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Insured into Poverty

The income limits imposed by Medicaid can leave beneficiaries permanently poor.
August 19, 2014

In February 2012, Marcella ­Wagner, a nursing student who was then seven months pregnant, swerved to avoid another car on a Northern California freeway. She skidded off the road, crashed, and was left paralyzed from the chest down. She also had little use of her hands.

book cover
Trapped in America’s Safety Net
By Andrea Louise Campbell
University of Chicago Press, 2014, $15

Amazingly, doctors were able to deliver a healthy baby. But ­Wagner now needed extensive daily assistance. She and her husband, Dave ­Campbell, who worked for a small manufacturer and earned $39,000 a year, had only a short-term health insurance policy to cover her pregnancy. Faced with a long-term disability, they were able to afford only a policy that came through Medi-Cal, the state version of Medicaid. Medi-Cal is a means-tested program that requires recipients to have income below certain levels and only $3,150 in assets beyond a house and one vehicle. So to get health care, Campbell and Wagner have been restricting themselves to an income not exceeding 133 percent of the poverty level—any salary increase beyond that must go straight to insurance costs. Accepting money from Medi-Cal also requires that the couple can’t put away any money for retirement or their child’s college education.

Andrea Campbell, a political science professor at MIT, says such restrictions represent “a huge hole, and one that ­people don’t know about.”

Campbell understands this from the inside out: she is Dave Campbell’s sister. Two months after the accident, she wrote an op-ed in the New York Times calling for the implementation of the Affordable Care Act (ACA) to help more people obtain health insurance in the first place. Two months later, the U.S. Supreme Court upheld the constitutionality of the ACA—and Justice Ruth Bader Ginsburg cited Campbell’s piece in her concurring opinion.

“I had no expectation of that at all,” says Campbell. “That was incredible.”

Now she has written a book on the subject, Trapped in America’s Safety Net: One Family’s Struggle, just published by the University of Chicago Press. In it, she details how her family copes with financial restrictions that healthy people do not have.

“In many ways,” she says, “these programs as currently designed thwart people’s efforts to better their lot.”

As one remedy, Campbell would like to drop asset caps for programs like Medicaid, whose eligibility requirements vary from state to state. Although the ACA helps subsidize private insurance for many, such insurance doesn’t include the type of long-term care that Wagner needs. Medicaid, which the ACA is helping to expand, remains the only program that covers that type of daily care.

Campbell notes that two-thirds of Americans between the ages of 18 and 64 live in a household where someone will enroll in a means-tested program. “These are programs that touch most American families, so all of us have a stake in their being better designed,” she says.

Recent Books from the MIT Community

Restraint: A New Foundation for U.S. Grand Strategy
By Barry R. Posen, professor of political science and director of the MIT Security Studies Program
Cornell University Press, 2014, $29.95

The Social Machine: Designs for Living Online
By Judith Donath ‘86, SM ‘86, PhD ‘97
MIT Press, 2014, $40

Category Theory for the Sciences
By David I. Spivak, research scientist, MIT Department of Mathematics
MIT Press, 2014, $50

Good for You, Great for Me: Finding the Trading Zone and Winning at Win-Win Negotiation
By Lawrence Susskind, MCP ‘70, PhD ‘73, professor of urban and environmental planning
Public Affairs Press, 2014, $25.99

Architecture by Moonlight: Rebuilding Haiti, Redrafting a Life
By Paul E. Fallon ‘77, SM ‘81, MArch ‘81
U. of Missouri Press, 2014, $29.95

Building Information Modeling: BIM in Current and Future Practice
By Karen M. Kensek ‘84 and Douglas E. Noble
WILEY, 2014, $85

George Frideric Handel: A Life with Friends
By Ellen T. Harris, professor emeritus in the Music and Theater Arts Section
W. W. Norton, 2014, $39.95

The Design of High-Efficiency Turbo­machinery and Gas Turbines (2nd edition)
By David Gordon Wilson, professor emeritus of mechanical engineering, and Theodosios Korakianitis
MIT Press, 2014, $60

Please submit titles of books and papers published in 2013 and 2014 to be considered for this column.

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