 65 percent of elderly recipients. More than half of the households that rely on SNAP benefits are headed by a single adult, nearly all women.

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Ryan’s plan would block grant SNAP the same as Medicaid. Currently, eligibility for the program has few restrictions, allowing it to serve a wide swath of needy people—47 million participants. On top of this, it’s extremely flexible, allowing it to be one of the most effective cushions for the rising misery during the recession. That would all change under a block grant. Eligibility would vary by state. Meanwhile, while SNAP reaches 75 percent of those who are eligible, we can look at the low rates of TANF participation to see what would happen if it were block granted.

Discretionary spending

Ryan’s tax reforms would lead to the federal government losing out on $7 trillion in revenue, mostly with tax breaks aimed at the rich and corporations. But at the same time, he promises to balance the budget in ten years. To get there, he’ll cut spending by $5.7 trillion compared to the current baseline (which, lets remember, is already so low that it’s cutting into vital programs). These cuts won’t fall evenly on defense and non-defense spending—he actually increases defense spending compared to current law by $500 billion over the same time period.

Yet discretionary spending will be cut by more than $200 billion. Ryan would extend the Budget Control Act caps, which is already set to cut $1.5 trillion in discretionary spending. Women benefit enormously from the programs funded by this spending. Over 80 percent of the households that receive Housing Choice Voucher rental assistance are headed by women. The Women, Infants and Children program, or WIC, helps 9 million low-income mothers and children with supplemental nutrition and health care referrals. Programs like childcare assistance and Head Start are also funded through this money. All would stand to see huge cuts.

There are likely lots of other ways this budget will harm women—we’ll find out as budget wonks continue to analyze it. But it’s clear either way that Paul Ryan took his defeat and decided to double down on the policies he set forth. Women voters roundly rejected him and his running mate in 2012. This budget does nothing to address their needs and works against the most vulnerable among them.

Who actually does support Paul Ryan’s budget? John Nichols answers.

Housekeepers at the Westin Hotel. (Flickr/Douglas Muth)

Our workforce, once dominated by men, is now pretty much equally split between the genders. But a funny thing has happened since women entered it in droves: rather than all workers enjoying the stable, unionized, blue collar jobs men typically held until the latter part of the twentieth century, the jobs held by all workers look more and more like stereotypical “women’s work.” These jobs expect workers not just to make a product, but to do it with a warm attitude. They are less likely to be full-time, but instead modeled after part-time work for “pin money.” And an increasing number of jobs are low-pay, low-benefit work in the service sector, once the purview of women workers. We’re all women workers now, and we’re all suffering for it.

A couple of weeks ago, a number of bloggers took notice of a growing trend: the increasing demand for “affective labor” or “emotional labor” in service sector jobs. This was exemplified in a London Review of Books article about how workers at Pret A Manger are not just expected to show up at work, make sandwiches and ring customers up, but to do it with a happy attitude. Enumerated “Pret Behaviours” (since deleted from the company’s website) expect that the company’s workers “create a sense of fun” and are “genuinely friendly” and warn against those who are “moody or bad-tempered,” “annoys people” or “is just here for the money.” Heaven forbid that a low-pay, unstable service sector job be about earning income to cover one’s expenses.

This sort of requirement is not unique to Pret; in fact, it seems to be an increasingly common expectation. (This is why the cashiers at Trader Joe’s always seem eager to share an off-topic personal anecdote while they bag my Joe’s Os.) Researcher Arlie Hochschild estimated that about a third of all jobs entailed emotional labor in 1983 when she first wrote about the subject in her book The Managed Heart, but today, reports Timothy Noah, Hochschild estimates it’s closer to half.

In response, Sarah Jaffe rightly pointed out that this trend isn’t exactly new for one segment of the population: female workers. Women have long been expected to put on a smile and flirt at work, from nurses to domestic workers to waitresses to sex workers. In fact, the obligation to be happy and comforting was a big part of the few career paths offered to women in the 1960s as the transition from the homemaker model began to slowly give way to working outside the home.

