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MIT School of Humanities, Arts and Social Sciences - Great Ideas Change the World

Research | Political Science

Repairing America’s social safety net


After a 2012 accident left nurse Marcella Wagner paralyzed from the chest down, she and her husband, Dave Campbell, found themselves in a precarious situation. In order to qualify for Medi-Cal — California’s Medicaid program — to pay for Marcella’s healthcare expenses, the family was required to remain in poverty.

Recipients of Medi-Cal at that time were allowed to hold no more than $3,150 in assets, aside from a home and one vehicle, and needed to stay within a strict income threshold. This system of limits and rules, called means-testing, is used in social support programs across the nation. Each system of means-testing is specific to the state, but they’re intended to ensure that people receiving benefits are those who most need them.


An unintended effect

In this scenario, however, as in many others, means-testing has worked to prolong and deepen the cycle of poverty. With so little in the bank, unexpected expenses become crises. One car per household makes job security a hurdle. Having a child, as the Campbells do, complicates the situation further, since common-sense activities such as college savings are also off-limits.

“It’s a huge hole, and it’s one that people don’t know about,” says Andrea Campbell, a professor of political science at MIT and an expert in social policy.


Better designed policies are possible

Campbell now knows about this hole from personal experience: she is the sister of Dave Campbell, and has spent much of the last two years trying to help her family obtain the best care possible. Her research, documented in Trapped in America’s Safety Net: One Family’s Struggle, also points the way toward more sensible policies.


Most American families are affected

“These are programs that touch most American families, so all of us have a stake in their being better-designed,” Campbell says. And many of us are just a swerve on the freeway away from the same situation, she concludes: “I hope part of this conversation is about the precariousness of the middle class, because it is striking how many people have low incomes, very little in savings, and live month to month.”

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