Public assistance programs are meant to relieve the hardships impoverished families experience as well as prevent families from remaining impoverished in the future or into the following generation. Over 12 percent of Americans—nearly 37 million people— are currently living below the poverty line. Even more Americans have income above the poverty line but still experience difficulties making ends meet. The poverty level for a family of four is just over $20,000 per year; this is roughly the equivalent of two parents each working a full-time, minimum-wage job five days a week for 52 weeks. Before discussing the policies that seek to help impoverished families, we should understand the characteristics of the Americans most likely to be impoverished today.
Families and persons most likely to be impoverished or affected by poverty are the elderly, minorities (especially African American and Latino), children, women, single mothers, young parents, people living in the South, the poorly educated, the unemployed, and those who live in very urban or very rural areas. Particular attention has been paid to the elderly poor in the United States, and programs such as Social Security and Medicare have alleviated a great deal of elderly poverty since their inception. Minorities face numerous challenges to employment and have less access to high-paying jobs, making them more likely to be impoverished than whites. It is important to note, however, that there is a greater absolute number of poor whites than there are poor minorities in the United States; it is a common misconception that most poor families are African American or Latino. Children make up a large percentage of impoverished Americans, because they have no source of personal income and are largely dependent on their parents for support. Women, similar to racial and ethnic minorities, face employment challenges and still make less money dollar-for-dollar than do men in comparable jobs. As the primary caregivers of their families, single mothers face even more difficulties in the workforce, because they have to manage work, child care, and parenting duties without the help of a partner. For these reasons, single mothers are also more likely than two-parent families to be impoverished.
Young parents, such as those who begin to have children while in their teens, face a greater likelihood of poverty than parents who postpone childbearing until later ages; this is due to their having little time to establish a career or finish higher education. Families living in the South or in urban or rural areas are at higher risk for poverty as well. Although poverty used to be a solely urban phenomenon, rural residents have become increasingly impoverished through the decline of small, family-owned farms and now face the same limited access to low-paying jobs as urban residents. Additionally, rural residents lack public transportation resources and often cannot retain a job because they have no reliable means of getting there. Urban residents and families living in the South lost good jobs that included benefits and a decent wage as industry moved out of these areas into lower-cost parts of the country (like the suburbs) and to other parts of the world. Individuals with low educational achievement and those who are unemployed are also more likely to be impoverished than individuals who have high levels of education and those who hold jobs.
Poverty can result in a number of complications for families, including low educational achievement due to living in neighborhoods with poorly funded schools and overfilled classrooms. Two of the most visible effects of poverty are poor health and subpar access to preventative health care. Families living in poverty often cannot afford health insurance without public assistance and therefore forgo preventative care such as yearly checkups, immunizations, prenatal visits, and cancer screenings, which results in allowing serious diseases to proceed or worsen undiagnosed. Families without health insurance often rely on hospital emergency care when necessary, which is a less-efficient and more-expensive option than visiting a family doctor or other primary care provider. Impoverished families also tend to neglect dental care; untreated dental problems have future implications for general health and access to employment. Fathers of impoverished families are the most likely family members to neglect health care, followed by mothers and then children.
Living in poverty can also cause poor nutrition, and several programs have tried to provide the resources for adequate nutrition, appropriate caloric intake, and access to nutritious foods. Homelessness and access to substandard housing also occur as a result of poverty, because families often cannot afford to pay market-priced rent, let alone purchase a home. Several assistance programs are in place exclusively to prevent families from being without a place to live, as well as to regulate the standards of housing available. Substandard housing has been held accountable for compromising children’s health. Old lead paint on cracking banisters can cause lead poisoning, and mice, cockroaches, or other vermin have been cited as causing children’s asthma.
Public Assistance Programs
Antipoverty programs remain among the most highly criticized of all government programs in the United States. Much of this can be explained by the misperceptions that average Americans have of persons who are in poverty and who receive public assistance. There is a long-standing stereotype that persons receiving public assistance are attempting to work the system or are cheating to qualify for additional benefits. However, all public assistance and antipoverty programs in the United States are means-tested programs, meaning a family’s income has to fall below a specific guideline in order for that family to qualify for services. Public assistance programs are funded in part by the federal government and in part by state and local governments. The federal government sets guidelines for how families can qualify for programs as well as for how much funding each state must also contribute to the programs. Also referred to as the welfare system, public assistance is comprised of five major programs: Temporary Assistance to Needy Families (TANF); the food stamp program; the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); Medicaid; and Subsidized Housing Programs.