One of the few jobs women could get was flight attendant. As Gail Collins wrote in her book, When Everything Changed, most flights were full of male passengers and some even barred women from flying. But women, while kept from flying the planes, were sought after to be stewardesses. “[T]he airlines were looking for attractive, unmarried young women,” Collins writes, and even fired women who had husbands. There were limits on weight that were strictly policed to ensure that the women remained attractive. “The airline industry [argued] with a straight face that businessmen would be discouraged from flying if the women handing them their coffee and checking their seat belts were not young and attractive,” she wrote. The industry took things pretty far:

In 1971 National Airlines began its “Fly Me” campaign, in which lovely young women in flight attendants’ uniforms purred, “Hi, I’m Cheryl/Donna/Diane. Fly me.” Continental announced, “We really move our tails for you,” and Southwest introduced itself as the “love” airline, where passengers would be served “love bites” and “love potions,” otherwise known as snacks and drinks. Meanwhile the women who were dispensing the love bites, moving their tails, and (later) promising to “fly you like you’ve never been flown before” were being dressed in miniskirts, vinyl, hot pants, and—in the case of TWA—paper clothes, such as togas, cocktail dresses, and “penthouse pajamas,” that were supposed to match the entrées.

One can only imagine the attitude and smiling requirements that went with such jobs. A flight attendant couldn’t just show up and serve drinks to passengers; she had to act out the part of a happy, flirty hostess.

Now these practices, once reserved for young, attractive women, have spread throughout the economy and apply to both genders. Yet we still undervalue these emotionally demanding jobs. As Andrew O’Connell writes, men get a nearly 9 percent wage boost when they move to jobs that require increased cognitive labor, yet they take a nearly 6 percent cut in pay if they move to jobs that demand higher emotional labor. Women don’t get a penalty for moving into emotional labor, but they certainly don’t see a wage boost, as their pay stays flat. Perhaps this is because we still think of this as women’s domain, even though men are increasingly expected to do it too.

Meanwhile, women were the guinea pigs in another disturbing trend: the rise of the temp worker. As Erin Hatton wrote in The New York Times recently, the temp industry has added more jobs in the United States than any other over the last three years. The recovery period has undoubtedly seen the replacement of full-time jobs with part-time and temporary ones. Part-time employment grew from just under 10 percent in 2007 to over that in 2010, even though the percentage of workers in those jobs who would rather full-time work doubled. Temp jobs look even worse: they accounted for over a quarter of all new private sector jobs created in 2010, even though they were only about 7 percent of the jobs created in the wake of the 2001 recession. Hatton notes that employers could have chosen to invest in workers and their products. Instead, they took the low road.

Hatton writes that the temp industry sprung up near the height of unions’ power with the ability to skirt labor protections by “casting temp work as ‘women’s work,’ and advertising thousands of images of young, white, middle-class women doing a variety of short-term office jobs.” This strategy “exploited the era’s cultural ambivalence about white, middle-class women working outside the home. Instead of seeking to replace ‘breadwinning’ union jobs with low-wage temp work, temp agencies went the culturally safer route: selling temp work for housewives who were (allegedly) only working for pin money.” They were thus able to create an entire industry of low-pay, unstable work without running into battles with unions or having to offer the employees workplace protections like health benefits, organizing rights and anti-discrimination laws.

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But the “Kelly Girl” model of women working for fun eventually became a broader argument about the nature of wage work. The industry “began to argue that all employees, not just secretaries, should be replaced by temps,” Hatton writes. “And rather than simply selling temps, they sold a bigger product: a lean and mean approach to business that considered workers to be burdensome costs that should be minimized.” Workers were depicted as a burden to be dropped in the name of being lean and agile. This new model became more attractive during the recessions of the 1970s, and temps went from 185,000 a day to over 400,000 in 1980. That last number was the total number of temps employed per year in 1963. But then this became a way to structure the workforce even when times were good: as the economy boomed in the ’90s, the number of workers grew to nearly 3 million by 2000.

Even full-time employment looks increasingly like the service sector jobs that were once thought to provide women “pin money,” not the sole source of income for a family. A report from the National Employment Law Project found that mid-wage jobs have been all but replaced by low-wage jobs in the recovery period. Retail has led the pack in creating jobs—about a third of the people who got a job in November, for example, got it in retail. The sector added over 140,000 jobs between September and November. Food service and other service sector jobs also lead the pack. These have traditionally been dominated by women, but now if you want a job, both genders have to take a look at working jobs that offer little pay, few benefits and barely any stability.

