TIME Healthcare Policy

Getting Poor to Get Help: How a Tragic Accident Trapped My Family in Poverty

Trapped in America's Safety Net
Trapped in America's Safety Net Courtesy University of Chicago Press

Campbell is the author of the new book, Trapped in America’s Safety Net: One Family’s Struggle.

When Andrea Louise Campbell's sister-in-law was horribly injured, she and her family had to spend down their money and assets to get the medical care they needed

Nearly one-third of American households live in or near poverty. The causes are myriad – and much contested. Those on the political right tend to cite the personal shortcomings of poor individuals while those on the left blame systemic barriers to upward mobility. But as my family has painfully learned, there is another shocking cause: government policy.

In February 2012 my sister-in-law Marcella was in a car accident on her way to nursing school, where she was working towards a career which she hoped would catapult her and my brother Dave into middle-class security. Instead, the accident plunged them into the world of American poverty programs. Marcella is now a quadriplegic, paralyzed from the chest down. She needs round-the-clock personal care and assistance. The only source – public or private – for a lifetime of such coverage is Medicaid. But because Medicaid is the government health insurance for the poor, she and my brother must be poor in order to qualify. (Medicare does not cover long-term supports and services, and private long-term care insurance is time-limited and useless to a 32-year-old who needs decades of care). Thus, Marcella and Dave embarked on a hellish journey to lower their income and shed their modest assets to meet the state limits for Medicaid coverage.

To meet the income requirement, my brother reduced his work hours to make just 133 percent of the poverty level (around $2,000 per month for their family). Anything he earns above that amount simply goes to Medicaid as their “share of cost” – a 100 per cent tax.

Worse: the asset limit. In California, where they live, they can own only $3,150 in assets beyond their home and one vehicle. They’re “lucky,” a social worker tells Dave: if not for the baby (Marcella was pregnant at the time of the accident; the baby miraculously survived), the asset limit would be $3,000. As if you can raise a child on $150. This asset limit was last raised in 1989. It has fallen by half in real value since then.

Dave and Marcella began to liquidate. Under California rules, retirement plans are not exempt from the asset test. Marcella had to cash in a small 401(k) account from a previous job, paying the early withdrawal penalty to boot. Dave had to abandon his hobby, working on old cars, which violated the asset test. He sold them all, keeping a 1968 Datsun pickup because its tiny value didn’t impinge on the asset limit. The pickup is 45 years old, weighs less than a Miata, and has no modern safety features. The only able-bodied adult in the family has to drive to work in an unsafe vehicle. And they had to empty their bank account, watching their hard-earned security disappear.

As Dave and Marcella spent down their assets, they had to keep track of every penny. They could only put the money into the exempt items, the house and the used wheelchair van they bought for Marcella. They could not use the money to pay credit card bills, household bills, or Marcella’s student loans from her undergraduate degree. And they are barred from doing any of the things the middle class is constantly advised to do: save for retirement. Create an emergency fund. Save for college with a tax-free 529 plan. Just $3,150 in assets – that’s it.

What happens in an emergency? One day the van’s wheelchair ramp stopped working. The repair cost $3,000—the sum of their meager assets. Fortunately their tax refund had just come in and went straight back out to pay for the repair. We don’t know what they’ll do next time.

What would help folks like Marcella and Dave?

True universal health insurance. A universal social insurance program for long-term care, not just Medicaid. And one modest change: no asset test. Policy is already trending in that direction. Under the Affordable Care Act, those newly eligible for Medicaid face no asset test. (Unfortunately those in the original eligibility categories, including the disabled like Marcella, are still under the old rule.) About half of the states have no asset test for any Medicaid recipient; perhaps someone realized that trying to ferret out the tiny amount of resources most Medicaid applicants have is inefficient. As for Dave and Marcella, I suppose they might move to a state with more generous rules. However, no state helps with wheelchair renovations. Lacking the assets to buy a new house elsewhere, they must remain in the home their friends renovated for them on an entirely volunteer basis.

It’s bad enough that America’s system of social supports is so limited. That the government also forces some of its citizens to get poor to get the help they need is an abomination.

