Tangled net

Andrea Campbell’s Trapped in America’s Safety Net: One Family’s Struggle (University of Chicago Press, 2014) is a book from the left that provides evidence for what compassionate conservatives have long been saying: The social assistance system that purportedly serves the poor costs $1 trillion each year but works poorly for those who need it the most.

Campbell describes what happened when a hit-and-run accident left her sister-in-law, Marcella Wagner, paralyzed and dropped into the tangled webs of welfare hell. Given medical costs, she and her husband Dave Wagner could not make it on Dave’s income alone, but to qualify for social assistance he could not earn more than $2,100 per month and they could not have more than $3,150 in assets, not counting their house and car.

The Wagners also had to get rid of their 401K retirement savings account. They could not establish an emergency fund in case their water heater broke or they needed a new roof. Campbell writes, “In sum, they are barred from doing many of the things middle-class families are constantly advised to do. Save for retirement. Save for emergencies. Take advantage of tax-free college savings plans.”

Such rules counter the schemes of those who game the welfare system, but they do not and probably cannot take into account the individual situation of “a disabled person like Marcella who needs medical equipment such as a wheelchair, incontinence supplies, and assistive technologies, not to mention an accessible place to live and a wheelchair van for transportation. … Medicaid will pay for incontinence supplies, although fewer than Marcella actually needs; every month she has to apply and get approval for thirty additional catheters.”

Equipment is another matter: “The rehab facility social worker doubted Medi-Cal would pay for a fully reclining wheelchair, and ordered a partial-tilt one instead. Now when Marcella has to be catheterized every four hours, she has to stop what she’s doing and go home to a bed where she can lie flat. Later, her rehab physicians wrote her caseworker saying that Marcella needs a reclining wheelchair. After six months, no response.”

Welfare programs need income restrictions or else they would expand even more quickly than they do, but the restrictions can keep families from climbing out of poverty: When Dave increases his income, Marcella loses program eligibility. “Could we approach Marcella’s caseworker to run the what-if scenarios and see how much income Dave could earn without threatening her eligibility? No, state officials told me: county caseworkers are incredibly busy, particularly with Medi-Cal expansion under the Affordable Care Act.”

The result, for the Wagners and author Campbell, an MIT political science professor, is frustration in attempting to navigate “a collection of one hundred programs, each with its own income methodology and rules. … [The Wagners are] trapped in an eccentric’s mansion, where the stairways lead to ceilings and the doors open onto walls. … There’s not much incentive to earn more money, because social assistance recipients will lose most of that earning power as their benefits fall away.”

Campbell thus recognizes what conservatives have been saying for years: “Why seek a higher-paying job if it means a lower food stamp benefit and Earned Income Tax Credit refund? … The structure of American means-tested programs helps keep people poor.” It also keeps them unmarried or sometimes even pushes them toward divorce. Campbell’s solution is to have the government spend even more money, but that would end up hurting the poor even more and bankrupting America.

The only good news in this: The Wagners encounter compassion, not from government officials but from private citizens. Dave’s retired mother moves in and cares for the Wagners’ son, and when she has to leave, a preschool gives him a scholarship. A doctor waives his fee. Mercy Medical Center donates an air ambulance ride. Friends and family renovate the Wagners’ house to make it wheelchair accessible. A local construction company volunteers to coordinate the subcontracting. Local vendors donate items or offer them at cost.