None of this is the fault of women who decided to enter the labor force. As they made their way into a booming, middle-class workforce in the 1970s, companies could have responded by offering them the same stable, well-paid jobs that men had enjoyed. Instead, they lowered the bar. And now the bar is being lowered for everyone. The economy has been feminized as the floor keeps dropping beneath all workers’ feet.

Check out The Nation’s series on how labor can respond to the changing composition of employment.

Twenty years ago today, the US passed the Family and Medical Leave Act, finally codifying into law the right for most employees to take time off from work for the birth of a baby or to care for a seriously ill family member. Since then, workers have used it 100 million times to care for themselves and their families.

But this milestone, and all the good it’s done since, hasn’t been enough. We’ve fallen behind our industrialized peers on many key indicators since then. Only about 60 percent of workers have access to paid leave, putting a huge financial burden on new parents and those with sick family members. Our failure hits working families square on. But it’s a problem we all bear, because it’s also threatening our economic edge.

The US holds a dubious distinction: single parents in this country are the worst off compared to 16 other high-income countries, despite the fact that we have the highest rates of single parenthood. There are a variety of factors that go into getting that award—failing to ensure adequate health insurance coverage, long waits for early childhood education to begin, low rates of child support receipt—but an important factor is family leave. We’re the only one without paid leave, and we also fall behind in how much leave we guarantee. As the report notes, “The duration of the job-protected leave entitlement ranges from a low of 12 weeks in the U.S. to a high of 162 weeks in France and Germany.” Here’s how it looks for single mothers in various countries:

Yet even unpaid leave isn’t going far enough. About forty percent of workers aren’t eligible for FMLA leave. The Department of Labor just released new numbers on the FMLA, finding that nearly five percent of all workers needed to take leave and couldn’t, and over six percent had an unmet need for leave in the past 18 months. Those numbers have gotten worse since the 1990s: in 1995 just half that number needed leave but couldn’t take it in the previous 18 months. It’s worst for low-income workers: 8.2 percent of those who make less than $35,000 a year versus 3.4 percent of those who make over $75,000.

Of those who couldn’t take leave, nearly half said it was because they couldn’t afford it. No wonder, when half of all leave takers are either paid only part of their normal wages or nothing at all. Those numbers are again greater for low-income families. We also know that those who do take unpaid or partially paid leave struggle to make ends meet. The DOL reports that 30 percent borrowed money to get by during leave, more than 35 percent dipped into savings meant for something else, the same number put off paying bills, 85 percent had to limit spending and, most disturbing, almost 15 percent went on public assistance. That last figure has almost doubled over the past ten years.

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These problems have had a huge effect on our economy, specifically on women’s share of the workforce. After growing rapidly since the 1970s, women’s participation rate in the labor force started to flat line in the '90s. It was 74 percent in 1990 and has only grown to 75.2 since then. Turns out, though, that this makes us an outlier. In that same time period, other developed countries kept growing their share of women in the workforce. Twenty-one others shot up from an average of 67 percent to nearly 80. That means that while we used to rank at number six, we’ve sunk to number 17.

Paid family leave figures prominently when you look at the causes of these declining numbers. We enacted unpaid leave in the ‘90s, but since then other countries have mandated paid leave that’s longer than 12 weeks and have kept expanding it. If the US had kept up with the times and mandated paid leave, while adding in other policies like protections for part-time work and increased spending on child care, women’s share of the labor force would be at 82 percent, bumping us up to number 11. The lack of these policies accounts for nearly 30 percent in the deterioration of women’s participation rates. Before you think this is only problematic for a certain group of workers, remember that women’s entrance into the workforce since the 1970s accounts for a quarter of our GDP. Think about how much higher that would be if they’d kept making gains.

We are among just three countries out of 178 that don’t guarantee paid maternity leave. Being a mother and a worker shouldn’t be such a contradiction. The FMLA was vitally important, as the hundreds of millions of families who have used it can attest. But it’s clear that we’ve allowed ourselves to get left behind since then. Twenty years later, it’s time to update our policies so they look like we live in the 21st century.

For more on the plight of America's least well-off, check out Greg Kaufmann's blog.