Mike Kueber's Blog

January 29, 2013

Innovation and creativity used by Joaquin Castro against the radical, crazy Republicans

Filed under: Culture,Issues,People,Politics — Mike Kueber @ 8:58 pm
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Express-News columnist Brian Chasnoff’s column today appeared to have a two-pronged purpose:

  1. Advance the deification of the Castro twins.
  2. Create a perception that Democrats are on the verge of becoming competitive in Texas.

Chasnoff addresses the first prong by telling a three-act story involving Joaquin Castro.  In the first act, Castro is block-walking on the Republican northwest side of San Antonio.  Then in the second act, Castro is depressed because his list of targeted houses – those with reliable voters – causes him to walk past most of the houses.  And in the third act, Castro has an inspiration, which is to get the reliable voters to influence their unreliable friends and family to vote.  For melodramatic measure, Castro names his idea the “Victoria Project” after his late grandmother.

Your response to Castro’s inspiration might be, “Duh?  Tell me something I didn’t know,” but that is not how Chasnoff characterizes it.  Instead he describes it as an epiphany – “Castro’s idea, conceived that day on the campaign trail, is more modest in scale. But its creative approach might inform the myriad efforts here to revitalize Democrats, who haven’t won a statewide election in two decades.

And that brings us to the second prong of Chasnoff’s column – i.e., there is a serious movement underway to make Texas a competitive state for Democrats within the decade.  Chasnoff refers to an extensive new article in Politico.com that describes the myriad, far-reaching efforts to revitalize Democrats that might be informed by Castro’s creative approach, but instead of discussing those efforts, Chasnoff decides to elaborate on Castro’s “more modest in scale” project:

  • Each voter would cast a personal appeal powerful enough to motivate nonvoters to cast ballots.  Castro offered a fictional example: Maria Fernandez, whose father died from diabetes, emails 10 people “who really cared for her dad” with a message that “combines a personal narrative with a policy imperative.” In other words, Fernandez mourns both her father and GOP policy on health care.

The column concludes by suggesting that the Victoria Project would work perfectly against Republicans if Governor Rick Perry and party leaders persist in refusing to extend Medicaid under ObamaCare to two million poor, uninsured Texans.  According to Castro (and Chasnoff?), this position is beyond radical, it’s crazy.

Although this simple concept of trying to leverage your voters unquestionably makes sense, its effectiveness is questionable.  As Castro says, “It’s very intensive work.  There’s a lot of follow-through and a lot of handholding because you’ve got to help people craft the message.”  You think?

Think about crafting a message from your voters to their friends telling them about their poor family member who can’t afford ObamaCare, but would be eligible for free Medicaid if more people would vote Democratic.  Good luck on that in Texas.

November 29, 2012

How do the progressives propose to fix Medicare/Medicaid?

Filed under: Economics,Issues,Politics — Mike Kueber @ 2:07 pm
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One of the most fatuous charges made by Democrats during the recent presidential election was that Republicans plan to eliminate Medicare “as we know it.”  That charge is fatuous because every sentient person knows that Medicare as we know it is unsustainable and must be reformed.  At least, I thought every sentient person knew that. 

Before the election prompted both sides into making ridiculous statements, the conventional wisdom was that, because Social Security, Medicare, and Medicaid comprised such a large percentage of federal spending, the out-of-control federal deficit could not be tamed without making significant changes to those entitlement programs.  Everyone agreed on that.

Post-election, however, I have read a series of disturbing reports indicating that progressives/liberals are opposed to making significant changes to those programs.  Huh?  That doesn’t make any sense, but for some reason the mainstream media doesn’t press these people to explain their nonsensical position. 

An explanation for the media’s negligent conduct can, perhaps, be found in today’s editorial in the NY Times.  In that editorial, the Times asserts that neither Medicare or Medicaid can be touched without “hurting the most vulnerable Americans.” 

