“”Walmart just announced that the cost of their standard Thanksgiving meal is reduced by 25 percent this year from last year,” Trump said recently, failing to account for the fact that the price change is due to Walmart…changing the goods offered via their Thanksgiving meal bundle (and drastically shrinking its size) to get prices lower for cost-burdened consumers.”
“After a few months in the program, Smith was no longer diabetic, and she has now been sober for two and a half years.
Her story highlights the success of the Healthy Opportunities Pilot, which launched in North Carolina in March 2022. The program had benefits beyond health and quality-of-life improvements; researchers at UNC-Chapel Hill found the program saved $1,020 a year per recipient on health care costs, and the 38,000 participants had “significantly lower” emergency room visits than their peers.
The program was unique, funded with a five-year, $650 million federal grant approved by the first Donald Trump administration. The idea was to use fresh food, safe housing and transportation — social and economic factors that researchers say determine 80 percent of a person’s health — to improve the lives of the sickest, most expensive patients.
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But the Healthy Opportunities Pilot shows the limits of such food-based interventions in public policy. These programs often require longer-term investments, chafing against the cost-cutting instincts that characterize Trump’s second term and legislatures in most red states — the policy level at which most MAHA ideas are put into practice.
In the case of HOP, the Joe Biden administration approved a Medicaid waiver last December to continue the program in North Carolina, which Gov. Josh Stein, a Democrat, hoped to expand throughout the state over the next two years. But in June, the Republican-led state legislature declined to fund it. State lawmakers argue the program costs more than it saves — a claim that state policy experts dispute because of the way Republican lawmakers were calculating the numbers. These experts say the long-term savings potential was given short shrift.”
“Most Medicaid recipients (92 percent) under the age of 65 already work full- or part-time jobs, according to KFF.”
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“States have attempted to implement work requirements for their Medicaid programs, but have faced challenges to successful implementation. In 2018, when Arkansas attempted to implement similar Medicaid work requirements, confusion with paperwork resulted in 18,000 people losing health care, and there was no improvement in employment rates. Georgia’s work requirement program, which began in 2023, spent $55 million verifying eligibility. It enrolled only 2.3 percent of the estimated 240,000 Georgians who were eligible for the program.”
“President Donald Trump’s administration plans to end U.S. funding for Gavi, an organization that helps buy vaccines for children in poor countries, and will scale back efforts to combat malaria, among thousands of cuts revealed in a document prepared by the U.S. Agency for International Development.
The administration will continue to fund some grants that pay for drugs that treat HIV and tuberculosis and provide food aid to nations where civil wars and natural disasters are occurring, according to the document, which was first reported by the New York Times.
The document, reviewed by Reuters on Wednesday, lists international aid programs that will be dismantled as well as those that will be retained.”
“US philanthropy is still much, much, much more about rich guys like David Geffen slapping their names on concert halls than it is about donating to help people dying from malaria, or animals being tortured in factory farms, or preventing deaths from pandemics and out-of-control AI, to name a few EA-associated causes.
Pretending otherwise, though, lets more complacent philanthropists off the hook for refusing to think through the consequences of their actions.”
We should focus on helping those in poverty and those with a lack of wealth and opportunity, not people who have these problems specifically because of race. Those in trouble because of legacy racial issues will be helped by race-neutral welfare.
People around most leaders say the leader is good and they have respect for them. Even people close to Trump often later say he is nuts.
“In an ideal world, everyone who qualifies for an aid program ought to receive its benefits. But the reality is that this is often not the case. Before the pandemic, for example, nearly one-fifth of Americans who qualified for food stamps didn’t receive them. In fact, millions of Americans who are eligible for existing social welfare programs don’t receive all of the benefits they are entitled to.”
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“Means testing a given social program can have good intentions: Target spending toward the people who need it most. After all, if middle- or high-income people who can afford their groceries or rent get federal assistance in paying for those things, then wouldn’t there be less money to go around for the people who actually need it?
The answer isn’t so straightforward.”
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“Implementing strict eligibility requirements can be extremely tedious and have unintended consequences.
For starters, let’s look at one of the main reasons lawmakers advocate for means testing: saving taxpayers’ money. But that’s not always what happens. “Though they’re usually framed as ways of curbing government spending, means-tested benefits are often more expensive to provide, on average, than universal benefits, simply because of the administrative support needed to vet and process applicants,” my colleague Li Zhou wrote in 2021.
More than that, means testing reduces how effective antipoverty programs can be because a lot of people miss out on benefits. As Zhou points out, figuring out who qualifies for welfare takes a lot of work, both from the government and potential recipients who have to fill out onerous applications. The paperwork can be daunting and can discourage people from applying. It can also result in errors or delays that would easily be avoided if a program is universal.