The United States did not have any comprehensive public assistance programs until President Franklin D. Roosevelt mandated that the government provide employment through public spending during the Great Depression. Public assistance continued to provide services to impoverished Americans until President Lyndon B. Johnson’s War on Poverty attracted attention and, subsequently, scrutiny. Following the War on Poverty, the number of people accessing public assistance services grew rapidly. The enrollment for Aid to Families with Dependent Children (AFDC, a program that preceded TANF) increased by 270 percent, and enrollment for Medicaid (a program introduced in the 1960s) skyrocketed. The U.S. public continued to scrutinize the welfare system throughout the 1970s and 1980s, and all federally funded public assistance programs were eventually overhauled during the 1996 period of welfare reform under President Bill Clinton. The Personal Responsibility and Work Opportunity Reconciliation Act of 1996, commonly known as welfare reform, was hotly contested by advocates for the poor but did not end the debate over welfare. Although the number of people accessing social services has greatly declined since the 1996 reform (by as much as two-thirds), public assistance programs continue to undergo constant evaluations of their effectiveness.
Temporary Assistance for Needy Families
Temporary Assistance for Needy Families (TANF) is also referred to as cash assistance because it provides qualifying families with a monthly stipend of cash based on the number of persons present in a household and proportionate to the cost of living in their state. To qualify for TANF, recipients must generally have an income below the federal poverty level for their household size and must care for one or more dependent infants or children. Because mothers, rather than fathers, are more likely to have custody of their children, the vast majority of TANF recipients are women and their dependent children. Single persons not taking care of dependent children generally do not qualify for TANF.
Prior to the 1996 reform, TANF (then called AFDC) did not impose a time limit on recipient families, meaning that families could receive AFDC cash assistance indefi – nitely as long as they continued to meet the eligibility criteria. Opponents and critics of AFDC argued that the lack of time limits was not providing impoverished families with any incentive to get off assistance and go to work, and so post-1996 TANF instituted a federal standard of a 60-month lifetime limit per recipient. The second notable change of the reform called for stricter work requirements for its recipients, meaning a mother with children has to spend 10 to 40 hours per week participating in some kind of job training, job search, or educational program in order to remain eligible for TANF benefits.
Despite imposing time limits and work requirements, the 1996 reform also offered states some autonomy with respect to TANF. Individual states must follow the federal guidelines of the program but are allowed to amend the qualifying requirements if they so choose, meaning a family in one state might be permitted to have up to $2,000 in savings and still qualify for cash assistance, whereas another state might require families to have almost no assets in order to qualify. The lifetime limit for TANF can also be extended by individual states through the use of additional state funds, although some states have elected to make the 60-month limit noncontinuous (meaning a person can only be on TANF for 24 continuous months and then must leave welfare for at least a month before exhausting the rest of the time limit). States were also granted the ability to waive or change work requirements for recipients as part of various state-sponsored trial projects; this flexibility allowed states to experiment with TANF requirements in order to arrive at the best and most efficient way to move individuals from welfare receipt to employment.
The effectiveness of the change from AFDC to TANF is notable, as the number of individuals seeking cash assistance has declined by two-thirds. TANF is still not without controversy, however, as the program has been criticized for not significantly improving the lives of those who seek its assistance. Families that leave welfare often do not make a clean break from the program and get caught in an on-again–off -again cycle until they’ve exhausted their lifetime limit. Because families sometimes remain impoverished even after their TANF receipt, many argue that the program’s role as a transition from poverty to nonpoverty and employment has not been fulfilled. The emphasis on work requirements for welfare recipients has been very well received, as critics of TANF and AFDC were opposed to the idea that one could qualify for cash assistance without making a concerted effort to find employment. The success of these work requirements is limited, however, because requirements restrict the time a mother has to spend with her children and can put a strain on child care arrangements. Often, work programs offer child care assistance and other benefits, such as help with resume writing or transportation assistance, but these are not universally granted to all of those enrolled. Work programs are also criticized by recipients as being useless or as not teaching them anything, and the employment they find is often that of the minimum-wage, service-sector variety and offers no health insurance. One major challenge TANF faces in the future is to assist families in eventually achieving permanent, gainful employment in order to make a successful permanent transition out of poverty.