So, if the Times opposes any cuts, how does it propose to bring fiscal sanity to these programs?  Ironically, it suggests something that reminds me of the Republican plan to balance the budget through so-called dynamic scoring – i.e., a booming economy.  The Times claims that the costs of Medicare and Medicaid will become manageable in the future because ObamaCare will reform healthcare in America by making it better and more efficient.

There may have been a time in America’s past when we could afford to make economic decisions on the basis of what George H.W. Bush called voodoo economics, but that time is passed.  Neither party should be presenting budgetary proposals that depend on rosy, highly speculative scenarios.     

 

November 18, 2012

Rick Perry thumbs his nose at ObamaCare’s Medicaid expansion

Filed under: Issues,Medical,People,Politics — Mike Kueber @ 3:25 pm
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Rick Perry and a lot of Republican governors are back in the news lately because they are declining to participate in two major components of ObamaCare – (1) developing insurance exchanges, and (2) expanding Medicaid.    

Part of the problem with Medicaid is that people don’t have a full understanding of the role it plays in America’s safety net.  Most people believe the major difference between Medicare (healthcare for the elderly) and Medicaid (healthcare for the poor) and is that Medicare is insurance that the beneficiaries have paid for, while Medicaid is welfare that is paid for by general tax revenues.  That is correct, but another oft-overlooked difference is that Medicare covers virtually all of the elderly while Medicaid applies to only a fraction of the poor.  In fact, Medicaid is essentially limited to poor children and their parents.  It does not generally cover poor people without children.  (Incidentally, in 2012 the poverty line (Federal Poverty Level or FPL) for an individual is $11,170; for a family of four, the poverty line it is $23,050.) 

ObamaCare is changing the limited nature of Medicaid in two significant ways – (1) it will apply to all poor people, not just poor people with kids (this will bring in an additional 17 million beneficiaries to Medicaid), and (2) it will extend to people who earn no more than 138% of the poverty line.  That means a family of four can earn more than $30,000.

For families that are more than 138% above the poverty line, ObamaCare provides for them to purchase coverage at an insurance exchange and for this purchase to be subsidized by the federal government if the family earns less than 400% of the poverty line ($45,000 for an individual; $90,000 for a family of four).  The amount of the subsidy is calculated by limiting, on a sliding scale, a family’s cost for the purchase to between 2% and 9% of family income.

The insurance exchanges and the expanded Medicaid are the two most important mechanisms in ObamaCare to insure the heretofore uninsured.  Although the law couldn’t force states to develop insurance exchanges, it warned that the federal government would develop exchanges in those states that declined.  Similarly, the law couldn’t force states to provide the vastly expanded Medicaid, but, in addition to providing generous reimbursement, it threatened to withhold all existing Medicaid funding from those states that declined.

This summer, however, the United State Supreme Court threw a monkey wrench into the ObamaCare design by holding that Congress could not punish states by withholding Medicaid funds if a state declined to participate in expanded Medicaid.  And a bunch of governors in conservative states immediately, with much flourish, declared their opposition.  Texas’s Rick Perry was their leader: 

  • “I will not be party to socializing health care and bankrupting my state in direct contradiction to our Constitution and our founding principles of limited government.”

But since President Obama’s re-election, some of the governors are reconsidering their initial rejection of expanded Medicaid because, upon closer examination, the rejection is fiscally irresponsible. ObamaCare promises to reimburse states for 100% of its costs for three years and after that the reimbursement rate will be 90%.  How could a fiscally responsible state turn down a valuable benefit to the poor and near-poor individuals in a state if it only has to pay 10 cents on the dollar?  Not only does it benefit the state’s poor, but it also brings a lot of federal dollars into a state, which will more than make up the state’s 10% cost.

