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Social = Collective Society. Important Facts. What percentage of your paycheck is taken to pay for Social Security? 7.65% What % of Children under 18 live in poverty? 17.8% What is the name for federal insurance program for the elderly? Medicare. Important Facts.

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Social collective society l.jpg
Social = Collective Society

Dhrubodhi Mukherjee


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Important Facts

  • What percentage of your paycheck is taken to pay for Social Security?

  • 7.65%

  • What % of Children under 18 live in poverty?

  • 17.8%

  • What is the name for federal insurance program for the elderly?

  • Medicare

Dhrubodhi Mukherjee


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Important Facts

  • What is the name of federal medical assistant program for the poor?

  • Medicaid

  • What is the federal/state cash assistance program that has been designed to aid poor children?

  • Temporary Assistance for Needy Families (TANF)

  • How many members of Congress are there?

  • HOR – 434

  • Senate - 100

Dhrubodhi Mukherjee


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Social Welfare System

  • Social Issues/Problems

  • Policy Goals - Debate

  • Legislation and Regulation

  • Social Welfare Programs

Dhrubodhi Mukherjee


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Important Questions to Study Social Welfare Systems

  • Who gets services? (Eligibility)

  • Why do they get services? (Program Goals)

  • What do they receive? (Benefits)

  • How do they receive services? (Service Delivery system)

  • What does it cost? (Cost Analysis)

  • Who pays for it? (Financing)

Dhrubodhi Mukherjee


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World War II, The postwar era.

  • New Deal was dismantled during World War II.

  • All the programs for Social Security survived the war.

  • Post-war economic boom

  • Conservative pressure

  • Marshall plan

  • Increase in Military spending: Korean War 1950-53.

Dhrubodhi Mukherjee


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Welfare Vs. Military-Industrial Complex

  • Eisenhower: “Every dollar spent on guns is a dollar not spent on humanitarian programs.

  • Development of missile and costly aircraft.

  • Protection of Eastern Europe.

  • Proliferation of Communism.

  • Racial matters left to states.

Dhrubodhi Mukherjee


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Issues

  • Terms: Constituency

  • “War on poverty” …..President Johnson (the golden era of welfare policy)

  • Reagan Era: Introduction of Block Grants

  • “ending welfare as we know it” ….President Clinton ( a shift in attitude towards welfare policy)

  • Does public opinion translates into public policy?

Dhrubodhi Mukherjee


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Evolution of social welfare system

  • Industrialization and social welfare system

  • Social values and cycles of history

    • Work vs Leisure

    • Individualism vs Collectivism

    • Competition vs. Cooperation

  • Social control

  • Elite power

Dhrubodhi Mukherjee


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Competing ideologies and social welfare system

  • Worthy and unworthy poor

  • Blaming the victim

  • The culture of poverty

  • The Biological Determinism

  • Social Welfare as a right

Dhrubodhi Mukherjee


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Questions?

  • In ancient societies we did not have any welfare, why do we need it now?

  • Do you think social welfare is a human right?

  • Do you think, people who do not benefit from welfare but do pay for it should have a say in the continuation of welfare system?

  • How long should a person in need be served by welfare?

  • Do you think people who are at a disadvantage should share at least some blame for their plight?

  • Is welfare more important than defense?

Dhrubodhi Mukherjee


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Questions?

  • Do you think historically our welfare system have improved the life of people?

  • Do you think welfare serves more of immediate problem instead of addressing the root issues?

  • Do you think foreign nationals and temporary residents should also receive welfare benefits?

  • How much ones needs to be socially responsible and how much one needs to be self-reliant?

  • Do you think your values are reflected in the social welfare decision making?

Dhrubodhi Mukherjee


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Three issues that the president had raised that concerned welfare

  • Comprehensive Immigration Reform

  • Healthcare Reform

  • Global Warming

  • Public School

Dhrubodhi Mukherjee


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Should government involvement and spending in social welfare be reduced?

  • Do you favor or oppose it?

  • What is your justification?

  • What are the advantages of a government funded social welfare system?

  • What are the disadvantages of a government funded social welfare system?

  • What does the history say?

  • Do we have enough consensuses?

Dhrubodhi Mukherjee


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Should government involvement and spending in social welfare be reduced?

  • What are the alternatives to a government funded social welfare system?

  • Is money a problem?

  • How many people do need welfare?

  • What does evaluation reports say?

  • Does it discourage entrepreneurship motivation?

Dhrubodhi Mukherjee


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Should government involvement and spending in social welfare be reduced?

  • Does it create a culture of dependence?

