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Government Aid and the Me Versus Them Mindset

We could do a lot to change the widespread perception that programs that help needy people are about winners and losers.

As I learned while I was executive director of the Maryland Medicaid program's Office of Eligibility Services, many Americans view government aid as a zero-sum contest -- something they will not get if someone else does.

The vast majority of the hundreds of letters my office received each year from residents inquiring about their Medicaid eligibility included something along the lines of "I deserve it, but others don't." Writers of every race, creed and political affiliation, from mountainous Garrett County to inner-city Baltimore to the rural Eastern Shore, expressed that belief.

You don't have to look far in the world of online commentary to find more evidence of this me versus them perception. A student-loan borrower posted the following meme to social media: "Looking back, I wished that I'd had a welfare baby instead of getting a degree -- you get a free baby and don't have to pay back welfare at 8% interest." Or as Kristina Ribali of Watchdog Opinion wrote, Kansas' legislative efforts that have reduced that state's Temporary Assistance to Needy Families (TANF) rolls by more than half offer former welfare recipients "the possibility of providing luxury items for their families ... with their own hard earned money; not someone else's."

Reframing mission statements and other strategies that target the general public could improve individuals' perceptions of aid, but efforts that directly address individuals and their interests are more likely to succeed. Civil-rights organizers have found that individuals' attitudes change in a lasting way when they are engaged at the personal level. The Human Rights Campaign concluded that individuals came to accept gay rights once they realized that they regularly interacted with gay people.

Proponents of aid programs need to directly address Americans' concerns that they are "losing" aid to others. One way to do so is to lay out in clear terms who gets what benefits and for what purposes. High-school civic textbooks, for example, could let students know that some 55 million Americans from all walks of life -- from former bank CEOs to fast-food workers -- get Medicare benefits. And social-services agencies, through their websites and printed materials, could paint profiles of those who receive government aid. Kansas' human-services agency, for example, could share the following information with the state's residents:

• Approximately 15,000 Kansans receive TANF payments. The program provides temporary cash assistance only to needy families whose adults cannot work. Recipients must look for work and are subject to drug tests. Payments for an individual amount to less than $3,500 per year.

• Approximately 400,000 Kansans receive Medicaid. The program provides health insurance to individuals with limited income and resources. Annual per-person expenditures average roughly $6,000 but are closer to $15,000 for aged individuals in nursing homes.

• More than 400,000 Kansans receive Medicare. The program provides health insurance to aged and disabled individuals. Most individuals can buy in, but those who earned just $250-$1,300 per quarter for 10 years of their life can get free hospital coverage. Annual per-person expenditures exceed $8,000. Once enrolled, individuals usually receive benefits until death.

Upon viewing this information side-by-side, a pot-smoking Medicare beneficiary who had worked for only 10 years and who had previously bemoaned "welfare drug addicts" could realize that he had "won" government assistance. Similarly, the adult child of two seniors who qualified for Medicaid coverage of their nursing-home care after living a comfortably middle-class existence could realize that her family had "won" government aid as well. Once most Americans realize that almost everybody directly benefits from government aid at some point in their lives, perceptions will improve.

Cheryl A. Camillo is a 2015-2016 Fulbright Fellow to Canada and a former deputy Maryland state Medicaid director.
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