The food stamp program began in 1961 in response to physicians and army recruiters who noticed the pervasiveness of malnutrition within urban and rural populations. Created to provide a better opportunity for families to meet their basic nutritional needs, the food stamp program follows federal guidelines for qualification that are more lenient than those for TANF, meaning families who do not qualify for TANF may at least receive some food stamp assistance. If a family is already receiving TANF, they are automatically eligible for food stamps. If not receiving TANF, a family must have a gross income of less than 130 percent of the federal poverty level and less than $2,000 in assets (excluding the worth of their home and one car worth less than $4,500) to qualify. Food stamps may be used to purchase any type of food item except hot, prepared foods intended for immediate consumption. The amount of food stamps a family receives is based on the family size as well as the state’s cost of living. An average family of three (one adult, two children) receives $200 per month in food stamps. Families must requalify for food stamps every six months to one year but are not required to report changes in income in between requalification periods.
The effectiveness of the food stamp program has been criticized because food stamp participants are still more likely to have poor nutrition than are non–food stamp participants. The 1996 National Food Stamp Survey found 50 percent of respondents still experience times without adequate food, and many households do not get enough folic acid or iron in their diets. Food stamps are not restricted only for the purchase of healthy foods, which leads some researchers to believe they have not improved impoverished families’ nutrition and overall health. Food stamp participants are more likely to be obese, which could be due to families’ choosing to purchase high-fat foods. However, families that receive food stamps tend to spend more on food than they would otherwise, and food stamp participants showed increased consumption of protein, vitamins A, B6, and C, and other important minerals.
Food stamp fraud presents another point of concern for the food stamp program because food stamp recipients sometimes sell food stamps for cash as opposed to using them to buy food. The going rate for food stamp resale is between 50 and 65 percent of face value, meaning $100 of food stamps is worth about $50 on the street. Studies have suggested, however, that the people selling food stamps also buy stamps. This indicates that families might be so strapped for cash that they prefer to sell stamps when they need cash, but then later buy their stamps back to purchase food. Scholars have proposed that the food stamp program can circumvent this issue by distributing stamps throughout the month rather than in a once-per-month lump sum.
Like the food stamp program, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) was formed to provide nursing or pregnant mothers and children under five years old with better nutritional resources. WIC provides participants with certificates redeemable at participating markets for food items such as milk, cheese, cereal, beans, baby formula, and peanut butter in an amount equivalent to roughly $40 per month. These food items are sources of iron, vitamins A and C, calcium, and protein. WIC also provides participants with a nutritional education session each month when they come to get their WIC coupons and monitors the development of infants and children under five years old. Children are no longer eligible for WIC benefits after their fifth birthday, and mothers must be nursing or pregnant to qualify.
Participants must have incomes under 185 percent of the federal poverty level, although mothers and children under five years old automatically qualify if they are also receiving Medicaid. The more generous income guidelines have come under fire, because this allows more people to qualify for WIC and raises the cost of the program, although participation rates for WIC are much lower than they would be if every eligible individual participated. However, this underenrollment raises questions about whether WIC is truly serving the families who might need it the most. WIC, compared to the food stamp program, loses very little money to fraud, probably due to the food-item-specific nature of the program. The food coupons have very little resale value because they are restricted to certain food items and, furthermore, specific product sizes and brands.
Because WIC is the most-studied federal nutrition program, there is less controversy over whether WIC is effective compared to the food stamp program or the National School Lunch Program. WIC participation has reduced the incidence of low- and very low–birthweight babies, meaning public money spent on WIC saves on medical expenditures in the long run. Studies of WIC have also found positive health outcomes for toddlers, although not to the same extent as the outcomes for infants. Some have criticized the WIC program because it offers nursing mothers free formula and subsequently provides a disincentive to breast-feed. The health portion of the WIC program has begun to encourage mothers to breast-feed, but WIC mothers are still less likely to breast-feed than mothers not in the program. This program continues to cause controversy among health professionals and scholars who believe breast-feeding to be an important part of developing infants’ immunity, the mothers’ health, and the mother-child bond.
The Medicaid program seeks to provide federally and state-funded health insurance to qualifying low-income women and children. The Medicaid program also offers public health insurance to disabled (disability insurance) and elderly persons (Medicare). About half of all Medicaid recipients are low-income children and one-fifth are lowincome women. Medicaid is the most expensive public service program, spending about $280 billion annually, with most of the costs going toward the health care and treatment of the elderly. The $47 billion that goes toward impoverished women’s and children’s health care is still very costly, especially when compared to the annual cost of TANF ($16 billion) and the food stamp program ($24 billion). Despite the program’s vast spending, each year over the past decade, roughly 12 percent of all children in the United States have gone without health insurance. It is expected, however, that the Health Care and Education Reconciliation Act of 2010 will begin lessening that percentage.