Some state critics of ObamaCare have warned that there is no guarantee that the federal government won’t increase state responsibility in future years (states pay 43% of the costs of existing Medicaid benefits), but that warning doesn’t make sense because states could always discontinue a program if costs start exceeding benefits.  (Political feasibility is another thing.)  Furthermore, the fact that every state already participates voluntarily in the existing Medicaid with a 43% contribution rate suggests that these states would be falling all over themselves to get in an expanded program with only a 0-10% contribution rate.  

ObamaCare proponents have suggested that Perry and the other Republican governors were engaged in pre-election posturing, and will come around post-election.  In a Politico piece, Jennifer Granholm pointed out that Texas has 6.1 million uninsured, and the Medicaid expansion would cover 2 million of them, plus provide the Texas economy with a huge cash infusion of $76 billion for 2014-2019.    

Wow, that’s a lot of money to walk away from.  If I were a betting man, I would bet that Rick Perry is going to come around on this one.

July 9, 2012

Rick Perry tells President Obama to quit messing with Texas

Filed under: Issues,Medical,People,Politics — Mike Kueber @ 6:47 pm
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According to an article in today’s Texas Tribune, Texas governor Rick Perry has decided that Texas will resist the implementation of ObamaCare:

  • If anyone was in doubt, we in Texas have no intention to implement so-called state exchanges or to expand Medicaid under Obamacare.  I will not be party to socializing healthcare and bankrupting my state in direct contradiction to our Constitution and our founding principles of limited government.” 

The Tribune article points out that the decision with respect to state exchanges is not significant because ObamaCare provides that when a state refuses to set up an insurance supermarket, the federal government will step in with its own federal exchange.  But Perry’s decision is important with respect to the expansion of Medicaid.  The Medicaid expansion to individuals who earn up to 133% of the poverty line is essential to the ObamaCare objective of providing near universal health-insurance coverage.  According to a Fox Business report, ObamaCare is designed to extend health-insurance coverage to 16 million uninsured Americans through the insurance exchanges and another 16 million Americans through the Medicaid expansion. 

The Perry decision is bound to be controversial because (a) Texas has the nation’s highest rate of uninsureds (6.1 million) and (b) the federal government has promised to pay 90% of the cost of this expansion.  (Reminds me of that old saying from Alexis de Tocqueville about the proclivity of government to bribe people with their own money -“The American Republic will endure until the day Congress discovers that it can bribe the public with the public’s money.”) 

During the next ten years, according to DallasNews.com, the Medicaid expansion in Texas would cost the federal government $112 billion and Texas $9.5 billion.   Thus, many pundits predicted that states would be reluctant to turn down federal largesse, but Texas isn’t alone in tellling the federal government to go to hell.  Louisiana governor Bobby Jindal made a similar threat on a Sunday talk show last week, and according to an article in the Washington Times, there are more than a half dozen Republican governors who have made similar declarations.  According to TheHill.com, there are at least eight such governors, but it fails to identify them.  Slate.com places Wisconsin governor Scott Walker and Florida governor Rick Scott on the list of recalcitrant Republican leaders.        

DallasNews.com pointed out that Texas’s 6.1 million uninsured people, and “these folks obviously consume health care services, so their health costs get distributed across other populations: hospitals, insured consumers (who pay higher insurance premiums, to make up for the costs of the uninsured) and local taxpayers (who fund county hospitals that treat the uninsured).” 

Because of these facts, DallasNews.com pointed out the moderate Texas House Speaker Joe Straus, R-San Antonio, offered only partial support for Governor Perry:

  • Straus opposes the federal health law, and said he hopes Republicans will recapture the White House and Senate, and repeal it. If the law stands, however, Straus said the Legislature “will be much more involved in the decision making on this.”
  • But he said of Perry, “I have no quarrel with his approach today.”
  • The proposed Medicaid expansion as “a big, massive federal increase, … another entitlement,” that he said is unwise, “especially in these fiscal times.”

As a matter of principle, I agree with Rick Perry’s understanding of the federalism and the Tenth Amendment.  It is difficult to stand on principle, however, when it costs your citizens more than $100 billion over ten years.  I would accept the federal bribe while continuing to work toward the replacement of those politicians in Washington who delight in ignoring the Tenth Amendment.