 

Andrea Louise Campbell is professor of political science at the Massachusetts Institute of Technology. She is the author of Trapped in America’s Safety Net, out this month.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME Innovation

Five Best Ideas of the Day: September 19

1. China should match its massive investment in Africa with robust support for the Ebola fight.

By James Gibney in Bloomberg View

2. The market alone can’t drive advances in biomedical science. Philanthropy has a role.

By David Panzirer in Wired

3. Far from radical, the new USA Freedom Act protects citizens from government spying with better oversight and less secrecy.

By Mary McCarthy in USA Today

4. Outdated laws on debt collection and wage garnishment are crushing the working poor.

By Paul Kiel in ProPublica and Chris Arnold at National Public Radio

5. Scotlands referendum was a reassuring exercise in the ‘majesty of democracy.’

By Michael Ignatieff in the Financial Times

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

TIME poverty

Parking Meters Aren’t Going to Fix Homelessness

Real Change Movement
An example of one of the Real Change Movement's meters Real Change Movement

The converted parking meters have mixed results around the U.S.

It’s an eye-catching way to raise money and awareness about homelessness: 14 parking meters around Pasadena, Calif., all converted to collect change for those living on the streets.

In the last few weeks, Pasadena has joined several large cities around the U.S. that have set up what are essentially “homelessness meters.” They’re retrofitted parking meters that allow passersby to donate money by depositing coins or even swipe debit or credit cards. That money then goes to homelessness charities and organizations rather than directly to the homeless themselves.

“This is a clear alternative where people contributing know that all the money will go to effective services,” Bill Huang, the Pasadena housing director, told The Los Angeles Times.

Supporters say the money goes to organizations like the United Way or local homeless groups that know how to effectively use the funds for food, support and shelter and get around the possibility of that money going to drugs or alcohol. Two of Pasadena’s meters, painted bright orange and affixed with smiley faces, have reportedly raised $270 in their first three weeks. But elsewhere around the U.S., the meters have decidedly mixed results. In Orlando, for example, 15 homelessness meters have brought in just $2,027 in three years, and that was after the city spent $2,000 getting them up and running.

“I don’t know that these meters have been very effective anywhere, certainly not in Orlando,” says Jim Wright, a University of Central Florida professor who studies homelessness. “The concept was, I believe, oversold by the advocates and too rapidly embraced by politicos trying to create the impression that they were doing something significant about the homeless problem.”

Andrae Bailey, chief executive officer of the Central Florida Commission on Homelessness, which collects the money from Orlando’s meters, says they were installed in 2011 without a comprehensive homeless strategy focusing primarily on housing those in need.

“We tried to do meters without having a plan to house veterans and those with mental illness and disabilities,” Bailey says. “Anything other than a housing solution for the chronic homeless is a recipe for disaster.”

In Denver, 50 homeless meters bring in around $3,000 to $6,500 total each year, according to Denver’s Road Home, which launched the Donation Meter Program in 2007. The money goes to support services like housing, shelter, mental health and support services, says Denver’s Road Home executive director Bennie Milliner.

But some housing advocates criticize the meters as merely an attempt to reduce panhandling. Paul Boden, director of the Western Regional Advocacy Project, a collective of various West Coast homeless organizations, says that the installation of meters is often in conjunction with either increased enforcement of panhandling laws or additional legislation. Both Denver and Atlanta, which installed meters several years ago, have also worked to crack down on panhandlers.

“It’s a way to possibly reduce panhandling,” says Dennis Culhane, a University of Pennsylvania psychiatry professor who studies homelessness, adding that he doesn’t see much substantive impact from the meters on truly solving the problem of homelessness in those cities.

TIME Economy

The Poverty Rate Just Declined for the First Time Since 2006

New York City's Homeless Population Shows Sharp Rise In Last Five Years
A homeless man sleeps on a Manhattan street on Aug. 22, 2014 in New York City. Spencer Platt—Getty Images

45.3 million Americans, or 14.5% of the population, lived below the poverty line in 2013

The percentage of Americans living in poverty declined year-over-year for the first time since 2006 last year, according to a report released Tuesday by the United States Census Bureau.