  • Does it go with the values that our founding fathers held?

  • What is the place of social welfare system in a market economy?

  • What can we learn from different experiments in other countries?

Dhrubodhi Mukherjee


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Our worldview influences our support on social policy making be reduced?

  • Positivist

  • Post-Modernist

Dhrubodhi Mukherjee


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Who influences social policy making? be reduced?

  • Administrators

  • Legislators

  • Judiciary

  • Executives

Dhrubodhi Mukherjee


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Can social policy making decrease the need for welfare in future?

  • Residual Policy Making

  • Institutional Policy Making

Dhrubodhi Mukherjee


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Residual Welfare Services future?

  • Residual Services

    • Eligibility based on proving a need

      • The breakdown of other systems that should be working

      • Success is measured by the decrease of numbers receiving services

      • Stigma is attached to recipients

      • Services are means tested

        • Food stamps

        • TANF

        • General Relief

        • Head Start

        • WIC Nutrition Program

Dhrubodhi Mukherjee


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Institutional Welfare Services future?

  • Services are preventative

  • Eligibility is flexible

  • Minimal stigma

  • Benefits are universal

  • Negative outcomes are prevented

  • Services include

    • Redistribution of wealth

    • Guaranteed income

    • Negative income tax

    • Children’s allowances

    • Socialized health care

Dhrubodhi Mukherjee


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Who performs social policy making? future?

  • Private sector

  • For profit

  • Non-profit

  • Public sector

  • Government (Federal, State, Local)

  • Can private sector policy influence public sector policies?

Dhrubodhi Mukherjee


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Local and Subnational Policy making future?

  • The Hierarchical Model

  • Do local governments only implements the policy made by the Federal government?

  • Does local governments enjoy an independent policy making right by the constitution?

  • According to the Constitution the Federal Government has no constitutional power to develop and implement social policy

Dhrubodhi Mukherjee


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State and Local Governments future?

  • State governments gives local governments the power to rule through charters.

  • The charters specifies the responsibilities and obligations granted to local governments

  • Can state governments take away such powers from local governments?

Dhrubodhi Mukherjee


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Overlapping jurisdictional Authority future?

  • Local level policy analysis becomes complex because of the overlapping jurisdictional authority

  • Counties, townships, municipalities, city governments

  • School Districts, Special Districts or Authorities such as Port Authority, Airport Authority, Transportation, University,

Dhrubodhi Mukherjee


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Can state boss over local governments at will? future?

  • Article 10 of the US Constitution named “popular sovereignty” protects local governments from state, very much the same way states are protected from Federal government

Dhrubodhi Mukherjee


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Feds bypass State to ally with locals future?

  • Title II of Higher Education Act lets Federal government fund local schools districts directly independent of state jurisdiction

  • No-Child-Left-Behind Act

  • War on Poverty programs

  • Housing Codes

Dhrubodhi Mukherjee


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The role of non-profits future?

  • Can the county commissioners direct the local United Way to use its funds to support specific social programs the county may need?

  • However, the local United Way can be encouraged to support existing public social services

Dhrubodhi Mukherjee


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Non-Profits and Public Agencies future?

  • Non-profits are supposed to be more innovative in designing new social welfare program that they run

  • At times the success of non-profit exposes the faults in public social welfare systems

  • States are encouraged to be innovating and chart new direction, like the non-profits, through block grants

Dhrubodhi Mukherjee


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Partnerships future?

  • Council of Governments (COG)

  • Example: Older American Acts – Area Agencies on Aging (AAA)

  • Public-Private partnership--- Bank Mortgage

  • If private social welfare agencies desire contractual relationship with public agencies, then it must agree to abide by the regulations set down by the public agency

Dhrubodhi Mukherjee


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Operation issues future?

  • How do local governments manage this confusion with overlapping jurisdiction?

  • Informal Policy Making

Dhrubodhi Mukherjee


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The effects of competing values on social systems future?

  • Social responsibilities for the care of the poor and those in need

  • Personal responsibilities through self-reliance?

  • Conservative Vs Liberals

  • Social Work Values

  • Impact of values on social welfare policies

Dhrubodhi Mukherjee


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Inter-govt relations future?

  • Whether Fed and State/local govt share the same objectives

  • If state/local govts receive Fed fund then they have to adhere to Fed guidelines

  • Carrot and Stick approach

Dhrubodhi Mukherjee


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Federal Govt. Money future?

  • Morrill Act (1862)

  • Payments to Individuals

  • Grant-in-Aid (categorical grants)

  • Block Grant

  • Subsidies

  • Interest-free bonds

  • Tax Incentives

Dhrubodhi Mukherjee


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Categorical Grant and Block Grant; Comparison future?

