Older immigrants can get Medicaid

The American economic system is based on private, free enterprise and “personal responsibility,” which writer and lecturer Ralph Waldo Emerson advocates as a virtue valued by the Americans. Indeed, many see it as a matter of honor to take care of oneself. Nonetheless, there is a wide range of government support available to those who are temporarily or permanently in need. This chapter highlights two areas in which assistance can be given: social assistance and health care.


In the United States, aid to the poor has traditionally been the responsibility of private charities or local governments. New immigrants mainly relied on compatriots who had already immigrated to help them build a new existence. In the late 19th and early 20th centuries, several European countries introduced state welfare programs. Rapid industrialization and the availability of farmland, factors that seemed to confirm the belief that anyone who wanted to work could find a job, was slow to take hold in the United States.

The Great Depression that began in 1929 destroyed this belief. For the first time in United States history, significant numbers of Americans lost their jobs to the failure of many banks and corporations. President Herbert Hoover believed that if companies could operate without government interference, they would correct the economic situation. In the meantime, he relied on state and local governments to help those in need, but they did not have sufficient financial resources to do so. Most Americans felt that Hoover was not doing enough about the Great Depression, and in 1932 they elected Franklin D. Roosevelt president.

Within a few days of taking office, Roosevelt presented bills to the US Congress to revitalize and reform the economy. Congress approved almost everything the president asked for, and soon after, the government created jobs for hundreds of thousands of people. They were employed on large public projects such as dam or road construction, renovation of public buildings, setting up electrical systems for rural communities, and preserving natural spaces.

The majority of the programs that began during the Great Depression were temporary measures to alleviate the economic situation, but one - Social Security - became an American institution. Social security, financed by wage deductions from the working population, ensures that retirees receive a modest monthly income. In addition, those who depend on it receive unemployment or disability insurance and other support through them. Pensioners' social security benefits can be paid out from the age of 62, but most wait until the age of 65 if the benefits are slightly higher. In the recent past, there have been concerns that Social Security would not have sufficient financial resources to meet its obligations in the 21st century, when the proportion of older Americans is expected to increase dramatically. Politicians have suggested several ways to make up the expected deficit, but a long-term solution is still being discussed.

In the years since Roosevelt, other American presidents, particularly Lyndon Johnson in the 1960s, have set up social programs. These include Medicaid and Medicare, which will be discussed later, food stamps, certificates that can be used to purchase groceries, and public housing that is built at government expense and made available to low-income people.

Americans in need can also turn to non-governmental agencies for help. There is a wide range of private charities and volunteer organizations. Volunteering in the United States is increasing, especially among retirees. It is estimated that nearly 50 percent of Americans over the age of 18 volunteer and nearly 75 percent of all households in the United States donate money to charity.


The majority of Americans can make a living on their own wages without the support of a universal welfare system. These so-called middle-class Americans are generally homeowners, own cars, travel every year, and can - at least in part - finance their children's college education. The majority of Americans put money in savings accounts for greater spending; many also invest in the stock market in the hope that their investments will pay off.

Many buy insurance, especially life and health insurance. Often the company they work for makes a contribution. Many companies have retirement plans that allow them and their employees to save money for retirement. Along with social security payments, the retirement plans allow American retirees to live comfortably. For older Americans who need long-term care outside of a hospital, on the other hand, a care facility can be very expensive.

In 1993, a family of four with incomes less than or equal to $ 14,763 was considered poor; 15.1 percent of American families fell into this category. In addition to the above benefits, many families below the poverty line receive monthly allowances, which are given by the government to people on low incomes to pay for essential items such as food, clothing and housing. The most popular form of allowance is through a program called Aid to Families With Dependent Children (AFDC). The program was originally launched to help children whose fathers had died, but it has become the main source of regular income for millions of poor American families.

The total cost of all government assistance programs - including Social Security, Medicare, Medicaid, and various social assistance programs - is nearly half of the federal government's total spending. This represents a doubling of the percentage that was reached in the 1960s.


Certain aspects of the American welfare system - particularly the AFDC payments - were criticized in the 1980s and 1990s, and the system itself became a campaign topic in national elections. In the 1992 presidential campaign, for example, then Governor Bill Clinton promised an "end to welfare as we know it". Many middle-class Americans refuse to use their tax dollars to aid those they see (legitimately or not) as unwilling to work. Some critics argue that dependence on welfare can become permanent as a generation from the previous one follows into the system. Some people believe that the system encourages young women to have children out of wedlock, as state grants increase with the birth of each child. Other experts argue that the root causes of poverty - a lack of education and opportunities - must first be addressed; the welfare system is everything that separates the poor from dire need.

The allegation that welfare programs tend to keep the poor dependent and deprive them of control over their lives has led to the adaptation of certain government programs. For example, the government allowed tenants in social housing projects to buy the buildings and take over their management.