45.3 million Americans, or 14.5% of the population, lived below the poverty line in 2013, down from 15% in 2012. The percentage of children under the age of 18 living in poverty declined to 19.9% in 2013, down from 21.8% the preceding year. It was the first recorded drop in childhood poverty since 2000.

The officially defined poverty threshold for a family of four in 2013 was $23,834.

Nonetheless, the report emphasized that the long-awaited declines in poverty were not quite large enough to be considered statistically significant improvements (i.e. definitively greater than a measurement error). The general findings of the report, entitled Income and Poverty in the United States: 2013, was that the measures of poverty had plateaued, with household income registering a statistically insignificant uptick to $51,939, an improvement of $180 over the previous year.

 

TIME poverty

Pasadena Is Repurposing Some of Its Parking Meters to Help the Homeless

The collected sums will be small, but officials say the meters, painted bright orange, are also intended to raise awareness about homeless programs

Motorists feeding the meter in Pasadena could now be helping to feed the homeless.

The Californian city is repurposing 14 of its parking meters to collect change for nonprofit programs that serve the homeless, the Los Angeles Times reports.

The collected sums will be small: the two meters so far converted have only raised about $270 in three weeks, according to the Times. Still, local officials told the Times that the meters, painted bright orange, with smiley faces and inspirational sayings, are also intended to raise awareness about the city’s homeless programs and encourage more donations to charitable organizations in general.

Some advocates for the homeless contend that the meters will hurt, not help, the homeless, because they do not put money directly into homeless hands but funnel it through organizations — and, in doing so, reinforce the belief that it is better to not give directly to the homeless because they will spend the money on drugs or alcohol.

Such advocates say some homeless people rely on direct donations to handle problems that fall outside a charitable program’s remit.

Pasadena’s meters were designed by students at the Art Center College of Design.

[Los Angeles Times]

TIME 2016 presidential election

Iowa’s Leftwing Anti-Hillary Voters Look to Bernie Sanders

Though neither has declared their candidacy, dueling events show Democratic divisions

(Des Moines, Iowa)It is perhaps telling that the host of Vermont Senator Bernie Sanders’ event Sunday night in Des Moines, Dave Swinton, has just rushed back from the Harkin Steak Fry in Indianola, where Hillary Clinton made an appearance the same day, flipping red meat and hinting at a run.

The 50-year-old senior pastor plans on caucusing for Clinton if she runs in 2016, and his wife, Shari, couldn’t resist the opportunity to take the whole family out to the event just 30 miles south. Swinton left most of his family behind while former President Bill Clinton was speaking so he could make it back in time to set up for the Sanders event scheduled in the basement of his Des Moines church, Grace United Methodist.

Swinton is curious to hear Sen. Sanders, an Independent, speak. A progressive group Swinton often works with has rented out his church’s basement for the event.

“Hillary seems to be the strongest candidate, and I have a lot of confidence in her leadership,” he says, taking a break from setting up chairs. “I thought her speech today hit all the right notes.”

Swinton’s political leanings show the uphill battle in store for a politician like Sanders in trying to gain traction in the 2016 Democratic primaries, should he decide to challenge the 800-pound shadow gorilla in the race, the former Secretary of State.

At the 37th annual Harkin Steak Fry—where Hillary Clinton received the tacit endorsement of Iowa’s powerful Democratic senator and Steak Fry host Tom Harkin— earlier Sunday afternoon, a crowd of more than 10,000 roared in approval when she hinted that she may just run again.

“Hi, Iowa,” Clinton yelled. “I’m baaaack!”

By contrast, Sanders’ event was a relatively low-key affair attended by more than 450 people–still a decent crowd, considering the next caucuses are more than 16 months away. Most who showed were left-leaning populists who supported John Edwards in 2008 and consider themselves solidly in the anti-Clinton camp.

“I like the issues Bernie’s hitting, his anger, because I’m angry,” says Mark Brooks, 62, an Air Force veteran who believes Clinton is too “corporate” to be a good president. “This isn’t the country I defended,” he adds.

Sanders’ message resounded with Brooks. Sanders noted, “We have more people living in poverty than any other time in the history of the United States of America,” touching on 2008-era Edwards’ populist message on poverty.

