1. Social Welfare Policy
and Services
SOCW 410
Fall 2014

2. The policy process

3. Technical Aspects of the
Policy Process
• Public policy in the United States is
made through a deliberative process
– Involves the two bodies of elected officials
that make up a legislature
• There are several critical junctures in a
proposal’s passage into legislation
• The federal budget process

5. Policy Analysis Framework

6. A Critical Analysis of the
Policy Process
• The public policy process often proves
frustrating for social activists
• The policy process consists of a series
of discrete decisions
• Institutional conception of social welfare
• Residual conception of social welfare
• Bureaucratic & market rationality

7. The Policy Process
• Social Stratification
– Differentiate groups with influence from
those lacking
• Marginalization
– The governmental policy process poses
problems for administrators and
practitioners

8. The Policy Process
• Legislation
– Much public policy work is conducted by
federal legislators
–Lobbying and campaign contributions
– Social advocacy groups usually rely on
volunteer lobbyists

9. The Policy Process
• Implementation
– The fact that a policy has been enacted
does not necessarily mean it will be
implemented
• Evaluation
– Spawned a veritable industry in program
evaluation

10. Social Stratification

11. Social Insurance

12. Definition of Social
Insurance
• Social insurance is the cornerstone of
U.S. social welfare policy
– Compelled to insure themselves
• Unlike Social Security, public
assistance programs are subject to
means tests
– And are based entirely on need

13. The Background of Social
Insurance
• The first old-age insurance program
was introduced in Germany in 1889
• Social Security Act of 1935
– Repeatedly modified, almost always in the
direction of increased coverage

14. The Financial Organization
of Social Insurance
• Social insurance is relatively
straightforward
• Social Security and Medicare taxes are
divided among several trust funds
• The trust funds are governed by a
board of trustees
• Surplus

16. Key Social Insurance
Programs
• OASDI
– Combination of Old-Age and Survivors Insurance
(OASI) & Disability Insurance (DI)
– Cost-of-living adjustments (COLAs)
• Unemployment Insurance
– The Unemployment Insurance System and Benefits
• Workers’ Compensation
– Began in 1911 in Wisconsin and New Jersey
– WC programs are problematic in several ways

17. The Social Security
Dilemma
• Was long perceived by policy analysts
and legislators as the third rail of politics
• Arguments against the Current Social
Security System
– Social Security is fueling intergenerational
tensions

18. The Social Security
Dilemma
• Arguments for the Current Social
Security System
– Social Security is a special kind of
“investment”
– Social Security in Trouble
• The Long-Term Prospects for Social
Security

20. Conclusion
• The U.S. Social Security stands out as
one of the best in the world
• Social insurance programs are a
mainstay of the American social welfare
state
• Social insurance programs represent a
major source of security
– For elderly Americans & present-day
workers

21. Public assistance programs

22. Assumptions and Myths about
Public Assistance
• American attitudes toward public
assistance
– Characterized as a mixture of compassion
and hostility
• Myths
• Facts

24. Aid to Families with Dependent
Children
• AFDC was arguably the most
controversial program in the U.S.
welfare system
• The requirement for receiving AFDC
• One notorious chapter in AFDC history
involved the man-in-the-house rule

25. Aid to Families with Dependent
Children
• The Personal Responsibility and Work
Opportunity Reconciliation Act of 1996
– Emergency Assistance Program
– Entitlement
– Participation rate

26. Aid to Families with Dependent
Children
• The American Recovery and
Reinvestment Act of 2009
– Passed in 2009 to strengthen safety net
programs such as TANF and SNAP
• Has the PRWORA Worked?
– By 2000, Democrats and Republicans had
pronounced the PRWORA a raging
success

27. Supplemental Security Income
(SSI)
• Designed to provide cash assistance to
the elderly and to disabled poor
individuals
• Two groups of SSI recipients that have
shown dramatic growth in their numbers
– Children with disabilities
– Adults with disabilities related to drug
addiction and alcoholism

28. General Assistance
• Most states limit GA eligibility to the
severely poor, without children
• Some states fund GA programs
– But delegate administration to counties,
municipalities, or towns

29. Trends and Issues in Public
Assistance
• The responsibility of states to care for
their poor is not new
• Transforming Public Assistance Policy
into Labor Policy
– AFDC had been a sore spot for
conservatives since its inception

