Taking Back America

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How Medicaid forces families like mine to stay poor

From Vox
By Andrea Louise Campbell on July 28, 2015

“You’ll have to get rid of everything”

On a crisp California morning in February 2012, my sister-in-law, Marcella Wagner, was driving down the interstate toward Chico State University, where she had just entered the nursing program. She was thinking about the day ahead when suddenly another driver swerved in front of her. To avoid a collision, she jerked the wheel hard, and her car veered off the freeway. It rolled over, crushing the roof. The other driver sped off, never to be found. Marcella was seven and a half months pregnant. Miraculously, the baby survived and was not harmed. But Marcella was left a quadriplegic, paralyzed from the chest down and with little use of her hands. She will need a wheelchair and round-the-clock personal care assistance indefinitely.

The accident caused more than the physical and emotional devastation that upended Marcella’s career plans. It also brought about an economic tragedy that hurtled her young family into the world of means-tested social assistance programs, the “safety net” of public programs for the poor. My brother, Dave Campbell, works for a small company that doesn’t offer employee benefits. Nonetheless, before the accident Marcella had managed to secure health insurance for both her and the baby. Her pregnancy and 60 days’ postpartum care was being covered by Access for Infants and Mothers, California’s health insurance program for middle-income pregnant women. After the birth, Marcella would have been able to join the university’s student health plan. The baby would be covered by the Children’s Health Insurance Program, the federal-state plan for lower-income children. Marcella and Dave thought they were all set. And then, with the accident, they fell down the social assistance rabbit hole.

At first I thought I would be a great help to Marcella and Dave as they negotiated this web of programs. After all, I’d been teaching and writing about social policy for years, first at Harvard and then at MIT. But I was soon humbled by how immensely complicated the programs are on the ground, and shocked by how penurious. The programs that Marcella now needs as a quadriplegic have helped her in many ways, but have also thrust her, my brother, and their young son into poverty, with little hope of escape. Until this accident, I did not realize the depth of the trap.

And this is not just the story of one family hit by tragedy. Millions suffer under such program strictures and limitations. Between ages 25 and 65, two-thirds of Americans will live in a household receiving means-tested benefits, according to sociologists Mark Rank and Thomas Hirschl. And even if we avoid these programs during our working years, most of us will be disabled at some point in old age, and Medicaid — a means-tested social assistance program — is the most likely source of the help we’ll need. This is an American story, the product of the uncertain and incomplete system of social protections in the United States.

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