Access to health insurance and preventative care is important for impoverished families’ well-being, and Medicaid insurance provides very low-cost health care to families who qualify. As of the change implemented by the Defi cit Reduction Act of 1984, any families who qualify for TANF are automatically eligible for Medicaid benefits as well. The Medicaid income cutoff s continued to become more generous, and more federal funding was set aside in order to guarantee more children’s access to health care. Medicaid benefits became available to pregnant women, two-parent families, and to teenage mothers living with their parents, as long as the incomes of these various types of households fell within the qualifying income guidelines. By the 1990s, families with incomes at 130 percent of the federal poverty line or below became eligible for Medicaid, with some states choosing to raise eligibility guidelines further, up to 185 percent of the poverty level. By October 1997, 41 of 50 states were using their own funds to raise the income guidelines for women and children.
Having Medicaid does not necessarily translate into having access to health services, because providers often restrict their practice to allowing only a certain percentage of Medicaid patients or refuse to see these patients at all. Additionally, the length of Medicaid doctor visits is, on average, shorter than the average non-Medicaid visit, which may indicate a lower quality of care for Medicaid patients. Medical institutions often cite Medicaid’s slow reimbursement and excessive paperwork as a reason to prefer privately insured patients. Despite Medicaid’s controversial position with practitioners, public health remains an important service that, at the very least, makes preventative and routine health care available and affordable to low-income women and their children.
Although there are multiple kinds of housing programs, only two will be discussed here. Housing programs began in general with the passing of the Housing Act of 1949, which called for an end to unsafe, substandard housing. Some housing programs operate by offering incentives to contractors to construct low-income housing. In contrast, the programs discussed here provide low-cost housing to families at lower-than-market rent. Public housing developments are perhaps the most visible of these programs. These developments offer available units to families with income below the poverty level for rent proportionate to one-third of their monthly income.
Although public housing must meet a certain standard of cleanliness and construction, some housing developments have not uniformly met these guidelines. Public housing generally gets a bad reputation regardless of its quality or location. Families must often sign up for housing years in advance, due to the long waiting lists that exist for these units. In cities such as New York, over 100,000 families are on a housing waiting list. In contrast, the availability of public housing units in central Pennsylvania has motivated families to move to the area just to have access to housing.
The Section 8 program operates along the same income and benefit guidelines as public housing developments, except Section 8 allows families to select the housing of their choice. After a family gets past a waiting list longer than that for most public housing, Section 8 grants the family with a voucher and the family must find private-sector housing that meets the quality standards of public housing. If a family is able to do this, the voucher pays for a portion of the family’s rent. This amount is typically proportionate to two-thirds of the market-rate rental price. As with public housing developments, the family ends up paying for one-third of the total rental amount.
Public housing is exceedingly helpful for the families who are able to get through the waiting lists, although a great deal of controversy remains over whether public housing developments are good and safe environments for children. The main issue public housing faces is providing all of those families in need with affordable housing options. As waiting lists indicate, this goal has not been met.
Poverty is clearly a problematic circumstance for families, and although antipoverty programs have had success in reducing the number of families in poverty, public assistance programs face various controversies of their own. Perhaps one of the most important issues with public assistance programs is their uniform neglect of fathers. Fathers cannot qualify for cash assistance unless they have full custody of their dependents, and fathers do not qualify for food stamps for the same reason. WIC is aimed only toward women and their children under five years old, and public housing does not typically provide housing services to men without families. In cases where the father is not married to the mother of his children, the father’s presence in a public housing unit is actually illegal and may cause a mother and children to lose their housing subsidy.
In light of recent programs that promote marriage among low-income, unmarried parents (such as the Healthy Marriage Initiative), public assistance programs should consider expanding the eligibility requirements to men rather than restrict services to women and children only. Marriage programs do not cooperate with public assistance programs in a way that is productive for creating stable families; the fact that a mother can lose access to public housing if her partner lives with her is an indication of this. In order to successfully continue to provide impoverished families with much-needed resources, perhaps even a resident father’s income, and encourage unity among families, public assistance will have to consider changing its policies in the future.
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