30. Trends and Issues in Public
Assistance
– The PRWORA was passed in a period of
robust economic growth
• Teenage Pregnancy
– Has been strongly associated with public
assistance and welfare dependency
– Ten percent of all U.S. births in 2009 were
to mothers under the age of 20

31. Trends and Issues in Public
Assistance
• Welfare Behaviorism
– Behavioral Poverty
– Personal and Parental Responsibility
• Welfare to Work
– Workfare

32. The Evolution of Public
Assistance
• There are myriad ways to provide social
assistance to the poor
• Recipients of public assistance
programs
– Fare less well than as those covered under
the social insurances

33. Conclusion
• The U.S. welfare system has
dramatically transformed over the past
20 years
• The conversion of public assistance
policy into labor policy
• Privatized social services

34. Health care policy

35. Why Is Health Care Important?
• Both wellness and sickness care are important
to individual lives
• The health care sector has continued to grow,
while most other parts of the economy stalled
• It is a source of innovation—pharmaceuticals,
technology, and systems
(Continued)

36. Why Is Health Care Important?
• Health care is one of the most important
industries in the United States:
• National health expenditures are almost $2.5
trillion annually (2009)
• It is 17.6% of GDP (2009)
• It employs more than 14 million Americans (2008)
(Continued)

37. • The division of labor between the public health
system, which keeps people healthy, and the
medical care system, which takes care of them
when they are not
• The importance of institutions, such as hospitals
• Medical technology that fuels expansion
• A dysfunctional financing and payment system
• Tension between the free market and government
control
Defining Characteristics of the U.S. Health Care
System

38. • We spend too much
• Quality of care is uneven
• Too many people lack access to care
How Well Are We Doing? (Continued)

39. • Improving quality
• Improving access and coverage
• Slowing the growth of health care costs
Major Issues and Concerns
(Continued)

40. • Encouraging healthy behavior
• Improving the public health care system
• Improving coordination, transparency, and
accountability of local health care systems
Major Issues and Concerns (Continued)

41. • Consumers, patients, and taxpayers
• Health care professionals and institutions
• Pharmaceutical, insurance, and other for-profit
companies
• Payers and organizations that regulate or
accredit health care organizations
Stakeholders

42. • Department of Health and
Human Services
• Social Security Administration
• Department of Labor
• Department of Homeland
Security
• Department of Defense
• Department of Veterans Affairs
• Department of Agriculture
Many Government Agencies Are Involved in
Health and Safety
• Department of Justice
• Department of Energy
• Department of Housing and
Urban Development
• Department of Transportation
• Department of Education
• Department of Commerce
• Environmental Protection
Agency
(Continued)

43. • National AIDS Policy Office
• National Bipartisan Commission
on the Future of Medicare
• National Council on Disability
• Office of National Drug Control
Policy
• Uniformed Services University
for the Health Sciences
Many Government Agencies Are Involved in
Health and Safety (Continued)
• State Department
• Agency for International
Development (Global Health)
• U.S. Chemical Safety Board
• Consumer Product Safety
Commission
• Drug Enforcement
Administration
• Medicare Payment Advisory
Commission

44. Where You Live Matters
FIGURE 1A.7
Achieving long and healthy lives.
Source: McCarthy, D., How, S.K.H.,
Schoen, C., Cantor, J.C., & Belloff, D.
(2009). Aiming higher: Results from a
state scorecard on health system
performance, 2009. Retrieved
September 9, 2010, from
http://www.commonwealthfund.org/Content/Chart
s/Report/Aiming-Higher-2009-Results-from-a-
State-Scorecard-on-Health-System-
Performance/State-Ranking-on-Health-Lives-
Dimension.aspx. Reprinted with
permission.

