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And get rid of the 1996 PRWORA rule changes that allow states to make their own eligibility rules for Medicaid; remove that part and just start funding the program federally instead of jointly with the states, because right now, it's incredibly unfair.
Hypothetical example:
Janice is a low-income single woman, 22 years old, living in rural West Virginia. Jobs are scarce in her county, and the available jobs are nearly all retail. Her job as a local grocery store clerk pays minimum wage, and she receives no health insurance coverage because her employer makes sure that she never works a full 40 hours, thus forcing her to remain at part-time status, technically. Janice is managing to survive on her meager paycheck, but she cannot get health care. Her county's free clinic is overwhelmed and booked up solid for months in advance. She has severe pain from tooth decay, wrist and back pain from hours and hours of standing on her feet at the cash register, she has some food insecurity at home, and when she suddenly suffers a job loss, she needs some help in the worst way. She applies for Medicaid, but even though her income is well below the eligibility level, her application is denied because she is an ABAWD--an in-house acronym for "able-bodied adult without dependents." She is granted a tiny amount of SNAP (food stamp) benefits, but because she is an ABAWD, she can only receive those benefits for THREE months maximum, after which she cannot receive SNAP benefits again for three years unless and until she finds a job--and even then, her benefit amount is relatively tiny and subject to strict conditions, time limits, and endless red tape. These are all regulations that are part of West Virginia law, which is allowed to be more restrictive than federal law thanks to the 1996 reforms.
However if Janice gets pregnant and has a child, she is instantly eligible for full Medicaid benefits, vastly-expanded SNAP benefits with few restrictions for the first few years of her child's life, WIC, TANF, and a host of other benefit programs, none of which have a work requirement if you have a child under the age of 5, making them extremely attractive to someone who's having serious trouble finding an adequate job.
Don't get me wrong. I do NOT believe that women have extra babies JUST to receive benefits. The very idea is incredibly stupid, because the expense of 18+ years of childrearing FAR outweigh the pittance that the federal government allots for poor parents, and because the increase in benefits per child born is very small--not even close to the added expense, and sometimes nothing at all. However, it makes NO sense to put low-income young women who are childless into a position that basically forces them to consider pregnancy and childbirth (at least in part) as a plausible path to get the medical care they desperately need. When you need to see a doctor and there's no other way to pay for it, having a baby can be awfully easy to rationalize, especially for young women who are raised in a culture that promotes family and motherhood as "proper roles" for women and college and careers as "ivory tower" nonsense that shouldn't even be seriously considered. Suddenly the extra expenses of childrearing become fuzzy and the consequences light compared to the idea of a cuddly baby that brings community acceptance and an easier (financial) life along with it, at least for the short-term. Short-term priorities are common in poor households; those who have nothing and never expect to GET anything find solace in focusing on the here-and-now, rather than depressing themselves with thoughts of the future they don't expect to have.
If our goal is to see fewer poor women choosing to have children before they can afford them, we should be focusing on expanding public assistance benefits (ESPECIALLY Medicaid) to single adults without children, so long as they fall under the income guidelines. It's time to stop pretending that able-bodied, low-income adults should be expected to "pay their own way" in terms of medical care. The idea is not just unfair--it's LUDICROUS. These people make $7.25 an hour--roughly $230 a week, $920 a month, after taxes, and that's if they are LUCKY enough to have a full-time, 40-hour-a-week, miserable manual labor job. Many, many low-income people do NOT have full-time jobs; their employers deliberately schedule them for less than 40 hours every week in order to ensure that they aren't expected to provide any benefits like health insurance. Unions are not necessarily helpful, either; it depends entirely on how hard the union is willing to fight, and a lot of them don't fight the part-time-no-benefits scam. I will guarantee you that if you've eaten at a fast-food place, if you've shopped at big-box stores like Wal-Mart, if you've bought groceries at a store that pulls the part-time-no-benefits scam on its employees, then you have contributed to this problem. We are all guilty. The cheap prices and good deals that the middle-class survives on are subsidized by the untreated illnesses, chronic back pain, and malnutrition of the poor. Yes, I know--you can't afford otherwise. Well guess what? Those low-low-prices are not a "deal"--they ARE paid for, just not by you. The ten bucks you saved by shopping at a big-box store was paid in misery and pain by the people working there who have no benefits and get few (if any) raises. You didn't save money--you just forced a poor person to absorb the extra cost.