  • BGs give state and local govts more power

  • BGs are more flexible

  • CGs have strings attached

  • CGs include matching fund from Feds

  • CGs are complicated to administer

  • CGs are more expensive to administer

  • BGs could be more effective than CGs

Dhrubodhi Mukherjee


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Forms of social welfare assistance future?

  • Cash

  • In-kind

  • Vouchers

  • Social Insurance

Dhrubodhi Mukherjee


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Income Maintenance- Social Insurance future?

  • Social Security-OASDI

  • Medicare

  • Unemployment Insurance

  • Workers Compensation

Dhrubodhi Mukherjee


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Income Maintenance: Public Assistance future?

  • Assistance made as unpleasant as possible to deter use

  • Recipients should be made to work regardless of job conditions or pay

  • Payments must be lower than what can be received at a job

  • Aid should only be temporary

  • Assistance should be denied to those who voluntarily quit their jobs.

Dhrubodhi Mukherjee


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Income Maintenance: Public Assistance future?

  • AFDC/TANF

  • Food Stamps

  • SSI

  • Medicaid

  • Housing Assistance

Dhrubodhi Mukherjee


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Private Programs future?

  • Health Care

  • Private Pension Plans

  • Disability Payments

  • Life and Death Insurance

Dhrubodhi Mukherjee


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Social policy analysis future?

  • Investigation and Inquiry into the causes and consequences of public policy.

  • To provide guidance and direction to policy makers

  • Information gained through policy analysis can be used to develop policy alternative

  • To assess existing and previous policies

Dhrubodhi Mukherjee


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Social welfare policy analysis future?

  • social policy arena is diverse with numerous interest groups.

  • Its both art and science

  • Social welfare policy follows a linear flow

Dhrubodhi Mukherjee


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Policy Analysis Framework future?

  • Problem Identification

  • Locating the focus of policy decision

  • Determining Alternatives

  • Predicting Policy Impact and Unintended Effects

  • (most of the times an expected impact of a social policy differ from the real or actual impact)

Dhrubodhi Mukherjee


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Models of Social Policy Analysis future?

  • Define a problem

  • Devise alternatives that would resolve it

  • Gather and examine data to empirically support these alternatives

  • Carry out a cost-benefit analysis

  • Evaluate whether its achieving its intended result

Dhrubodhi Mukherjee


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Incrementalism future?

  • Its not always feasible to gather all information and information of all possible choices are not readily accessible

  • Its always better to make small changes in the existing policy and as gather more information and move on eventually the existing policy will transform itself into a new one.

  • Social Security and TANF are examples of incremental policy making

Dhrubodhi Mukherjee


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Is policy making a rational process? future?

  • Do rational policy making exist?

  • Rational policy making (ideally) involve

    • Knowledge of the values of all segment of the society

    • All possible policy alternatives and their consequences

    • Cost and benefits analysis (which is hard to come by)

    • Do you think this is possible?

Dhrubodhi Mukherjee


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In reality; the making of public policy is usually messy and irrational

  • Numerous factors interfere into rationality

  • Competing values

  • Interest groups with varied resources

  • Lack of time to weigh all possibilities

  • Lack of adequate information

Dhrubodhi Mukherjee



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Windows of opportunity irrational

  • Compelling public problem

  • A Solution

  • Political support

Dhrubodhi Mukherjee


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Street Level Bureaucrats irrational

  • Service workers

  • Implementation

Dhrubodhi Mukherjee


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Component 1: Social Issues irrational

  • What is the definition of the problem?

  • Are there competing conflicting definitions?

  • Is there a general agreement?

  • What is the extent of the problem?

  • Who is defining it at this time and why?

  • Who disagrees and why?

  • (once there is enough agreement then goals begins to emerge)

Dhrubodhi Mukherjee


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Component 2: Goals irrational

  • What is the general goals?

  • Are there sub-goals?

  • Do the sub-goals conflict?

Dhrubodhi Mukherjee


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Component 3: Policy/Legislation irrational

  • What is/are relevant public policies?

  • If there are no public policies, why?

  • What are the objectives of the policies?

  • Are there hidden agendas?

  • Who supports the policies?

  • Who opposes the policies?

Dhrubodhi Mukherjee


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Component 4: Affected populations irrational

  • Who is touched by the policy and programs?

  • Are there positive effects?

  • Are there negative effects?

Dhrubodhi Mukherjee


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Component 5: Intended Results irrational

  • What was supposed to be the result?

