The American Way of Poverty: How the Other Half Still Lives (34 page)

Sondra Youdelman, executive director of Community Voices Heard, recalled a client who had gone from TANF onto disability and then applied for food stamps for herself and her two sons, aged 17 and 19.
Sorry
, she was told,
your family can only access the assistance if the two boys, one in college, one still in high school, work for the benefits
.

“If you don’t comply you are sanctioned. You can appeal, but 80 percent of people who are sanctioned don’t,” Jennifer Hadlock, a colleague of Youdelman’s, stated. “They screw up all the time, and cut people off who are actually complying. Ten thousand at any one time are sanctioned, out of 180,000 on cash assistance.” Community Voices Heard had documented stories of welfare recipients either doing make-work or literally having to sit hours a day doing nothing in a jobs center that is such in name only, just so that the Big Apple’s welfare bureaucracies could say that work requirements were being met. It was a façade worthy of the fabled Potemkin village creators.

Similar situations abound around the country. In 2012, in California alone, according to Jessica Bartholow, 72,000 adults were being sanctioned with a loss of food stamps because they couldn’t find jobs.

All of this makes for a double-whammy on the poorest and most difficult to employ section of the population. In the middle of this extraordinary recession, noted Youdelman with deliberate understatement, ramping up punitive enforcement efforts when the poorest of the poor attempted to gain food assistance “seemed odd and counter-intuitive to us.”

While the Obama administration waived most work requirements for food stamp recipients during the recession, it never found its way to lifting this burden on the bottom part of the economy. The result? While food stamps served to limit the slide into poverty for the newly unemployed working poor, the program did little to halt the slide into ever-deeper poverty for those who had no jobs to lose in the first place.

A related program to food stamps, school meals,
is
also counter-cyclical, but in a peculiarly delayed way. It works best when students enroll at the start of the school year. But if a recession kicks in mid-year, as, inconveniently, most do, with rapid job and income losses, the school lunch enrollment systems operated by states struggle to
keep up. Usually there’s a gap of weeks to months between when a family falls into poverty and when the kids start receiving free meals. Making matters worse, at the same time school years are being cut by cash-strapped states and school districts, meaning more days when children go hungry, and partially canceling out the benefits accrued kids by access to the breakfasts and lunches.

To make this nutritional program more fully counter-cyclical, so-called “feeding programs” have to be properly funded for the periods when school’s out. The federal government already has pilot programs, in Kansas City and other locales—the programs Rush Limbaugh so colorfully denounced for creating dependent little serfs—doing this. In the coming years, expanding such funded programs would better integrate this nutritional assistance into the overall welfare system.

BURIAL PLOTS, BROKEN GLASSES, AND OTHER PROBLEMS WITH MEDICAID

One other core part of the safety net is also largely counter-cyclical, designed to kick in with greater assistance when the need increases. And that is Medicaid, which grants families with kids access to healthcare once they reach a certain threshold level of poverty.

But while Medicaid is a whole lot better than nothing, it has, historically, been severely restricted in a number of ways. In fact, until all the major Affordable Care Act provisions kick in, in 2014, most states won’t extend Medicaid to childless adults. At the same time, a minority of states, again mainly southern ones, will continue to place huge restrictions on adults of
any
status, even those with young children at home, gaining access.

The problem, however, goes beyond one of gate-keeping. Even in states that have relatively liberal eligibility requirements for their programs, there are strict asset tests in place that have the effect of forcing the temporarily out of work and/or cash poor to strip themselves of almost all their worldly possessions (homes, car, retirement
accounts, savings) simply to gain healthcare—even if this ends up condemning them to long-term poverty by depriving them of the possessions and financial cushions that people need before they can even start working their way up the economic ladder again.

How, for example, can an unemployed person in an area without public transport get a job, and travel to that job, if he has had to sell his vehicle so as to get medical coverage? Or how can a person afford to retire if she has had to liquidate her small nest egg for that healthcare access? What should the middle-aged businessman in California who had lost his business during the recession and who needed knee surgery before he could take on new work do when he was told that he couldn’t get medical assistance, and thus couldn’t get his surgery, until he had stripped himself down to a maximum of $2,000 of assets? It is, truly, a Faustian bargain into which large numbers of Americans have been pushed.

In some instances, the asset tests are particularly macabre. Linda Pratt was a mother of four, and a guardian to three more, and a woman who had spent her entire adult life in near-minimum-wage jobs—most recently working with mentally disabled children for $8 or $9 per hour. Pratt’s husband, Lloyd, several years her junior, was a construction worker. Neither had insurance through their work, and both earned so little that, as a family, despite the two incomes they were below the poverty line. When Linda’s husband had a stroke, in his late forties, and ended up hospitalized, the couple were bankrupted by their medical bills. Their home had already gone underwater because of the collapse in the housing market; now their van was repossessed. But when they applied for Medicaid, they were denied. The reason they were given: they had too many assets. And the assets they had? Each of them had bought a burial plot, so that when they eventually died they wouldn’t be confined to a pauper’s cemetery.

“There is no kind of medical coverage for either me or Lloyd; and we go to work every single day,” Pratt said quietly, sitting in a little wooden church, built on a small back road in Flint, in which she went to pray. “My husband still does not have any feeling from
his knees down—they’re permanently damaged from the stroke. But he still goes every single day. Lately he’s been having chest pains and didn’t want to tell me because he would have to go to the hospital.”

In other words, while Medicaid
does
enroll more people during recessions, it does so in a way that, at times, might actually have the effect of tamping down economic recovery down the road by locking recipients into a deeper poverty than they were in when first they lost their income. In deep recessions, in particular, modifying, or eliminating, asset tests for Medicaid would go a long way toward keeping people both healthy and out of long-term poverty. Yet that hasn’t happened. The political will simply isn’t there.

