In 2021, the United States came closer to enacting the first federal paid family and medical leave program when the House passed the Build Back Better Act, H.R. 5376. Ultimately, paid family and medical leave and other caregiving priorities were dropped from the final enacted bill now known as the Inflation Reduction Act. However, the run-up to House passage marked a period of rapid policy development and evolution that resulted in more detailed paid leave proposals. In this brief, we describe and compare the proposals under debate. Proposals by the White House and Congress generally prioritized expanded coverage and eligibility for workers, benefits that replace a larger share of earnings for lower-wage workers, and integration with existing state paid family and medical leave programs and employer benefits. Policy constraints imposed by negotiations over the Build Back Better Act reduced the length of leave, maximum benefit level, and job protections in the House-passed bill. Research is needed to estimate the impact of the various proposals on worker access, take-up, benefit levels, participation in other programs, employment, health, and consequences for business.