December 4, 2011

Dr. Berwick leaves Medicare/Medicaid

Filed under: Issues,Medical,Politics — Mike Kueber @ 2:52 am
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The New York Times reported today that the federal head of Medicare/Medicaid for the last 17 months, Dr. Donald Berwick, had his last day on the job on yesterday.  According to the Times, Berwick believed “20 percent to 30 percent of health spending is ‘waste’ that yields no benefit to patients, and that some of the needless spending is a result of onerous, archaic regulations enforced by his agency….  [He] listed five reasons for what he described as the ‘extremely high level of waste.’ They are overtreatment of patients, the failure to coordinate care, the administrative complexity of the health care system, burdensome rules and fraud.”

One of the reasons that Republicans in the Senate refused to confirm Berwick was his statement in 2009 that, “The decision is not whether or not we will ration care — the decision is whether we will ration with our eyes open…. My point is that someone, like your health insurance company, is going to limit what you can get. That’s the way it’s set up. The government, unlike many private health insurance plans, is working in the daylight. That’s a strength.”

Sounds to me like Berwick is the kind of guy we need in Washington, at least until we can repeal ObamaCare.

 

 

October 19, 2011

The rising cost of medical care

Filed under: Economics,Issues,Medical,Politics — Mike Kueber @ 10:39 pm
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Two weeks ago, I had my knee partially replaced.  Because I hadn’t received any sophisticated medical care for many years, I was interested to learn first-hand the effect of the medical-care inflation that I had been reading about.

A few days before the surgery, my surgeon’s office called me to make arrangements for that part of his bill not covered by insurance.  Because I have a group-insurance policy that ObamaCare has characterized as gold-plated (i.e., a family policy that costs more than $23,000 a year), my share of the surgeon’s bill was only 10% because I had already met my deductible.

Much to my surprise, my doctor’s office said that my share would be $136. I was so surprised by that amount that I twice asked my doctor’s office to repeat the amount.  Based on my rudimentary math, I calculated that the doctor’s total bill would be $1,360.  That couldn’t be right, could it?

Even though knee-replacement surgeries have become so streamlined that the procedure takes less than an hour, $1,360 didn’t seem reasonably related to the partial replacement of a knee.  But applying further math to this situation – if my doctor did 20 of these surgeries a week, he would be able to gross $1,360,000 a year, plus income form his office practice, so I guess his fee was adequate.

Regarding the cost of sophisticated medical care in 2011 – so far, so good.

But today I received my hospital bill. This looks more like what I expected.  I went into to Methodist Texsan Hospital on Tuesday morning and was discharged Wednesday afternoon, thus I was in only one night.  Yet the total charges were $28,987.35.  Wow.  The dominant drivers of the bill were:

  • $9,092 for the OR, $1,305 for the recovery room, and $2,100 for my room.  I would love to know what formula a hospital administrator uses to come up with those amounts.
  • $6,264 for supply/implants.  This charge must be for the two items that partially replaced my knee.  It would be interesting to see how the forces of supply-and-demand resulted in that price.
  • $2,548 for anesthesia.  Could it be that the anesthesia costs more than the surgery?
  • $575 for physical therapy and $260 for physical therapy evaluation.  Based on the limited services that I received (a 15-minute evaluation, a 30-minute group
    session, and a 15-minute stair-climbing class), the therapy must be a huge profit center for the hospital.  The therapist was bringing in almost as much money per hour as the surgeon.
  • $1,615.46 for pharmacy and $414.54 for drugs.  Big Pharma needs its cut of the action, too.
  • $1,755 for sterile supplies.  Are you serious?  I wonder if there is any fat that could be cut from this item.
  • $780 for Lab/Chemistry and $569 for Path/Lab.
  • $370 for EKG/ECG.  From what I saw, this is a simple test with a simple machine.