45. The Uninsured
• Health care in the United States is
marked by several contradictions
• More likely than the privately insured to
not receive needed medical care

46. The Organization of Medical
Services
• Most health care costs in the United
States are paid for by:
– Private insurers, public plans, and the
direct public provision of health care
• Major components of medical services
in the United States

47. • Historical developments: Increasing costs and
growing influence of hospitals
• The rise of employee-sponsored health
insurance (1940s)
Government as Payer
(Continued)

48. • Enactment of Medicare and Medicaid (1960s)
• The Clinton failure and state reforms (1990s)
• The Patient Protection and Affordable Care Act (2010)
Government as Payer (Continued)

49. Major Public Health Programs:
Medicare, Medicaid, and S-CHIP
• Health care spending is the 2nd
fastest-
growing component of the federal
budget
• Medicare
– Critics charge that the MMA
– Gaps in Medicare Coverage
– Reimbursements to Providers

50. Major Public Health Programs:
Medicare, Medicaid, and S-CHIP
• Medicaid
– Medicaid is a federal/state program
– The medically needy
• The Children’s Health Insurance
Program (CHIP)
– State Children’s Health Insurance Program
(S-CHIP)

52. The Tobacco Settlement
• Public policy is occasionally made by
the court system rather than the
legislature
• 600-page Master Settlement
Agreement
– Requiring them to pay $206 billion to 46
states over a 25-year period
• Australian Parliament passed a “Plain
Packaging” bill

53. The Health Care Crisis
• Health care in the United States is
plagued with problems such as:
– Eroding coverage, rising and shifting costs,
• And an increasing number of anxious citizens
fearful about getting and keeping health
insurance

54. The Health Care Crisis
• Overview of U.S. Health Care
Expenditures
• U.S. Health Care in International
Perspective

57. Explaining the High Cost of
U.S. Health Care
• Some factors that attribute for the
enormous cost of U.S. health care
system
• Hospital Costs
• Physicians’ Salaries
• The Pharmaceutical Industry

58. Cutting Health Care Costs
• There are two aspects to cutting health
care costs
– Cutting costs for governmental health care
programs;
– Lowering health care costs in:
• Insurance, physician, pharmaceutical and
hospital sectors

59. Cutting Health Care Costs
• Managed Care
– Managed care plans generally gatekeep
the access to specialists for consumers
– Managed care companies are boxed in to
a degree

60. Cutting Health Care Costs
• The Underinsured
– The U.S. medical system provides high
quality care for most people….
• In the upper and upper-middle classes

61. Reforming U.S. Health Care
• The American health care system is
partly driven by ideological values
• National Health Service
• National Health Insurance
– Single-Payer System
• Incremental Reform

62. Reforming U.S. Health Care
• The Patient Protection and Affordable
Care Act (P.L. 111-148)
– Enrollment and Employer Requirements
– Cost and Funding
– Health Insurance Exchanges (HIE)
– Subsidies

63. Reforming U.S. Health Care
– Regulations of the Health Insurance
Industry
– Public Health
– Medicare
– Medicaid
– Abortion

64. Comparative Analysis: Health
Care in Canada, UK, & Australia
• The Canadian Health Care System
– Public Administration
– Comprehensiveness
– Universality
– Portability
– Accessibility
– Freedom of Choice

65. Comparative Analysis: Health
Care in Canada, UK, & Australia
• The United Kingdom’s National Health
Service
– The NHS is currently the world’s largest
publicly-funded health service
• The Australian Health Care System
– A hybrid public–private system

66. Conclusion
• The American health care system
raises important questions
• The United States is one of the few
industrialized countries without:
– A universal health care system

67. Quiz Questions
• The government-provided healthcare
program for the elderly is known as:
– Medicaid
– Affordable Care Act
– Medicare
– Blue Cross

68. Quiz Question
• When a third-party insurance company
pays medical providers instead of
consumers paying directly:
– Consumer demand for health care rises
– Out-of-pocket costs to the consumer go up
– Consumers more clearly understand the
true cost of healthcare
– The supply of healthcare falls

69. Quiz Question
• Health spending is a growing share of
our economy because:
– Aging population and rising costs
– No costs is too small for a loved one
– Technology is expensive but improves care
– All of the above

70. Mental Health and Substance
Abuse

71. Mental Health Reform
• World War II
• Dr. Robert H. Felix

72. The Community Mental Health
Centers Acts
• Community Mental Health Centers
(CMHC) Act
– Passed by Congress and signed by
President Kennedy on October 31, 1963
• Transferring mental health care from
the state hospital to the community

73. Deinstitutionalization
• By the end of the 1990s:
– 93% of state psychiatric beds that had
existed in 1955 were lost to
deinstitutionalization
• Effect on institutional care for patients
with mental impairments