There’s also the fact that creating an income threshold creates incentives for people to avoid advancing in their careers or take a higher-paying job. One woman I interviewed a few years ago, for example, told me that after she started a job as a medical assistant and lost access to benefits like food stamps, it became harder to make ends meet for her and her daughter. When lawmakers aggressively means test programs, people like her are often left behind, making it harder to transition out of poverty.
As a result, means testing can seriously limit a welfare program’s potential. According to a report by the Urban Institute, for example, the United States can reduce poverty by more than 30 percent just by ensuring that everyone who is eligible for an existing program receives its benefits. One way to do that is for lawmakers to make more welfare programs universal instead of means-tested.”
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“There sometimes is an aversion to universal programs because they’re viewed as unnecessarily expensive. But universal programs are often the better choice because of one very simple fact: They are generally much easier and less expensive to administer. Two examples of this are some of the most popular social programs in the country: Social Security and Medicare.
Universal programs might also create less division among taxpayers as to how their money ought to be spent. A lot of opposition to welfare programs comes from the fact that some people simply don’t want to pay for programs they don’t directly benefit from, so eliminating that as a factor can create more support for a given program.
In 2023, following a handful of other states, Minnesota implemented a universal school meal program where all students get free meals. This was in response to the problems that arise when means testing goes too far. Across the country, students in public school pay for their meals depending on their family’s income. But this system has stigmatized students who get a free meal. According to one study, 42 percent of eligible families reported that their kids are less likely to eat their school meal because of the stigma around it.
Minnesota’s program has proven popular so far: In September 2023, shortly after the program took off, the amount of school breakfasts and lunches served increased by 30 percent and 11 percent compared to the previous year, respectively.
While it might not be politically feasible — or, in some cases, necessary — to get rid of means testing for all public subsidies, free school meals also offer an example of what a compromise might look like at the national level. Though Congress hasn’t made school meals free to all, it passed a provision in 2010 that allows schools to provide free meals to all students in districts where at least 25 percent (originally 40 percent) are eligible. The program showed that providing free meals to all lowered food insecurity, even among poor students who already qualified for free meals, by removing stigma. (The community eligibility provision now serves nearly 20 million students.)
As for how universal programs can be paid for, the answer is, yes, imposing higher taxes. It might seem inefficient to give people a benefit if you’re going to essentially take it back from them in taxes, but what you actually end up with is a much more efficient program that is more easily administered and doesn’t leave anyone out.”
“The Eastern Band of Cherokee Indians have a land trust, the Qualla Boundary, which straddles parts of Swain and Jackson counties in the Smoky Mountains, in the western part of the state. In the mid-1990s, they greatly expanded the gambling facilities on the Boundary to include a large casino. Some of the profits from the casino are ploughed back into the tribal community in the form of community services –roads and sewers, hospitals and clinics, gymnasia and schools. But some of the money goes straight back to the individual tribal members in the form of a payment every six months, the amount dependent on the profits from the casino. The “per cap”, as it is called, goes to everyone, young or old, healthy or sick, working or unemployed, law-abiding or not, as long as they are members of the tribe. (Money for children goes into a bank account for them until they graduate high school or reach age 21, whichever comes first.) In recent years the amount of the supplement has been around $4,000 a year.”
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“In 1993 my Duke University colleagues and I began a study of the mental health care needs of 1,420 randomly selected children living in the 11 western-most counties of North Carolina. We were especially interested in the American Indian community, because it provided strong access to mental health care. So we ensured that a quarter of the study sample were American Indian children – 350 of them.”
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“All of the American Indian children in the study, but none of the children in the surrounding counties, lived in families that had received a considerable boost in income.”
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“Four years after the casino opened, Indian children had fewer behavioral and emotional problems than did neighboring children. Moreover, the effect continued into adulthood. At age 30, one in five of the American Indians had mental health or drug problems, compared with one in three of those in surrounding communities. The Indians had less depression, anxiety and alcohol dependence. The payments had no effect on extremely severe but rare mental illnesses like schizophrenia and bipolar disorder. But those who had received the supplement had better overall health and fewer economic problems. The younger the participants were when their families started getting the casino payments, the stronger the effects on adult mental health.”
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“some individuals spent their extra money foolishly, on drugs and drink, just as was true outside the reservation. Most people used their income supplement wisely, however, and there was no evidence that people worked fewer hours. And, of course, it is much cheaper to give people a check than to administer all the complex means tests that go with government welfare programs such as Supplementary Security Income benefits.”
“The short-lived pandemic-era child tax credit expansion cut child poverty by more than a third. And the bolstered social safety net from Covid relief bills nearly halved child poverty in a single year — the sharpest drop on record. Once those programs expired, however, the child poverty rate bounced right back.”
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“Homeowners are told that their homes are the key to building wealth, so they reasonably want their property values to keep rising. For renters, on the other hand, any increase in housing costs is a loss. So while renters might want lawmakers to make room for more housing, homeowners often resist any change that could make their home prices stagnate.”