  • Who was supposed to have been affected?

  • How was the social problem supposed to have been changed?

Dhrubodhi Mukherjee


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Component 6: Actual Impact irrational

  • Cost and benefits?

  • Is the social problem changed?

  • If so, how?

  • Are there unintended results?

Dhrubodhi Mukherjee


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Policy Decision Making Process irrational

  • Executive (President): Single action leadership

  • Legislative (Congress): Negotiation-Compromise

  • Judicial (Courts): Formal-Legal Aspects

  • Administration (Staff): who benefits-who doesn’t, policy specific data gathered.

Dhrubodhi Mukherjee


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Summary: Questions you should ask irrational

  • Is the problem correctly conceptualized?

  • What is the extent of the problem and where is target population?

  • Does the program design fit with the objective?

  • Is there an underlying coherent rationale?

  • Are there efforts to maximize the chances of success of the provision?

  • What are the real projected costs?

  • What is the benefit, as related to the costs?

Dhrubodhi Mukherjee


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Summary: Questions you should ask irrational

  • Does the service reach the population targeted?

  • Is the program being delivered as it is designed?

  • Is the program reaching its goals?

  • Is something other than the program causing positive results?

  • How much the program costs and how much does it benefit the recipients?

  • Is the program the most efficient alternative?

Dhrubodhi Mukherjee


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Income Maintenance irrational

  • Equality

  • Equity

Dhrubodhi Mukherjee


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Poverty: Social policy perspective irrational

  • Defining poverty

  • Absolute measure of poverty

  • Relative measure of poverty

  • Poverty threshold

  • Poverty guidelines

Dhrubodhi Mukherjee


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SOURCE: U.S. Bureau of the Census, irrationalIncome, Poverty, and Health Insurance Coverage in the United States: 2004, Report P60, n. 229, p. 45.

Dhrubodhi Mukherjee


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Has the poverty rate changed overtime? irrational

  • 1959: 22%

  • 1969: 12.1%

  • 1975: 12.3%

  • 1983: 15.2%

  • 1991: 15.1%

  • 2000: 11.3%

  • 2004: 12.7%

Dhrubodhi Mukherjee


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2006 HHS Poverty Guidelines irrational

SOURCE:  Federal Register, Vol. 71, No. 15, January 24, 2006, pp. 3848-3849

Dhrubodhi Mukherjee


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What programs use the poverty guidelines? (DHHS) irrational

  • Community Services Block Grant

  • Head Start

  • Low-Income Home Energy Assistance Program (LIHEAP)

  • Community Food and Nutrition Program

  • PARTS of Medicaid (28 percent of eligibles in Fiscal Year 2003)

  • Hill-Burton Uncompensated Services Program

  • AIDS Drug Assistance Program

  • State Children's Health Insurance Program

  • Medicare – Prescription Drug Coverage (subsidized portion only)

  • Community Health Centers

  • Migrant Health Centers Grants

  • Family Planning Services

  • Health Professions Student Loans — Loans for Disadvantaged Students

  • Health Careers Opportunity Program

  • Scholarships for Health Professions Students from Disadvantaged Backgrounds

  • Job Opportunities for Low-Income Individuals

  • Assets for Independence Demonstration Program

Dhrubodhi Mukherjee


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What programs use the poverty guidelines? (Dept. of Agriculture)

  • Food Stamp Program

  • Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)

  • National School Lunch Program (for free and reduced-price meals only)

  • School Breakfast Program (for free and reduced-price meals only)

  • Child and Adult Care Food Program (for free and reduced-price meals only)

  • Expanded Food and Nutrition Education Program

Dhrubodhi Mukherjee


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Programs that do not use the poverty guidelines in determining eligibility

  • Temporary Assistance for Needy Families (TANF) and its predecessor, Aid to Families with Dependent Children (AFDC) (in most cases)

  • Supplemental Security Income (SSI)

  • Earned Income Tax Credit (EITC)

  • State/local-funded General Assistance (in most cases)

  • Large parts of Medicaid (72 percent of eligibles in Fiscal Year 2003)

  • Section 8 low-income housing assistance

  • Low-rent public housing

Dhrubodhi Mukherjee


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Dhrubodhi Mukherjee determining eligibility


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SOURCE: U.S. Bureau of the Census, determining eligibility Income, Poverty, and Health Insurance Coverage in the United States: 2004, Report P60, n. 229, Table B-2, pp. 52-7.

Dhrubodhi Mukherjee


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Ratio of Income to Poverty determining eligibility .

  • Family A has five members: two children, their mother, father, and great-aunt.