In 1996 a consensus was found for broader measures. A new law adapted social assistance by replacing AFDC with state-run and federally funded aid programs. The law limits a lifetime of welfare benefits to five years, requires employable adults to take up work after two years of welfare, excludes welfare for legal immigrants who are not citizens of the United States, and limits the receipt of food stamps to three months, unless the recipients have a job.


Self-employed private doctors who charge a fee for each visit to a patient are the norm in American medical care. Most doctors have contracts with one or more hospitals in their community. They refer their patients to the hospital when needed, which usually bills according to the number of days the patient is there and the treatment - x-rays, operating rooms, exams - he or she needs. Hospitals are run by cities, states or, in the case of veteran hospitals, by the federal government. Others are run by religious communities or other non-profit groups. Still others are run by companies that want to make a profit.

In the past 30 years, health care costs in the United States have skyrocketed. Health care spending rose from $ 204 per person in 1965 to $ 3,299 per person in 1993. One reason for the rise in health care costs is that the medical profession is one of the highest paying professions in the United States. The long and costly education they have to go through is often cited as the reason for their high income. Most aspiring doctors complete four years of college education, which can cost up to $ 25,000 a year, before spending another four expensive years in a medical school. Many young doctors are deeply in debt at the end of their training. They have to spend another three to five years in a hospital with long hours and a relatively low salary. Starting a doctor's office can also be costly.

The new devices and technologies for diagnosing and treating diseases are also expensive and the professionals who operate them must be well trained. Doctors and hospitals must purchase medical insurance to protect themselves from legal proceedings from patients who feel they are not being treated appropriately. The premiums for this insurance rose sharply during the 1970s and 1980s.


A mixed system of public and private health responsibility has developed in the United States. The vast majority of Americans pay some of their medical bills through insurance they get through their employers. Approximately five out of six American workers and their families are covered by group health insurance, which is paid either by the employer and employee together or by the employee alone. In the most common type of insurance, a monthly contribution or fee is paid by the employee. In return, the insurance company pays a percentage of the employee's health care costs, above a small amount, the deductible. Health insurances vary considerably. Some include dental bills and some include psychological counseling and therapy, and some do not.

Another health insurance model that many workers have available is what is known as the Health Maintenance Organization (HMO). An HMO consists of a group of doctors who offer their patients all the necessary services at a fixed price paid in advance. HMOs focus on preventive care because they have to pay the bill should a patient require services that the HMO cannot offer, such as special treatment, surgery or hospitalization. HMOs are growing in popularity and are widely viewed as a way to limit medical costs. However, some Americans are skeptical that HMOs limit the patient's freedom of choice.

In the more recent past, American doctors have also helped slow the rise in costs by reassessing the need for hospitalization. For example, many surgical interventions that used to be associated with hospitalization are now performed on an outpatient basis (the patient comes to the hospital during the day and goes home in the evening). The percentage of outpatient operations in hospitals has increased from 16 percent in 1980 to 55 percent in 1993. Even if a hospital stay is necessary, it is now shorter than in the past.


Although most Americans have some form of private health insurance, some people cannot afford it. You can get medical care through two social programs established in 1965.

Medicaid is a joint federal and state program that funds medical care for poor people. The requirements for obtaining Medicaid and the scope of benefits vary significantly from state to state. At a cost of approximately $ 156 billion a year, Medicaid is the largest social program in the United States.

Medicare is another form of government health insurance. This program pays numerous medical bills for Americans aged 65 and over or Americans with disabilities, regardless of age. Medicare is funded through a portion of Social Security contributions, beneficiary premiums, and government funds. Everyone who receives Social Security benefits is covered by Medicare.

One of the major problems facing the United States health system is the care of those who cannot afford health insurance and who are not eligible for Medicaid or Medicare. It is estimated that one in seven Americans will not have health insurance, at least temporarily, over the course of a year. They can be people who are unemployed, who have a job without health insurance, or who live just above the poverty line. These people can turn to government hospitals for emergency treatment, but often fail to go to any check-ups that could prevent disease.

When President Bill Clinton was elected to office in 1993, one of his primary goals was to help these uninsured Americans. After much discussion and debate across the country and across the population, Congress passed legislation in 1996 to make it easier for working families and their children to obtain health insurance. The new law extends access to health insurance for workers who have lost their jobs or who are trying to get insurance with a pre-existing medical condition, and includes a pilot program of temporary tax exemptions from savings accounts for medical bills.

Although healthcare costs continue to rise, the increase has slowed in recent years due to the proliferation of HMOs and other factors. In 1990 health expenditure rose by nine percent compared to the previous year. In 1994 the rate had dropped to 4.8 percent.


Original text: "Portrait of America: The Social Safety Net "from the brochure" Portrait of the USA "published by the US State Department's International Information Programs (published on America Service, August 17, 2006)