My bill was contractually reduced by $12,022.21 to a less shocking $16,965.14.  Of course, that contractual arrangement is the only thing that makes insurance affordable today.

When I was growing up, insurance companies typically paid a percentage of the total bill (usually 80%) and didn’t have much leverage to prevent the hospitals and doctors from charging whatever they wanted.  In fact, their only contractual protection was against their insured, not the doctor/hospital – i.e., the insurance policy promised to pay “reasonable and necessary” medical expenses, and the insurance company could argue that excessive charges were not reasonable or necessary.  The patient might remain personally liable for the unreasonable component of a bill.

Nowadays, insurance companies survive by pre-negotiating prices with doctors and hospitals and then by insisting that its insureds use doctors or hospitals with pre-approved prices.  Thus, instead of being concerned and outraged by some of the apparently exorbitant prices on my bill, I am comforted to know that my insurance company, Humana, negotiated all of the prices with Methodist.

This same concept needs to apply to Medicare and Medicaid.  And it needs to apply utilization as well as pricing because excessive pricing isn’t the only way for medical vendors to screw the payor.  They can also screw the payor by including services and treatments that aren’t necessary, which is called over-utilization.

Republicans set back the movement to get control of medical costs when they demagogued that nothing should come between a patient and the doctor.  Although that statement has some merit with respect to the treatment provided, it has no place in determining what treatments and services will be paid for by the insurance company or government payor.  Capitalism and supply-and-demand don’t function properly whenever the individual making the purchase decision is not the same person who has to pay for it.  That’s an economics fundamental that we need to get back to.

August 25, 2011

Entitlement has become an ugly word

Filed under: Issues,Politics — Mike Kueber @ 4:18 am
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The following diatribe is floating around Facebook:

  • Entitlement my butt!! Older Americans paid into Social Security with every paycheck. Their benefits aren’t some kind of charity or handout! Congressional benefits – free health care, outrageous retirement packages, 67 paid holidays, three weeks paid vacation, unlimited paid sick days – now THAT’S welfare.  And Congress has the nerve to call Social Security and Medicare entitlements? Re-post if you are sick of their crap and ashamed of our “leaders”!

Many Americans appear to have conflated entitlement with welfare even though there is a stark difference.  An entitlement is simply something that a person has a right to.  A government entitlement is a program that provides benefits to those beneficiaries who satisfy the eligibility requirements provided for in the law that authorizes the program.  The beneficiaries are legally “entitled” to the benefits.  By contrast, government welfare means a program that provides benefits to individuals who are in dire straits and need help.  Eligibility for welfare benefits is “need-based.”

Based on these definitions, Medicaid, TANF (temporary assistance to needy families), SNAP (food stamps), and Section 8 housing are America’s dominant welfare/entitlement programs.  Social Security, Medicare, and Unemployment Benefits are entitlement programs, but not government welfare because they are not need-based.

Welfare has always had a negative connotation because most Americans want to be self-sufficient and don’t want to depend on government charity or handouts, so entitlement beneficiaries don’t want to be lumped in with welfare beneficiaries.  The problem is that, because of the constant refrain that entitlement programs are bankrupting America, many people have begun to attach a negative connotation to all entitlement programs, too.

The author of the Facebook diatribe is trying to distinguish Social Security from other entitlements on the basis that individuals have earned the benefit by virtue of contributions, and that point has some merit, although Social Security benefits have always exceeded the amount that was actuarially justified.

Furthermore, Social Security is a red herring because most experts agree that Medicare and Medicaid, not Social Security, are the programs that need to be reformed before they bankrupt America.  Medicare is like Social Security in that beneficiaries have contributed to the system, but their contributions aren’t even close to actuarial justification.  And there are no contributions from beneficiaries entitled to benefits under Medicaid.   Interestingly, one of the suggested fixes to Medicare is to convert it to a welfare program – i.e., make it need-based.