    • Their threshold was $23,108 dollars in 2004.

    • Suppose the members' incomes in 2004 were:

  • Compare total family income with their family's threshold.

  •      Income / Threshold = $25,000 / $23,108 = 1.08

Dhrubodhi Mukherjee


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Two Views of Poverty determining eligibility

  • The poor are victims of their circumstances and do not have opportunities to advance

  • The poor are responsible for their circumstances and do not take advantage of available opportunities

  • The emphasis of antipoverty policy in the U.S. has shifted between these two views

  • The Personal Responsibility and Work Opportunity Reconciliation Act of 1996 emphasizes the second view

Dhrubodhi Mukherjee


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Dhrubodhi Mukherjee determining eligibility


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Dhrubodhi Mukherjee determining eligibility


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Brief History determining eligibility

  • 1601 – Elizabethan Poor Laws

  • 1935 – AFDC

  • 1980’sWelfare Reform Demonstrations

  • 1996 – PRWORA/ TANF

  • 2002 – TANF Reauthorization

Dhrubodhi Mukherjee


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Poverty Definition determining eligibility

  • If a family’s total income is less than the family’s threshold, then that family and every individual in it is considered in poverty.  The official poverty thresholds do not vary geographically, but they are updated for inflation using Consumer Price Index (CPI-U).  The official poverty definition uses money income before taxes and does not include capital gains or noncash benefits (such as public housing, Medicaid, and food stamps).

Dhrubodhi Mukherjee


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Work and Welfare determining eligibility

  • Family Support Act 1988

  • Job Opportunities and Basic Skills (JOBS)

  • Training Cost

Dhrubodhi Mukherjee


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Income Maintenance Programs determining eligibility

  • Title II of Social Security Act

  • The Social Security Trust Fund

  • Pay-as-you-go program

  • Social Security is considered to be an income and it is taxed

  • Social Security income is used to determine eligibility for Supplementary Security Income (SSI)

Dhrubodhi Mukherjee


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Social Security determining eligibility

  • Social Security alone in inadequate for most households

  • Work incentives play an important role in determining Social Security Benefits

  • Gender bias and Social Security

  • Social Security Privatization

  • Unemployment Insurance

Dhrubodhi Mukherjee


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Overview of the Aid to Families with Dependent Children Program (AFDC)

  • Established in 1935 as part of the Social Security Act

  • Shared cost program between federal government and states

  • Originally intended primarily for widows, AFDC increasingly served never-married mothers

  • States had discretion primarily over setting income eligibility limits and benefit levels

  • Activity requirements were weak and generally focused on education and training rather than work

  • States were not allowed to time limit beneficiaries

  • Beginning in early 1990s, states increasingly used waivers to try new approaches to reducing welfare dependence

Dhrubodhi Mukherjee


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Overview of the 1996 Welfare Reform Law (PRWORA) Program (AFDC)

  • Temporary Assistance for Needy Families

  • Non-marital Births

  • Supplemental Security Income for Children

  • Child Support Enforcement

  • Child Care

  • Food Stamps

Dhrubodhi Mukherjee


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Five Components of TANF Program (AFDC)

  • End Cash Entitlement

  • Block Grant Funding

  • Work Requirements

  • Sanctions

  • 5-Year Time Limit

Dhrubodhi Mukherjee


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Purposes of TANF Program (AFDC)

  • Provide Assistance to Needy Families with Children

  • End welfare dependence by promoting work preparation, work, and marriage

  • Prevent non-marital pregnancies

  • Encourage formation and maintenance of two-parent families

Dhrubodhi Mukherjee


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Number of Families Receiving AFDC/TANF, 1950-2004 Program (AFDC)

Dhrubodhi Mukherjee



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Percentage of Married, Single, Program (AFDC)and Never-Married Mothers Working, 1985-2000

Dhrubodhi Mukherjee


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Dhrubodhi Mukherjee Program (AFDC)


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Teen Birthrate, 1980-2000 Program (AFDC)

Source: National Center for Health Statistics

Dhrubodhi Mukherjee


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Funding Under AFDC Program (AFDC)

State Match

Federal Match

50%-78%

22%-50%

Dhrubodhi Mukherjee


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FEDERAL Program (AFDC)

STATE

The Federal government will provide a block grant to states of the full amount of Federal funds that the State received in Federal fiscal year 1994, 1995 or the average of 1992 through 1994

The State will provide 80%* of the State funding that was provided by the State in Federal fiscal year 1994

The Agreement Under TANF

*75% if participation requirements are met

Dhrubodhi Mukherjee


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TANF Program (AFDC)Temporary Assistance for Needy Families