Finally, state after state is limiting the services covered by Medicaid, meaning more people still end up paying out of pocket, or doing without, when it comes to such vital services as eye-care, dental work, and mental health clinics. Recall Patty Poole’s experience in New York when she needed a compression stocking to manage her lymphedema. Or put yourself in the shoes of Albuquerque resident Jamie McBride, a mother of two young children and wife to a recovering alcoholic and drug addict who, when I met her in December 2011, had spent over a year making do without needed eyeglasses because she had broken her previous pair and Medicaid no longer covered replacement glasses more often than once every three years. McBride’s husband had run a handyman’s company until the economic recession put a stop to that. Now, their income came from Jamie looking after her sister’s children, for which she received about $100 a week; when that didn’t cover their bills, the couple borrowed from other family members. They no longer had any credit cards—and no credit with which to open a card. Once they borrowed from a payday loan company they had seen advertised on television for gas and car repairs—using their car as collateral—and ended up paying, within a month and a half, 100 percent interest on their loan. They had not enough of value to be able to pawn anything for cash. Paying out of pocket for new glasses was, quite simply, out of the question. Penny-wise and pound-foolish, such cost-saving decisions, likely
to grow in number if Republican attempts to convert Medicaid into a block grant program to the states come to fruition, both stack up a host of medical issues down the road and also undermine the public’s confidence in the quality of services provided by Medicaid.

DIAL 211

Let me repeat what I wrote earlier. We know what to do to fix these problems. There’s no mystery, for example, about how to improve Lisa’s situation: When she was hard up, she ought to have been eligible for Medicaid; now that she’s less hard up, she oughtn’t to be hobbled by paying off loans for tens of thousands of dollars in medical expenses.

Around the country, we know how to craft big-picture federal reforms. We know how to let states tailor their own supplementary safety nets best suited to meet local conditions—witness, for example, the extraordinarily innovative thinking behind the network of coordinated care organizations in Oregon, championed by Governor John Kitzhaber, which are intended to rein in medical costs by encouraging more preventive and primary care, and low-cost interventions such as the provision of air-conditioning units, free of charge, to poor elderly residents, and those with congestive heart failure, during heat waves. And we know how to stimulate local programs, through combinations of federal aid and private sector and nonprofit grants, to improve the lives of millions of Americans.

We know what to do regarding unaffordable healthcare bills. So we also know how creative a role the federal government could play in generating jobs during times when millions are out of work. What we need is not more information, but more
political will
to do what is right by America’s residents.

Were that will to reform in place, we could, for example, take up the suggestion by Harvard’s Richard Parker that the federal government should expand what he terms “public works-lite,” especially for the millions of marginally disabled Americans currently enrolled on
SSI because they are “refugees” from other parts of the shrinking welfare system. Such a public works program, he said, ought to kick in automatically during either regional or national downturns, with money targeted to high unemployment zones within states.

A regional allocation of resources of this kind could be expanded to cover other welfare benefits as well, thus allowing deprived areas to access additional funding even if the state as a whole didn’t qualify. This would have the added benefit of bypassing often highly dysfunctional state agencies that operate in increasingly partisan state political environments, and it would give localities an incentive to link their most impoverished residents up with federally funded entitlement programs, rather than with state systems operating under limited block grants. In other words, it would replace disincentives for enrolling people with strong fiscal incentives, thus producing a safety net resilient in the face of stress instead of one that, increasingly, fails to catch those who fall during downturns. We could, for example, channel funding for childcare programs for low-income families directly to localities—instead of leaving such funding up to states that, all too often, cut access to programs once the economy heads south. We could do the same with drug treatment programs, mental health services, and shelters for the homeless.

And because of sophisticated database technologies, this could mostly be implemented at speed. If high numbers of people from one region start enrolling in programs available only to people below certain income thresholds, why not use those enrollments to trigger automatic membership in other programs? Low-income Social Security applicants, who have traditionally enrolled in nutritional assistance programs at only very low rates, could be automatically enrolled in food stamps—as will soon be the case in California and some other states.

In California, Assembly Bill 69 mandated an exchange of information between the Social Security Administration and the state’s Department of Social Services, allowing what Ken Hecht, executive director of California Food Policy Advocates, calls a “pre-population
of the food stamp application” when a Social Security application is filled in. Translation: Fill in one form, and the computer system will communicate that information to another government department with the intent of enrolling you in all the programs you are eligible for.

Similarly, food stamp enrollment for families could automatically trigger children’s Medicaid or S-CHIP enrollment. A version of this is already being done in Louisiana, where 40,000 low-income kids were given “express lane eligibility” into S-CHIP—a somewhat surprising accomplishment, noted CLASP’s Elizabeth Lower-Basch, given how abysmally Louisiana performs on most other poverty measurements. And a person released from prison without income and without up-to-date identification could be enrolled in, say, food stamps or Medicaid at the same time that his driver’s license is processed.

To a degree, such coordinated efforts already exist. In 1997, Atlanta began a 211 phone service. Twenty-four hours a day, seven days a week, residents could call the hotline and ask how to get connected to various different agencies and nonprofits to help them with an array of needs—be they energy assistance or drug treatment. Many other regions followed suit. In California, for example, large numbers of cities and counties now have their own 211 systems in operation. Taking these efforts a step further, through the coordination of benefits described above, would be neither difficult nor expensive. In an information-and-technology era such as ours, one-stop shopping for benefits makes sense both for individuals seeking help and for government agencies with the mandate to supply that assistance.