Considering all of this, you can see why it quite literally makes me physically NAUSEOUS whenever I hear some ignorant middle-class elitist pontificating about "welfare queens" and "chronically dependent people" who need to "get a job" and "stop sucking up my tax dollars." Those people wouldn't NEED so many of your damned tax dollars if you actually sucked it up and took on your share of the social burden rather than passing it off to the people who are already more burdened than you will EVER be. Maybe if the middle class were forced to actually shoulder their share of the burden instead of passing that weight off onto the backs of the poor, there would be some outrage. Maybe even enough to bring about significant change. Unfortunately I don't see it happening. People will always come up with a million reasons why THEY just HAVE to shop at that cheap big-box store, why they NEED to patronize the grocery store that offers no benefits and swindles its own employees with the part-time-no-benefits scam. Forgive me, but I just can't summon a lot of pity. Sure, things are hard for everyone right now--but they're harder on the poor, and a LOT more unfair.
The least, the very LEAST that we can do is to try and ameliorate some of the misery we inflict on the poor by electing people who really care about them--who don't consider public assistance to be something ugly and socially sinful, who understand that so long as the poor are stuck in low-income jobs with no benefits, there is simply no rational way that they can be expected to care for themselves alone. Seriously--think about it for a minute. Take the scenario I mentioned above--$230 a week net pay, $920 a month, no children. $7.25 is the federal minimum wage--some places have a better minimum wage, but they also have higher costs-of-living so the increase doesn't matter much for practical purposes.
How much is rent for an apartment? Depending on where you live, the average could be anywhere from $400 a month to $750 a month. (Note--poor people cannot just "move." Moving costs money--lots of it. They are pretty much stuck where they are, for the most part.) So let's say $600 a month for an apartment--we'll even include all major appliances, basic furnishing (sofa, bed, table, chairs) and the water/sewer bill in the rent, and we will assume that this apartment sits right on a major bus line in town, because our hypothetical poor person cannot afford a car or car insurance. Seems ideal, right?
Now--that leaves $320 a month. How much for utilities? Trash pickup, electricity, natural gas (few low-income apartments are modern enough to be all-electric), a basic landline phone (no long distance, but vital in order to find and keep a job.) Altogether we are looking at about $250 in utility expenses, averaged between summer and winter--with summer a bit cheaper and winter a bit more expensive (we are assuming our poor person has no AC, otherwise it would be more.) Few low-income apartments are energy-efficient and/or well-insulated; slumlords tend to cheap out on stuff like that, preferring to pass off those costs to their tenants. They're also the only ones who accept tenants with bad or no credit (incredibly common among the poor), so they're the only feasible game in town. $250 a month for four utilities is probably lower than it should be, but I'm trying to avoid accusations of being "unrealistic."
We now have $70 left. Note the major things we HAVEN'T mentioned yet--transportation money (bus fare), food, basic clothing and shoes, household necessities (toilet paper, soap, laundry coins/soap.) And the biggie--HEALTHCARE. Our poor person has no children to care for, and yet they have only $70 left to eat, clothe themselves, pay bus fare twelve times a week (ten to and from work, and to and from the store once on the weekend,) and keep their body and clothes neat and clean enough to maintain a job. And that's assuming that our poor person is a robot who has very little need for entertainment--no TV, no internet, no hobbies, and only library books to read (IF they can get a ride there and back, as they can't spare the extra bus fare.) There is absolutely no room at all for health care or prescription costs. NONE. If this person gets sick, they'll have to pray that there's someone they can borrow money from to get prescriptions filled, and god help them if it's anything more than what cheap antibiotics alone can cure.
We NEED public assistance, and we need it for more than just people with kids. There is simply no way that people can be expected to survive without it. The current healthcare reform bill is supposed to provide subsidies for the poor, but unless those subsidies are 100% of the cost, it's a pointless gesture because the rest of the money simply is NOT there. And if they ARE 100%, then why not just absorb the poor single adults into Medicaid instead of forcing them to buy private insurance with government money? It makes no sense--Medicaid is cheaper and more cost-efficient than an insurance company could ever be, and provides better quality care.
As for the argument about public assistance as a "burden" on middle-class taxpayers--we can either change the way we shop and prod corporations into paying fair wages and benefits, or we can stop bitching about increased taxes for public assistance and start expanding it to cover the desperate need that exists. But we CANNOT fail to do either. Society simply will not survive another generation like this. Like it or not, the freeloading days of the middle class are over.
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