74. The Revolving Door
• Of the 5,000 residents of homes, 946
had died between 1995 and 2000
• During the 1990s: 350 incidents of theft,
abuse, neglect, & molestation of
residents
– Not a single fine had been levied against
the companies that operated the group
homes

75. The Psychopharmacological
Scandal
• Psychotropic medication became a
routine form of treatment
• Desperate former mental hospital
patients turned to petty crime to gain
income
• The ascendance of the biomedical
model
• Side effects attributed to SSRIs

76. Children’s Mental Health
• The FDA does not require RTCs for
medication
– Unless it is specifically intended for
children
• Off-label prescriptions for children
• 80 percent increase in autism during
the previous decade

77. Mental Health and Substance
Abuse Funding
• Since 1981, all mental health
expenditures have been in block grants
to states
• Static funding has prompted innovation
in service delivery
– Provided the rationale for subsidizing
private treatment innovations in substance
abuse

78. Parity for Mental Health Care
• Congress agreed on legislation
establishing parity for mental health
care
• May have marked the end of the
downsizing of mental health care
– Yet much remained to be done

79. Post-Traumatic
Stress Disorder
• A decade of war in Iraq and
Afghanistan
• Not only were mental health disorders
among returning soldiers delayed
– But they were more prevalent among
reservists

80. Substance Abuse
• Mental health services are often
associated with substance abuse
• Interaction of emotional difficulties,
alcoholism, and substance abuse

81. Substance Abuse
• Alcohol Abuse
– Americans steadily increased their
consumption of alcohol
• From the end of World War II until the 1980s
• Fetal alcohol syndrome

82. Substance Abuse
• Drug Abuse
– The prevalence of drug abuse is more
difficult to ascertain
– Types of illegal substances vary
considerably
– The federal response to illicit drug use
– Intervention strategies focus on treatment

83. Policy Analysis Notes
• Community Mental Health Centers Act
• Omnibus Budget and Reconciliation Act

84. Policy Analysis Notes
• Mental Health Parity Act
• America’s Law Enforcement and Mental
Health Project Act

85. Conclusion
• Mental health and substance abuse
policies have been complex
• Should responsibility for the aberrant
rest with the federal government or the
states?
• Should the focus be on treatment or
interdiction?

86. Criminal Justice

87. Prison State Video Notes
• What are the mental health problems?
• What are the substance use problems?
• What are the crimes?

88. History of U.S. Criminal Justice
• Faith in social science that originated in the
West in the eighteenth century
• Modern criminology dates from the Age of
Enlightenment in the eighteenth century
• Early American colonists imported traditional
European thinking about crime

89. The Criminal Justice System
• The U.S. criminal justice system is similar to
education and mental health programs
– States & localities provide a larger portion of
services than the federal government
• The last decades of the twentieth century
witnessed a boom in prison construction

90. Juvenile Justice
• Juvenile justice is a significant feature of U.S.
criminal justice
• New York City House of Refuge
• Massachusetts Division of Youth Services
• Incarceration as the intervention of choice
• Boot camp

91. The New Jim Crow
• Race and ethnicity have been fundamental to
understanding criminal justice
• Association between incarceration, social
disadvantage & high school drop outs
• Gang involvement

92. The War on Drugs
• The deterioration of inner cities
• Government interdiction of supplies,
aimed at eliminating the substance
• Treatment programs deployed to
diminish the demand for illegal drugs
• The social consequence of the arrest
and incarceration

93. The Underclass and “Moral Poverty”
• 45% of prisoners were on probation/parole
when they committed their latest offense
– In 1991
• The conservative prescription for moral
poverty
• The evolution of liberal policies that divert
youth from delinquency

94. Legalization of Drugs
• Drug legalization had been a standard
demand among Libertarians
• Momentum toward legalizing drugs reached
its peak during the mid-1980s
• Fair Sentencing Act, signed by President
Obama in 2010

95. The “New Penology”
• The public was growing increasingly
intolerant of crime
• Although crime has fallen, incarceration rates
remain high
• Innocence Project
• Costly prison system

96. Conclusion
• Advocates continue to press for reform
• Some reformers have proposed more
humane facilities for inmates
• The Karnes County Civil Detention Center
• Humanizing corrections