If we’ve learned one thing from the ongoing health care debate, it’s that we need to look at America’s social benefit programs and consider a universal reset. There certainly is no shortage of policy ideas and passionate theoretical debates. As a global administrator of government health and welfare programs, we bring practical, applied experiences from those administering these safety net programs.

Over the past 40 years, we’ve seen two general principles:

1. People carefully consider their options when making choices about health care and human services programs. Therefore, when a program participant evaluates available benefit options, the participant will make a logical, sensible choice for the option that offers the greatest benefit or satisfaction for the participant and his or her family.
2. Due to unaligned programs with conflicting policy and funding models, the “mixed model” patchwork of public health and welfare programs makes it nearly impossible to efficiently achieve the stated objectives of individual programs. 

To envision how safety net programs could be more effectively coordinated and integrated to achieve policy outcomes, it is useful to revisit the intent that policymakers hoped to achieve when these programs were first created. Consider these examples:

• Medicaid was authorized under Title XIX of the Social Security Act of 1965 to provide medical assistance to state residents who met certain eligibility requirements for cash assistance. Later, the covered population was expanded to include low-income families (regardless of cash assistance), pregnant women, people of all ages with disabilities, and people requiring long-term care.
• Temporary Assistance for Needy Families (TANF) was authorized in 1996 as part of reform efforts to replace the Aid to Families with Dependent Children (AFDC) or cash assistance program, which was created in 1935. TANF provides temporary financial support to low-income families with dependent children with the aim of helping them achieve self-sufficiency. While there are exceptions, TANF benefits are intended to include a life-time limit of five years (or 60 months).
• Supplemental Nutrition Assistance Program (SNAP) was established in 2008, replacing the food stamp program established in 1964 by President Johnson. The purpose of SNAP is to increase food availability, combat hunger and promote a healthful diet by providing food assistance and nutrition education for low-income households. Able-bodied adults without dependents (ABAWDs) may only receive SNAP for three months within three years.

Over time, the original intent for these three programs has expanded and their target objectives have become blurred as federal and state leaders sought reform and bring more “creative” solutions to address more complex problems.

Welfare reform in the 1990s sought to resolve some of those flaws, make Americans more accountable for bettering their economic status, and provide a path to economic self-sufficiency. While this welfare-to-work approach primarily impacted single mothers, other family groups and single adults without children were barely impacted. Moreover, it created a paradox for low-wage workers who now faced a “benefit cliff” whereby modest gains in earnings could leave their families worse off because they no longer qualify for benefits like housing subsidies, food stamps or child care. Being the rational economic actors that they are, many participants made prudent decisions that kept them within the relative security of the safety net. Consequently, leaders are looking for ways to rethink these programs as they look for solutions to address the consequences of multi-generational poverty in their communities.

Reform efforts made in more recent years have primarily focused on changing program administration and eligibility requirements, specifically in the health care arena under the Affordable Care Act (ACA) as well as new proposals to replace ACA. However, the way in which government programs are administered has not changed enough to successfully transition individuals off of public programs nor to positively affect program budgets.

For governments to cultivate a culture of opportunity, they require administrative solutions that enable them to integrate and align program delivery. If done correctly, program participants will be provided prudent and logical benefit choices that offer a pathway to self-sufficiency rather than irrational benefit choices that create the benefit cliff.  

To accomplish this, governments must identify and address the roadblocks that an individual or family has to economic security and coordinating the support services. For example, just providing Medicaid coverage doesn’t help a family meet their basic needs if they are also homeless and unable to find work. Likewise, assisting people to find work in minimum wage jobs will not provide them with the economic security to afford health insurance. We can give governments administrative options that enable them to create a holistic approach to assessing individual needs, not just approving eligibility for programs, and focus resources on supporting that individual’s commitment to change and self-sustainability in the long-run.

Tackling reform in these programs may require a hard look at all of the “exceptions” that currently exist and definitely necessitate an alteration to how these programs are administered with a greater focus on cross-program integration. Should health, housing, workforce and nutrition be administered separately when they are so interconnected in an individual’s daily life? Can we more effectively utilize monetary and human resources by concentrating on those individuals and families who are willing and able to make changes in their lives to reduce reliance on public assistance? It’s essential that the thinking and approach for these programs change at all levels of accountability – federal, state and individual. Only through focusing on the individual ability and commitment to improving their life can we begin to untangle the web of social benefit programs.