Chapter 13

Why Has the American Welfare State Been Reluctant And What

Can We Do about it?

Manifestations of Reluctance • Even when domestic expenditures of local, state, and federal authorities are

aggregated, Americans devote (and have devoted at least since World War II) a relatively smaller share of their GDP to domestic spending than many other industrialized nations

• Most nations provide a combination of universal programs, which deliver services or benefits to people regardless of their income, and

– means-tested programs, which can be used only by people who fall beneath specific levels of income

• Fluctuations in program funding were endemic: – Various New Deal programs underwent drastic cuts, – the funding of many Great Society programs was cut in the late 1960s, and – mental health centers and – a variety of means-tested programs for the poor suffered deep cuts during the administrations

of Richard Nixon and Ronald Reagan

2.1.5

Manifestations of Reluctance

• Many American consumers pay relatively large shares of their personal income for social, medical, and educational services—a trend that in creased sharply in the 1980s and 1990s—and local and federal governments have increased fees and payment shares for many public programs

• The enactment of the Personal Responsibility and Work Opportunities Act of 1996 not only removed the welfare entitlement that had been embedded in the AFDC program:

– but established even more stringent policies to force millions of persons off welfare rolls without providing them guarantees of health care, child care, transportation assistance, and housing assistance if their wages were insufficient to bring them above official poverty levels

2.1.5

Manifestations of Reluctance

• Specific groups in the United States often confront even greater hardships than do their counterparts abroad. – Older Americans, while usually above the poverty line, encounter

insecurities not known to the European elderly, such as fears of medical bankruptcy

• Proposals to replace Medicare with medical savings accounts and • Social Security with individual retirement accounts which affluent

people would disproportionately benefit from these proposals—and most low- income persons would not be able to use them

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Manifestations of Reluctance

• States and localities vary greatly in their economic resources as well as in their political propensity to fund social programs

• With regard to welfare programs like TANF, for example, some states fund particularly low grants and implement particularly severe time limits, whereas other states are more generous

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Moral Flaws of the American Welfare State

• Poverty• Homelessness• Persons lacking medical insurance• Youth who graduate from foster care

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Moral Flaws of the American Welfare State

• Assistance to persons who are in jail or who retuned to community

• Low wages• Feminization of poverty• Legal status of immigrants

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Contextual Flaws of the American Welfare State

Causes of Reluctance

Cultural factors:•Problems and Panaceas•The Misleading Analogy of the Fair Footrace•Beliefs about Markets and Government•Beliefs about Equality

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Contextual Flaws of the American Welfare State

Economic Factors •Low Levels of Taxation•Military Spending

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Contextual Flaws of the American Welfare State

Institutional Factors•Jurisdictional Confusion

Social Factors•Racism and Prejudice

Legal Factors Political Factors

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Key Mental Health Reforms • Community Mental Health Centers Act of 1963 • Coverage of mental health benefits by Medicare

and Medicaid—and requirements by many states that private medical insurance plans must, if they cover mental health benefits, do so in a way that is equivalent to insurance coverage for physical Ailments

• Mental Health Parity Act of 1996 • Mental Health Parity and Addiction Equity Act of

2008• Reimbursements of mental health services by

Medicare and Medicaid

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Key Health Reforms

• Health Maintenance Organization Act of 1973 • Enactment of Medicare and Medicaid in 1965 with many

subsequent additions to them, such as the Disproportionate Share Program (DSH) under Medicaid to provide funds to hospitals with large numbers of uninsured persons and Medicaid recipients in their clientele and coverage of persons with end-stage kidney by Medicare

• Federal funding of medications for persons with HIV and AIDS under Medicaid

• Federal funding of many outpatient services in low-income areas through disproportionate share funding of Medicaid

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Key Health Reforms• Enactment of S/CHIP to provide health insurance

to children not covered by private insurance—and its expansion in 2009

• Pharmaceutical benefit added to Medicare in 2003 in Medicare Prescription Drug, Improvement, and Modernization Act

• Establishment of Veterans Administration • Enactment of the Patient Protection and

Affordable Care Act of 2010, as amended by the Senate

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Key Safety Net Reforms• Unemployment insurance (enacted in 1935, with many modifications

during recessions) • Enactment of entitlements such as Supplementary Security Insurance

(SSI), Food Stamps, and the Earned Income Tax Credit (EITC) • Temporary Assistance to Needy Families (TANF) established by the

Personal Responsibility and Work Opportunities Act of 1996 (it rescinded the Aid to Families with Dependent Children Program)

• Enactment of Section 8 housing vouchers (the Housing Choice Voucher Program)

• Making Home Affordable Program of 2009 • Programs of the American Recovery and Investment Act (the Stimulus

Plan) of 2009 • Establishment of the minimum wage by the Fair Employment Practices

Act of 1938 with many subsequent increases in its level

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Key Civil Rights Reforms

• Civil Rights Acts of 1964 and 1965, as well as many additional policies such as the Equal Employment Opportunity Commission (EEOC)

• Pregnancy Discrimination Act of 1978, which amended Title VII of the Civil Rights Act of 1964 to prohibit workplace discrimination on the basis of pregnancy

• Age Discrimination Act of 1975 • Fair Housing Act of 1968 • Americans with Disabilities Act of 1990, as well as the Rehabilitation Act of

1973 • Protection of confidentiality of health information by the Health Insurance

Portability and Account- ability Act of 1996

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Key Child and Family Reforms

• Title XX of the Social Security Act for social services • Child Care and Development Block Grant of 1990 • Child care tax credit • Special Supplemental Nutrition Program for Women,

Infants, and Children (better known as WIC) • Head Start Program

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Key Child and Family Reforms• Provision of federal assistance to child welfare agencies

through Title V of the Social Security Act, the Adoption Assistance and Child Welfare Act of 1980, the Family Support and Preservation Act of 1993 as extended by the Promoting Safe and Stable Families Act

• Federal subsidies for child care in the Child Development and Family Block Grant

• The Child and Dependent Care Tax Credit • The Family and Medical Leave Act

2.1.8

Critiquing Conservatives’ Case Against the American

Welfare State • Reducing Social Spending• Delegating Policy Responsibilities to State and Local

Government• Privatizing Social Services• Seeking Nongovernmental Substitutes for Publicly Funded

Programs• Using Deterrence• Relying on Personal Responsibility

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Contextual Factors That have Promoted Enactment

of Social Reforms• Cultural factors• Economic Factors• Institutional factors• Social factors• The sequencing of events• Legal factors• Political factors

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Toward Policy Practice and Policy Advocacy

• Participating in Social Movements • Establishing Advocacy Organizations• Seeking Social Reforms from within the Government• Educating the Public as a Prelude to Social Reforms• Electing Reform-Oriented Candidates to Office• Influencing Policy from Organizational Settings• Whistleblowing

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