  • Block Grant Funding

  • No Individual Entitlement

  • Work Requirements

  • Time Limits

  • Broad State Flexibility

Dhrubodhi Mukherjee


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Purposes of TANF Program (AFDC)

  • To provide assistance to needy families so that children may be cared for in their own homes or the homes of relatives;

  • To end the dependence of needy parents on government benefits by promoting job preparation, work, and marriage;

  • To prevent and reduce the incidence of out-of-wedlock pregnancies and establish annual numerical goals for preventing and reducing the incidence of these pregnancies; and

  • To encourage the formation and maintenance of two-parent families

Dhrubodhi Mukherjee


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The TANF Caseload Program (AFDC)

  • Families with an adult

    • Includes single parent and two parent families

  • Child-Only cases

    • Children with relatives

    • Parent(s) receiving SSI

    • Parent(s) ineligible (i.e. non-citizen status)

Dhrubodhi Mukherjee


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Status of TANF Leavers, 1999 and 2002 Program (AFDC)

1999 2002

  • Working 49.9% 42.2%

  • Recently Worked 6.5% 7.1%

  • Spouse working 9.9% 7.5%

  • Disconnected 9.8% 13.8%

  • Return to TANF 20.4% 25.5%

  • Receiving SSI 3.5% 3.8%

Source: Loprest, Urban Institute Fewer Welfare Leavers Employed in Weak Economy

Dhrubodhi Mukherjee


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The case against welfare state Program (AFDC)

  • Social problem still persist

  • Inequality growing in manifold

  • Tax increases with welfare

  • Creates a class of dependent people

  • Evaluation of welfare gets more political than performance based

  • Some welfare programs, in fact, negatively affected its target population

  • Bad for competition based market economy

Dhrubodhi Mukherjee


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The case for welfare Program (AFDC)

  • The problems could have been worse

  • Tax cuts not necessarily direct into constructive investment and poverty reduction

  • Factors other than welfare that contributed to social problems

  • Our perceptions on social problem make us believe its still while it has made improvement

Dhrubodhi Mukherjee


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The case in favor (cont..) Program (AFDC)

  • some social problems have clearly been redressed

  • some new problems have emerged

  • in some cases the social problems have not changed but the expectations soared

  • in some cases social problems have been poorly administered

  • AMA and interest groups regulates welfare effectiveness

Dhrubodhi Mukherjee


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Missed opportunities Program (AFDC)

  • Funding

  • Education

Dhrubodhi Mukherjee


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Limitation of welfare Program (AFDC)

  • Complex causes

  • Capitalism

Dhrubodhi Mukherjee


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Would conservative measures solve the problem? Program (AFDC)

  • Reduce spending

  • Delegating policy functions to state and local government

  • Privatizing social services

  • Civil society to take over

  • Deterrent policies

  • Reliance on personal responsibility

Dhrubodhi Mukherjee


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Challenges to future welfare Program (AFDC)

  • Globalization and the emergence of flat world

  • Historic tradition of welfare in America

Dhrubodhi Mukherjee


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US has the best health care system in the world Program (AFDC)

  • US spends around $5000/person/year on health care: the costliest in the world

  • We have the best medical technology and prescription drugs

  • We spent around 20-25% of health care cost on administration

  • Our health care is getting privatized each passing day

  • And we sue our doctors if they don’t “treat” us well

Dhrubodhi Mukherjee


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Well-being indicators Program (AFDC)

  • Infant mortality rate (7.2%/1000)

  • Disability Adjusted Life Expectancy (DALE)

Dhrubodhi Mukherjee


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What constitute a good health care system Program (AFDC)

  • Cost(1st)

  • Access

  • Health and Well-being (26th)

  • Responsiveness (1st)

  • Fairness in Financing (55th)

  • Attainment and Performance (15th)

Dhrubodhi Mukherjee


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Health Insurance Program (AFDC)

  • Private

  • Public

Dhrubodhi Mukherjee


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Public Health Insurance Program (AFDC)

  • Medicare Part A

  • Medicare Part B

  • Medicaid

  • State Children’s Health Insurance Program (SCHIP): Social Security Act Title XXI

Dhrubodhi Mukherjee


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Healthcare Management Program (AFDC)

  • Centers for Medicare and Medicaid Services

  • Health Care Financing Administration (HCFA)

  • Health Maintenance Organization (HMO)

Dhrubodhi Mukherjee


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Noninsured Healthcare Program (AFDC)

  • Maternal and Child Health Program (MCH)

  • Special Supplemental Food Program for Women, Infants and Children (WIC)

  • US Public Health Services (PHS)

    • Center for Disease Control (CDC)

    • Food and Drug Administration (FDA)

    • National Institute of Health (NIH)

    • Health Resources and Services Administration

Dhrubodhi Mukherjee


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What's driving medical costs? Program (AFDC)

  • Medical technology: New medical devices and the latest pharmaceuticals are pushing prices up fast.

