Falling through the cracks of the American welfare system

Image: On this map, the darkened counties in Mississippi are some of the poorest counties in the entire United States. These counties were not served by Obamacare health insurance subsidies. (source)



A look back at three of the worst examples I have ever encountered of neoliberal welfare programs letting eligible individuals fall through the cracks.

First, a 2013 warning about Obamacare in Mississippi (emphasis added):

No insurer is offering to sell plans through the federal health law’s marketplaces in 36 of the state’s 82 counties, including some of the poorest parts of the Delta region, said Mississippi Insurance Commissioner Mike Chaney.

As a result, 54,000 people who may qualify for subsidized coverage would be unable to get it, estimates the Center for Mississippi Health Policy, a nonpartisan research group.

Many make a living picking soybeans, working on tree farms or in fast food restaurants, earning too little to buy coverage on their own.

“That’s the place where it’s most needed,” said Roy Mitchell, executive director of the Mississippi Health Advocacy Program. “There’s a high uninsured population there. One of the highest infant mortality rates in the country is in that area.["]

Second, a 2001 study of the Child Care and Development Fund--a program that is supposed to pay for child care for young children so their parents can go to work (emphasis in original):

Based on recently released and revised data from the U.S. Department of Health and Human Services (HHS), CLASP estimates that states served about 14 percent of federally-eligible children (approximately 1 out of 7) in FY 2000.

You did not misread that: CCDF was so poorly funded that 86% of eligible children did not receive benefits.



If we can't even be moved to care about children and working parents, then unwanted groups such as Native Americans and Alaska Natives certainly won't raise our sympathies, either--especially not during the 2013 federal budget sequester, when money (as usual) came before human lives:

Even in normal times, the Indian Health Service operates with about half the money it needs. Tribal Council members told me that some of their health funds last only until May. If you get sick after May, too bad. Now these health care programs, already rationing care, are subject to the sequester. The Indian Health Service estimates that as a result it will have 804,000 fewer patient visits this year.

And, mental health:

“Since the beginning of the year, there have been 100 suicide attempts in 110 days on Pine Ridge,” Abramson said, referring to an Indian reservation in South Dakota. “Because of sequestration, they will not be able to hire two mental health care providers. As one tribal health official told NIHB, ‘We can’t take any more cuts. We just can’t.’”  

And South Dakota's Pine Ridge tribe isn’t unique. American Indians and Alaska Natives have the highest rates of suicide compared to any other ethnic group...

“As young as nine-years-old, we’ve heard of kids committing suicide. All the way up to the elders, you know, grandmas and grandpas,"...

In other news, 100% of those enrolled in Social Security and Medicare received benefits.

Social Security and Medicare are entitlements; "entitlement" is a technical social policy term that simply means that the government has a legal obligation to provide benefits to all who are eligible. This is a feature of all social democratic programs, including Social Security and Medicare.

But liberal social welfare programs--like Obamacare, the Child Care and Development Fund, and the Indian Health Service, along with most of the American welfare system--are not entitlements, so there is no legal obligation to ensure those eligible actually receive benefits. You will only receive benefits if your receipt of those benefits is politically expedient. If--as in Obamacare--service is unavailable in your area because endemic poverty and high infant mortality make the sale of health insurance--even with generous public subsidies--unprofitable, you are out of luck. If money runs out for the year because Congress only set aside enough money for to meet a small fraction of total need--like in CCDF and IHS--most eligible individuals won't receive benefits.

The only way to ensure welfare state equity is to make eligibility universal and benefit provision a legal entitlement.


Related: The Human Case Against Means Testing