9. Expand access to health care
Since it was signed into law in 2010, the Affordable Care Act (ACA) has expanded access to high-quality, affordable health coverage for millions of Americans, especially those with preexisting conditions. Today, 31 million Americans are enrolled in coverage through the ACA marketplaces or the law’s expansion of Medicaid. However, 12 states continue to refuse to expand their Medicaid programs to cover adults making up to 138 percent of the federal poverty guideline—placing a heavy burden on families already on the brink. About 2.2 million uninsured people are without an affordable option for health insurance because they live in nonexpansion states and have incomes too low to qualify for marketplace premium tax credits.
Expanding Medicaid would mean more than just access to health care; it would give people financial protection from unexpected medical costs and free up limited household income for other basic needs such as paying rent and putting food on the table. Increases in Medicaid enrollment are associated with reduced rates of medical debt and other unpaid bills among low-income individuals. Studies also link Medicaid coverage to improved access to health care services, greater financial security, lower mortality rates, reduced racial health care disparities, and lower rates of eviction.
While the American Rescue Plan included increased federal Medicaid funding for two years as an incentive to encourage more states to expand their programs, it is unlikely that the remaining nonexpansion states will take up this option. Congress has an opportunity to enact federal policies that ensure people in the Medicaid coverage gap can gain access to affordable, comprehensive health insurance.
For more information on Medicaid, see “The Pandemic and Economic Crisis Are Wake-Up Call for State Medicaid Expansion,” “Expanding Medicaid in All States Would Save 14,000 Lives Per Year,” and “Building On the ACA To Reduce Health Insurance Disruptions.”
10. Reform the criminal justice system and enact policies that support successful reentry
Robust changes are needed to restructure and reform a U.S. criminal justice system that incarcerates more of its citizens than any other country in the world, holding about 2.3 million people in prisons, jails, and other correctional facilities. If not for the rapid increase in mass incarceration since 1980, poverty rates would have dropped by 20 percent by 2009. The impact on communities of color is particularly staggering: Black and Latino men are, respectively, 6 times and 2.5 times more likely to be incarcerated than white men; and Black and Latina women are, respectively, 1.7 times and 1.3 times more likely to be incarcerated than white women. Likewise, Native Americans are incarcerated at more than twice the rate of white Americans.
Mass incarceration is a key cause and consequence of poverty. When a person is incarcerated, their family must find a way to make ends meet without a necessary source of income. Additionally, even a minor criminal record or an arrest without a conviction can prevent an individual from getting a job, housing, or certain benefits, contributing to cycles of multigenerational poverty. Currently, there are more than 44,000 legal sanctions that create barriers to housing for people with criminal records. Moreover, various restrictions prohibit justice-involved individuals’ access to SNAP and Temporary Assistance for Needy Families (TANF) benefits if they have prior felony drug convictions, unless additional requirements are fulfilled. This can include being required to wait for months after completion of a sentence to be considered eligible or to participate in mandatory periodic drug testing, both of which are unnecessary obstacles that hinder successful reentry.
Sentencing reform is essential to addressing mass incarceration. Policymakers should also implement clean slate laws, which help expand access to automated criminal record clearing, and explore alternatives to incarceration, such as diversion programs for individuals with mental health and substance abuse challenges. Additionally, it is critical to review the role of policing in public safety, health, and well-being. There has been a recent move across the nation to divert away from police certain health, public safety, and community care emergency responses and funds—such as responding to people experiencing a mental health crisis—that better fit agencies and social workers. Barriers to employment, housing, education, and public assistance must also be removed. A decades-old criminal record should not consign an individual to a life of poverty.