“It’s a crying shame!” a man yelled in the audience.

“It is a crying shame,” Sanders replied.

Calling for a new jobs program, investment in education and the public funding of elections, Sanders highlights that economic disparity in America has never been greater.

In his speech, Sanders rattles off figures that point to the unfairness that many of his supporters are most concerned about: that top 25 U.S. hedge fund managers made $24 billion last year, or the equivalent of the annual salaries of 450,000 public school teachers. That Walmart is now the largest employer in America while the Walton family, which owns Walmart, possesses as much wealth as the bottom 40% of all earners in America.

“It’s called indentured servitude!” another man yelled—at the top of Sanders’ speech, the politician encouraged “small-d” democratic participation, or what other candidates might consider heckling.

“Sometimes, it is,” Sanders answered gravely.

Right now, Sanders, who would have to switch parties to run for the Democratic nomination, is Clinton’s only major competition on the progressive left. But that doesn’t mean liberals aren’t hungering for some more competition. Stephen Blobaum, 51, a Des Moines salesman, also caucused for Edwards in 2008. He and his father, Reed Blobaum, 79, came to see Sanders speak and support his fire, but both are holding out hope that Massachusetts Sen. Elizabeth Warren will make a run.

“She’s my girlfriend,” Reed Blobaum says with a cheeky smile. “’We admire what Bernie’s doing, but she’s an accomplisher. She gets things done. And Hillary needs to get done.”

TIME Innovation

Five Best Ideas of the Day: September 11

1. National service is a critical American value that has the power to unite us.

By Condoleezza Rice and Robert Gates in Time

2. The challenge for America’s strategy against ISIS isn’t our military might. It’s the will of our partners in Iraq and Syria.

By Jeff Shesol in the New Yorker

3. After a decade of urban violence, blacks in America report PTSD symptoms at the same rate as veterans of our last three wars.

By Lois Beckett in Essence

4. Municipal buses move more than 5 billion people annually. Converting them to electric power would slash carbon emissions dramatically.

By Daniel Gross in Slate

5. To gather valuable health data from the poor, texting survey questions yields impressive results.

By the University of Michigan Health System

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

TIME History

How the Job Corps Is Still Helping Thousands of Americans Find Work, 50 Years Later

Job Corps Memphis Perez
U.S. Labor Secretary Thomas Perez talks with carpentry students during a trip to the Benjamin L. Hooks Job Corps Center in Memphis, Tenn., Aug. 20, 2014. Jim Weber—AP

The little-known program has helped more than 2 million find jobs since its founding

Fifty years ago, Charles “Huckleback” Logan was down on his luck. The 17-year-old had failed out of school and was living with his grandmother in an apartment filled with cockroaches. He had been stabbed at a party shortly after seeing a friend shot dead.

But Huckleback’s life took a turn for the better when he became the first person to enroll a newly created Job Corps that would house him, feed him, and teach him a skill that would allow him to earn a living and stay off the streets.

“I just don’t want no more trouble,” Huckleback told TIME after joining the program.

Today, 50 years later, the program is virtually unknown to most Americans, but it continues to serve communities across the country. Approximately 60,000 modern-day Hucklebacks take part in the program each year, being taught valuable skills in more than 100 areas. In total, some 2.7 million young people have participated in the Jobs Corps since President Lyndon Johnson launched the program as part of his Great Society initiative in 1964. And just like in the 1960’s, participants come from the harshest of circumstances. Still, 80 percent of program graduates leave with a full-time occupation.

“Very often a lack of jobs and money is not the cause of poverty, but the symptom,” Johnson told Congress in 1964 as he declared his War on Poverty, a set of programs the efficacy of which historians continue to debate today. “The cause may lie deeper in our failure to give our fellow citizens a fair chance to develop their own capacities, in a lack of education and training, in a lack of medical care and housing, in a lack of decent communities in which to live and bring up their children,” Johnson said.

TIME India

Rice, Not Ice: India’s Answer to the Ice Bucket Challenge

The movement's Facebook page describes it as an "Indian version for Indian Needs"

How does India do the Ice Bucket Challenge? They don’t. Instead of pouring buckets of ice and water over their heads, people in India have been filling a bucket with rice and giving it to local people in need.