Entitlement reform is needed.  Everyone agrees that Social Security is in a category by itself because contributions approximate benefits, but that is not true about Medicare.  Any serious attempt to balance the budget, like the Paul Ryan proposal, will need to make major changes to Medicare and Medicaid.

August 18, 2011

Bexar County-subsidized health coverage

A recent article in the San Antonio Express-News reported that the board of managers for the Bexar County’s health system (primarily the county hospital) would not be requesting a rate increase.   The president of the system said they were being asked to do more with less, but they accepted the challenge.

Although the decisions of the system’s board and the president are commendable, the most newsworthy information in the article is the extent to which the county hospital is subsidized by taxpayers.  The article reported that the average homeowner in Bexar County would pay $400 a year to the county-owned system.  Furthermore, state and federal funding for the hospital was being cut by $15.5 million in 2012, but the article didn’t reveal the actual amount of that funding.

Although these numbers may not seem huge for a county that is approaching two million people, you should keep in mind that the federal government through Medicaid assumes the financial burden for supplying medical care to millions of people too poor to buy their own medical insurance.

I have previously blogged that Bexar County provides extremely generous quasi-insurance for medical care to low-income residents – i.e., those with incomes less than 300% of the federal poverty guideline are eligible for CareLink – and I am happy to see that the managers of this system are attempting to do some belt-tightening.  By doing some additional internet research on Bexar County’s health system, I was able to learn:

  • Medicaid covered 21% of the services provided by the system in 2009.  Furthermore, Medicare covered 19% and private insurance covered 18%, but 41% had either no coverage or CareLink.
  • Operating expenses in 2009 were $890 million, and because of the large number of uninsureds who couldn’t or wouldn’t pay their bills, the system had an operating loss of $222 million in 2009.
  • Property taxes contributed $280 million (28%) of the system’s revenue in 2009, and this turned its operating loss into an overall gain for the year.

As I previously blogged, this decentralization of this essential governmental service to the county appears to be moderately successful and is probably a better approach than centralized ObamaCare.

July 19, 2011

AARP demagoguery

Filed under: Issues,Politics,Retirement — Mike Kueber @ 2:34 am
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While watching the news on TV this afternoon, I caught the tail end of an AARP commercial weighing-in on the debt-ceiling negotiations in Washington.    According to the retired teacher in the AARP commercial, the Washington negotiators are considering cuts to Social Security and Medicare, when they should be looking to cut waste and eliminate loopholes.

As I blogged only yesterday, there is always an open season in Congress for eliminating waste, but if they knew what the targets were, they would have already eliminated them.  Cuts at this time have to be made to programs that many believe to be worthwhile.

The AARP commercial is demagoguery because no one is suggesting cuts to Social Security that would affect the retired teacher in the commercial.  The proposals that I have heard discussed would affect future retirees only.  Furthermore, the AARP website claims that the Social Security system is financially solvent, but conveniently fails to mention that Medicare and Medicaid are two of the biggest reasons for our current financial pickle.

I guess it is expecting too much for a group like the AARP to take positions that look beyond its own special interests.  But we have to hope that its members do.

June 5, 2011

Welfare as we know it in 2011

Liberals often complain that America doesn’t provide a world-class safety net for its poor, especially since 1996 when President Bill Clinton promised to “end welfare as we know it.”  Conservatives respond that reports on the demise of welfare in America are greatly exaggerated.

Prior to 1996, the cornerstone of American welfare was the Aid to Families with Dependent Children program (AFDC).  AFDC was an open-ended entitlement, with each state given limitless money by the federal government.  Thus, there was no incentive for states to direct welfare funds to the neediest recipients or to encourage individuals to go off welfare because the state lost federal money when someone left the system.  Furthermore, there were social-engineering complaints that AFDC encouraged poor women to have kids and remain unmarried.