  • Litigation: The rising cost of malpractice insurance is also increasing the practice of defensive medicine.

  • Uninsured: The growing number of uninsured is an increasing burden on the medical establishment.

  • Administrative costs: Health bureaucracy consumes money that does not go directly to patient care.

Dhrubodhi Mukherjee


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Access to Health Program (AFDC)

  • All are not allowed

  • Private insurance coverage based on employment

  • Public insurance for the

    • elderly (Medicare)

    • Military veterans

    • Poor and the disabled (Medicaid)

Dhrubodhi Mukherjee


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Percent of population covered by public health care Program (AFDC)

  • More focus on cure than prevention

  • Factors outside the hospital are more important than the ones inside it

  • De-rgulation of healthcare or More govt. involvement?

Dhrubodhi Mukherjee


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What is the “Ownership Society”? Program (AFDC)

“An ownership societyvalues responsibility, liberty, and property. Individuals are empowered by freeing them from dependence on government handouts and making them owners instead, in control of their own lives and destinies. In the ownership society, patients control their own health care, parents control their own children's education, and workers control their retirement savings.” - CATO Institute

"Ownership brings security and dignity and independence. In all these proposals, we seek to provide not just a government program, but a path — a path to greater opportunity, more freedom and more control over your own life.“ - President Bush, August 2004

Dhrubodhi Mukherjee


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Ownership Society Policies Program (AFDC)

  • Structured through individual or “personal” savings accounts

  • Main proposals would privatize Social Security (“Social Security Choice”) and reduce taxes on saving for retirement, health care, upgrading skills, and education

  • Would also encourage more business ownership and homeownership

Dhrubodhi Mukherjee


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Who Owns America? Program (AFDC)

QuintileIncomeWealth

Bottom 40% 10% 1%

Bottom 60% 23% 4.5%

Top 20% 56% 83%

  • Income inequality slowing, wealth inequality rising

  • Non-whites hold 10% of the wealth of whites

  • $330 billion a year in tax breaks to support wealth accumulation, but only helps upper-half of population

Dhrubodhi Mukherjee


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Housing Issues Program (AFDC)

  • Housing Act 1937

  • US Department of Housing and Urban Development (HUD)

  • Inadequacy vs. Affordability

  • Housing Standard

  • Housing Supply

  • Housing Subsidy

Dhrubodhi Mukherjee


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OVERVIEW Program (AFDC)

CONTEXT: EVOLUTION OF HOUSING POLICY DEBATE

HYPOTHESES: HOW COULD HOUSING AFFECT WELL-BEING?

WHAT WE KNOW: FOCUS ON PUBLIC HOUSING

NEXT STEPS: THE GOOD AND THE BAD

Dhrubodhi Mukherjee


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Preview Program (AFDC)

  • Two views: “making ends meet” (shelter burden) and housing-as-location

  • Some experiments to date

  • Lessons and suggestions (research, policy, and practice)

Dhrubodhi Mukherjee


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Making Ends Meet (1): Program (AFDC)Getting and staying housed

  • Housing a huge component of household costs (>=food costs). See Edin & Lein, Ehrenreich

  • Most working poor are renters but some own (rural versus urban, low/high wage regions).

  • Four options: subsidized unit, unsubsidized unit, unit shared with relatives or friends, streets and shelters

  • Entry barriers for renters: first/last rent, search costs

  • Other: federal “tax” of 30 cents on each $1 earned by those in subsidized housing

Dhrubodhi Mukherjee


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Making Ends Meet (2): Program (AFDC)Tough trade-offs

  • Elastic, informal, ad hoc arrangements: add resiliency but huge stressors (on family and its sources of support)

  • “High cost of being poor”: captive market encourages price gouging (motels, regular landlords)

  • Choose your “ecological” threat: Difficult relative or boyfriend? High-crime neighborhood? Isolation from jobs, health care, networks?

Dhrubodhi Mukherjee


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Making Ends Meet (3): Program (AFDC)Surprises and Counter-intuitives

  • Household preferences and resources varied: depend on neighborhood quality of projects in particular city, local priority policies for rental subsidies if you’re homeless, expectations of co-habitants about pooling resources, experiences of abuse.

