Louisiana is scraping the bottom of US maternal and early childhood health outcomes, and has decreased workforce productivity and economic competitiveness . Without investment in early care and education, Louisiana can expect more of the same. With investment in early care and education through LA B to 3, Louisiana will be transformed in one generation. The Commission recommends an investment of $85.8 million to create LA B to 3, and an increase of nearly that amount annually over the next decade. State investment should launch this effort with expanded, combined funding (local, state, federal, philanthropy) thereafter. (author abstract)