In 1996, President Bill Clinton and the Republican-controlled Congress passed the Personal Responsibility and Work Opportunity Reconciliation Act (PRWOR), which gave control of the welfare system back to the states.  The PRWOR, which gave each state a flat-rate per state based on population, eliminated the AFDC and replaced it with a new program called Temporary Assistance for Needy Families (TANF), with the emphasis on temporary.  It encouraged states to require some sort of employment search and imposed a five-year lifetime limit on cash assistance.

TANF was generally considered a success by liberals and conservatives because it resulted in a steep drop in the number of people on welfare (from 12.3 million receiving AFDC in 1996 to 4.4 million received TANF in 2010), increased employment, and reduced child poverty.  In the aftermath of the financial crisis of 2007-2008, however, liberals are reconsidering whether the earlier good numbers were merely a fortuitous result of a booming economy.  With that in mind, President Obama used his Economic Stimulus Act of 2009 to again base federal grants to the states on the number of people signed up for welfare rather than at a flat rate, which will encourage states to maximize participation in their welfare programs.

Earned Income Tax Credit (EITC)

Although AFDC and its successor TANF are what most people think of when referring to government welfare, these programs are only a small part of America’s patchwork of welfare.  In fact, TANF is not even the only current cash disbursement to the needy – the other is the Earned Income Tax Credit (EITC).  The EITC, started in 1975, provides a tax credit to low- and moderate-income workers, and when the EITC exceeds the
amount of taxes owed, it results in a tax refund to those who qualify for the credit.  For tax year 2010, the maximum EITC for a person or couple without qualifying children is $457, with one qualifying child is $3,050, with two qualifying children is $5,036, and with three or more qualifying children is $5,666.  In 2004, the program cost $34 billion.

Supplemental Nutrition Assistance Program (SNAP)

SNAP is the modern-day successor to the Food Stamp program, which was created by the Food Stamp Act of 1964.  There are currently 44 million Americans receiving food stamps, and program costs nearly $50 billion.  Although liberals sometimes contend that food stamps primarily benefit African-Americans, actually 43% of all beneficiaries are white, 33% are African-American, 19% Hispanic, and 2% Asian.  Welfare reform in 1996 imposed some duration limits on receiving food stamps, but these limits do not apply to children, who comprise 49% of the beneficiaries.
Illegal immigrants are not entitled to food stamps, but their citizen children are.

Low-income housing (Section 8)

Section 8 of the U.S. Housing Act of 1937 authorizes the federal government to provide rental-housing assistance.  It currently provides benefits, primarily through the Housing Choice Voucher program, to 3.1 million low-income households.  Typically, tenants pay about 30% of their income for rent, while the rest of the rent is paid with federal money.  Thus, the more income that a beneficiary makes, the less the federal government will subsidize.

Medicaid and ObamaCare

Medicaid was created in 1965 as a part of the Social Security Act, and although participation by each state is voluntary (states pay for almost one-half of all costs), all states have participated since 1982 when Arizona joined.  It is a means-tested health program, but poverty alone does not necessarily qualify someone for Medicaid.  Beneficiaries (over 60 million) are primarily low-income households with children (45 million),
disabled people ((9 million), and poor old people in nursing homes (6 million).   ObamaCare will significantly expand the scope of Medicaid by providing coverage to all adults with income up to 133% of the poverty line.  The cost of Medicaid is already approaching $400 million a year and will skyrocket under ObamaCare.

Summary

To summarize, America still provides welfare through TANF, but there is a five-year lifetime limit on cash payments.  The EITC provides a tax credit to low-income workers, primarily those with kids.  SNAP provides food to low-income people, and there are no duration limits to children.  Section 8 provides housing at a cost that is limited to 30% of a person’s income.  And finally Medicaid under ObamaCare will provide full medical coverage.

The only thing left is the job that candidate Obama promised to everyone who wants one, but as a conservative wag noted, what
left-thinking person wants a job when they already have all of these other fine benefits.

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