  • “The projects” stigmatized but in demand in many markets: long waiting lists, deep stigmas of public housing.

Dhrubodhi Mukherjee


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Housing as Location (1): Program (AFDC)Overview

  • Housing as a “bundle” good: unit + location

  • Locational quality = set of neighbors (“social ecology”), economic site (in labor and land markets), political-administrative (public services, civic infrastructure)

  • Realities: locational choices made quickly, info very imperfect, difficult to calculate full costs and benefits (e.g., short/long term), limited by own preferences and those of others (including discrimination by race, class, family status)

Dhrubodhi Mukherjee


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HUD’s Financial Resources Program (AFDC)

  • Community Development Block Grant/HOME

  • 202/811 Programs

  • Capital Bond Fund Financing

Dhrubodhi Mukherjee


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Community Development Block Grant Programs (CDBG) Program (AFDC)

  • Community Development Block Grant Programs

    -The rehabilitation of affordable housing has traditionally been the largest single use of CDBG grants.

    -CDBG funds are distributed by formula around the country based on population, income levels, poverty rates and age of housing stock.

Dhrubodhi Mukherjee


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202/811 Programs Program (AFDC)

  • Eligible Uses for 811 Funds

    -Provide interest-free capital advances to non-profit sponsors to help finance the development of independent living condominium units and small group homes for persons with disabilities.

  • Both programs provide funding assistance to project owners to subsidize operating expenses.

Dhrubodhi Mukherjee


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Capital Fund Bond Financing Program (AFDC)

  • Eligible Uses for the Funds

    -Mixed finance projects and improvements to building systems such as windows, doors, deferred maintenance.

Dhrubodhi Mukherjee


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Important Resources Program (AFDC)

  • http://www.policyalmanac.org/directory/Social_Welfare-Housing.shtml

  • http://www.npr.org/news/specials/housingfirst/

  • http://www.hud.gov/

Dhrubodhi Mukherjee


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Social policy goals in regards to Child Welfare Program (AFDC)

  • What are the social problems concerning children that needs policy attention?

  • Why it is important?

  • Should the government interfere?

  • Debate over how these problems be addressed?

  • What are the institutions should be assigned to address them?

  • How much role should parents play?

Dhrubodhi Mukherjee


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Concerns Program (AFDC)

  • Non-traditional family

  • The African American community

  • Uncollected Child Support Payments

Dhrubodhi Mukherjee


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Where policy should focus? Program (AFDC)

  • Protection?

    • Economic protection

    • Health protection

  • Parental Responsibility?

    • Traditional Families

    • Non-traditional Families

  • Residual or Institutional?

    • For only poor children

    • For all children

Dhrubodhi Mukherjee


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A Brief History Program (AFDC)

  • Children as “little adults”

  • The “child saving” movement

  • 1909 White house conference for children and youth

  • 1912 Children Bureau at Department of Labor

  • Maternity and Infancy Act 1921

  • SSA 1935 Maternal and Child Health Act

Dhrubodhi Mukherjee


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Mission and Goals of Child Welfare Program (AFDC)

  • Safety

  • Permanency

  • Child Well-being

  • Family Well-being

Dhrubodhi Mukherjee


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Policy Issues Program (AFDC)

  • Parental responsibility vs. Child rights

  • Protection of children vs. Liberation

  • Need-based vs. Universal Services

  • Child Poverty

  • Various forms of family life

Dhrubodhi Mukherjee


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SSA: Child Welfare Policies Program (AFDC)

  • Title IV B: Assistance to Children

  • Title IV A: Permanency Planning

  • Title IV D: Child Support Enforcement

  • Title IV C: Research and Training

  • Title V: Maternal and Child Health

  • Title XIX: Medicaid

  • Title XX: Social Security Block Grant

  • Title XXI: State Child Health Insurance

Dhrubodhi Mukherjee


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Child Welfare Policies Program (AFDC)

  • 1972 Supplemental Social Security Insurance

  • 1974 Child abuse prevention and treatment act

  • 1978 Indian Child Welfare Act

  • 1980 Adoption Assistance and Child Welfare Act

  • 1993 Family and Medical Leave Act

Dhrubodhi Mukherjee


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Child Welfare Policy Program (AFDC)

  • 1974 Juvenile Justice and Delinquency Prevention Act

  • 1975 The Education for All Handicapped Children Act

  • 1965 Head Start Act

  • 1990 Family Support Act

  • 1965 ESEA

  • 2002 No-Child Left Behind ACT

  • 1996 PRWORA

Dhrubodhi Mukherjee


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