According to the Independent, the Rice Bucket Challenge was started by Manju Latha Kalanidhi, a journalist from Hyderabad, India. The first donation was made Sunday Morning and the movement’s Facebook page has more than 35 thousand likes so far.

As explained on the page, there are four steps to the Rice Bucket Challenge:

1) Pick up a bowl of rice from your kitchen

2) Go to the nearest needy person and give it to them

3) Click a picture and post it on Facebook with the hashtag #RiceBucketChallenge

4) Tag all your friends and ask them to take up the challenge

According to the World Bank, 312 million people in India live below the poverty line.

TIME poverty

How Ferguson Went From Middle Class to Poor in a Generation

Outrage In Missouri Town After Police Shooting Of 18-Yr-Old Man
A man with a skateboard protesting the shooting of Michael Brown by a police officer walks away from tear gas released by police August 17, 2014 in Ferguson, Missouri. Joshua Lott—Getty Images

The same decay that sparked unrest in one Missouri town is taking place across the country

In 1990, Ferguson, Mo. was a middle class suburban enclave north of St. Louis with a population about three-quarters white. In 2000, the town’s population was roughly split between black and white with an unemployment rate of 5%. By 2010, the population was two-thirds black, unemployment had exceeded 13%, and the number of residents living in poverty had doubled in a decade.

Demographic transformation came fast and stark to Ferguson, Missouri. So what happened?

The situation there is “really not so different than the rest of St. Louis County,” said Dr. Norm White, a criminologist with the Saint Louis University School of Social Work. “The problems we saw in the urban core have become the problems of the suburban umbrella.”

The big picture trends White describes aren’t even unique to St. Louis County. Poverty in America’s suburbs has been on the increase nationwide for decades, as the suburbs themselves have grown and affordable housing options moved farther out from urban centers. Opportunities for low-skill jobs—already diminished due to the decline in American manufacturing—in sectors like retail and construction have became more concentrated in suburbs. And its not only a matter of emigration of low income people into the suburbs. Long-term residents in some places have became poorer; suburban areas were hit particularly hard by the recession and housing crisis in the 2000s.

With respect to St. Louis in particular, White points to the razing of the Pruitt-Igoe housing project — a public works project as extraordinary a failure as was the scale of its original vision — as a key factor in the flight to the suburbs. First erected in the early 1950s, the 33, 11-story towers on 57 sprawling acres in St. Louis was designed by the architect who went on to build NYC’s now-fallen World Trade Center.

The complex was intended to be a modern, vibrant community to replace the old poverty-stricken neighborhoods of the poor. In reality, the structures became crime-plagued labyrinths left unmaintained by the city and beginning in 1972 they were torn down, jumpstarting the processes that sent the poor of St. Louis, as elsewhere, out of the city and into the suburbs in search of affordable places to live.

Like most states, Missouri allows for highly fragmented municipalities, each of which retains its own tax revenues and the power to write its own zoning laws. Newer, wealthier suburbs sometimes write zoning restrictions to ban high-density housing, and thus affordable apartments. But Ferguson, an older suburb, has no such restrictions, according to Professor Clarissa Rile Hayward of Washington University in St. Louis. The result is a town where the population of the poor is not only large but also highly concentrated.

“A decade ago, none of the neighborhoods there had poverty rates above 16%,” says Elizabeth Kneebone, a fellow at the Brookings Institution who has written extensively on the rapid growth of suburban poverty in America. Now every neighborhood but one in the town has a poverty rate over 20%, the point at which typical social ills associated with poverty like poor health outcomes, high crime rates and failing schools start to appear, she says.

“Ferguson is just the place that the scab got pulled off,” White, the criminologist, tells TIME. “The reason why this is so intense is that there are a lot of these little communities that have been left almost to rot. Physically the buildings are falling down. There are no social service programs.”

As to whether or not the spotlight currently shining on the problem of suburban decay will result in a renewed commitment to address poverty in the U.S., White believes politicians and the media will move on. “You listen when the fires are burning,” he said, “but you then go away when the fires are extinguished.”

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