Our Tattered U.S. Safety Net, Part Two: Subsistence Income and Healthcare

This piece originally appeared on Fran Quigley’s blog Housing Is A Human Right on February 6, 2026.

For our series on how existing U.S. programs come up well short of meeting needs, Part One last week covered food and family support. You can read it here. This week, Part Two: our subsistence income programs and healthcare.

As a reminder, Jacobin published my article last week that covered much of this same ground in one piece. You can read it on their site here.

Subsistence Income

Beyond a few isolated projects, the U.S. does not have a guaranteed minimum income program, despite such programs’ proven effectiveness at meeting basic needs like food, shelter, and healthcare. The closest we have is the Supplemental Security Income, known as SSI.

SSI is a federal program for persons who are living with severe disabilities that leave them unable to work and have little to no income or assets. Many of our clinic’s eviction court clients, and many unhoused individuals, are among the 7.5 million people who receive SSI.

Simply put, SSI’s rules ensure that all who receive it are condemned to extreme poverty. For an individual, the maximum monthly SSI check is $967. Couples who are both eligible for SSI are limited to $1,450 per month.

Many of our clients who receive SSI spend literally every penny of their check on rent, with nothing left over for other living expenses. They cannot access any other resources to cover their expenses, since they risk being cut off from the program if they receive more than $20 in cash or in-kind assistance from family or others.

At least they are enrolled in SSI. The program’s onerous financial and disability eligibility requirements cause less than half of all SSI applications to be granted—less than a third of them at the initial application stage.

Virtually all of the denied applicants we see are clearly eligible for the program, yet ensnared in a cruel Catch-22: the same disabilities and poverty-caused barriers that lead them to need SSI contribute to them getting overburdened by the red tape of the application process.

Healthcare

Images Money's photo, licensed as CC BY 2.0

Medicaid is the health insurance program for low-income people that is jointly funded by federal and state governments. Medicare provides health insurance for people over age 65 and some people living with disabilities—it can overlap with Medicaid when those covered people are also low-income. Over 70 million people in the U.S. have their healthcare coverage through Medicaid, including two of every five children in the country.

That number should be far higher.

Complicated application requirements have long blocked millions of people from receiving Medicaid. Onerous recertification requirements knocked off many who were once enrolled. Then, Donald Trump and Congressional Republicans decided to make it worse.

The OBBBA imposed work requirements for Medicaid, even though most enrollees under age 65 are either working already or are living with disabilities or have other barriers preventing them from paid work. The administrative burden of Medicaid work requirements already in place in states like Arkansas have caused tens of thousands to lose healthcare while not increasing employment at all.

The OBBBA also terminated Medicaid and Medicare coverage for many lawful immigrants who are refugees, asylees, and survivors of domestic violence.

Medicaid is popular—three-fourths of people in the U.S. support the program. But it has significant flaws, largely arising out of the widespread privatization of the program.

Most Medicaid enrollees have their healthcare controlled by managed care organizations. Those companies seek to maximize profits by restricting networks of providers and blocking care via measures like requiring prior authorization, barriers that are applied more frequently to Medicaid enrollees than those with other forms of insurance.

Those cost containment measures are deeply damaging. A 2024 survey by the American Medical Association showed large majorities of physicians reporting that prior authorization often delays care to the point where patients abandon treatment or have to be hospitalized. In fact, many Medicaid enrollees with prior authorization requirements never get the care their provider recommended.

Administrative barriers like these, coupled with low reimbursement rates, cause many providers to refuse to accept Medicaid patients. The problem is particularly pronounced in behavioral health. Almost 40% of Medicaid enrollees live with a mental health or substance use disorder, but only about one-third of psychiatrists will accept new Medicaid patients.

Next week: Part Three will cover unemployment insurance and housing—along with a reminder that even our flawed safety net programs have a deeply positive impact.If those programs are fully funded and accessible to all who need them, we can end U.S. poverty.