Breaking Down on the ‘Last Mile’

Vulnerable mothers deserve better than aid programs that fail to deliver.

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(Stock photo from Getty Images.)

In the wake of the Dobbs ruling and subsequent state-level actions on abortion, this is the season for the pro-life movement to make big asks on behalf of vulnerable families. Leading politicians from both parties have endorsed expanded support for families and children, even if they haven’t agreed on which approach to take. But to have a real win for moms and babies, the pro-life movement needs to make sure that any program it backs will be designed to actually reach the families that need it most. After all, an aid program matters little without funding to support the last mile of work to deliver aid to the most vulnerable families.

Sen. Marco Rubio and Rep. Nancy Mace have introduced the “Standing with Moms Act” which simply proposes creating a national website where mothers can look up local and federal relief programs. That’s marginally useful, but the more common problem is that even when parents know about programs, the promises are only good on paper, not in reality.

During the pandemic, I got my expanded child tax credit payments without a hiccup, but families that didn’t file tax returns couldn’t receive payments automatically. They had to initiate the ask, navigating the IRS’s clunky website—which initially didn’t work on mobile phones. 

It wasn’t just a problem with programs cobbled together on the fly. Temporary Aid to Needy Families (TANF), which was established in the 1990s, made headlines when Brett Favre allegedly diverted more than $5 million of the program’s funding to build a volleyball stadium at his daughter’s college, but TANF fails in small ways every day: Today it reaches only about 1 in 5 families with children in poverty. In New York City, tens of thousands of free preschool spots go unclaimed because the city hasn’t reached out to the poorest families to sign up.

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  1. Avatar photo
    Ben Connelly

    “ VaccinateCA initially swung into action with a low-tech solution—they simply called California pharmacies to ask whether vaccines were in stock and logged what they learned on a map. The group attracted volunteers and funders, all committed to connecting people with what they’d been promised on paper, until eventually they were running paid call centers and providing the back-end data for the CDC’s official Vaccines.gov page.”

    Indicating that the private sector and civil society can step to the fore in the absence of government action.

    “ We had to make things right for our users—a business can’t survive if it doesn’t provide real value to its customers. But too often, the government doesn’t treat the people it serves as though their needs are real and urgent. It offers aid without access, as though the point of the program was more to tout our own charity than to actually help.

    A program for the poor should be designed for the poor. Our brusque, byzantine bureaucracies make it hard for poor families to welcome even a planned, wanted child. It is much harder when the new baby is a surprise and strains both the mother’s finances and her ability to keep up with the paperwork that helps her family afford groceries. Vulnerable families don’t just need monetary aid, but to be treated with dignity and care at every step of the application and administrative process. Every parent knows that care isn’t a matter of just proving that you tried, but of sustained, sincere accompaniment with your child when they need you. Our aid to parents has to work the same way. It will cost more financially to do it right, but it costs us much more morally to make empty offers to the poor.”

    Perhaps unintentionally, you make what I consider to be a great case for why we should eliminate government involvement in this area, which is merely standing in the way of civil society. Local, private associations are better able to meet people’s needs than governments. And passing a program that doesn’t work is merely an excuse - something we can pay ourselves on the back for (“we’re a moral society because we have socialized healthcare”), while doing nothing personally about the most vulnerable.

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    David Eggleston

    We’ve known for decades that the Blue Model’s failed. Sadly, instead of promoting a viable Red Model, the GOP seems stuck on rugged individualism and Liberty!tm. I’ve worked for charities that spent more time touting their charity than actually helping people in need, so I get what you’re saying. When a nonprofit says that it “runs like a business,” they’ve given up on being charitable, and of course they still don’t run like a business. Grrr!

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  3. Sdwats61

    Well written piece. I am skeptical of government programs because they fail to deliver benefits to those in need and they do not account to determine they are achieving objectives. Our politicians pass the program, congratulate themselves and move on. We the taxpayers nod wearily and the program moves into the administrative ether. Your reporting needs to become a continuing focus for journalism,to critique both parties posturing.

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  4. Nordic_man

    The thing is that when you have conservatives that don’t want these programs in the first place, but they can’t say it because the attack ads make themselves they switch to complexity. Remember when Ron desantis commented that the Florida unemployment system seemed designed to stop people from getting benefits? And then the former governor was found to have basically said that it was done on purpose?

    On the other side the dems are so worried about the attacks from the right about welfare queens that they are determined to get these programs to only help the deserving poor, whoever that is?, which leads the dems to add complexity to preempt attacks from the right.

    Let’s look at SSDI. Often called America’s hidden welfare system, because it grows with economic downturns and tends to prevent people from wanting to go back to work. It, like normal social security is going broke and got an infusion of cash from the normal social security trust fund. What is the proposed solution? Make SSDI more unattractive (as in reduce benefits, which are already less than 25k with requirements that you never work), and just deny more people. Just whatever you do make the numbers go down. Let’s forget there are people out there who actually need this (and a whole host of people why want to, and could work, if the government and private sector did the basics to enable it, but that costs money we can see, for people who aren’t my tribe so fuck that) just make the numbers go down

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    1. Avatar photo
      JohnM.

      Yes, there are a lot of people who really need SSDI, but there are also a lot of people who don't need it, yet who still receive it. SSDI is riddled with fraudulent claimants because it was so easy to get. Bad back? Hearing loss? Try and disprove those claims. Alcoholic/drug addict? Get in line. Anecdotally, there are two entire families in my neighborhood who receive SSDI fraudulently, so we can imagine the numbers nationwide. Almost reminds me of Britain's 'dole' system of welfare back in the 20th century. I don't know what the answer is either.

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      1. Nordic_man

        I think one of the ways to deal with SSDI (which is totally a non starter politically) is to find people in the workers comp program and provide them with the important parts of the SSDI wraparound. Medicaid and retraining. Lots of people working blue collar jobs who get injured enough that they can’t work with their hands could return to different work, problem is that to get SSDI you basically have to not work while you are trying to get on it, can’t be attempting retraining, you essentially have to be completely poor and helpless. We then wonder why these people don’t jump at the chance to try work again when we train them for years to be helpless and jobless to get what they need. If instead we responded to SSDI claims with either an obvious “yeah you need this”, or a “maybe but let’s see how job refraining big goes, and while you are here here is easy access to Medicaid and a stipend to get you through, and we will review after training is done” we would get people before we train them to be helpless.

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        1. Avatar photo
          JohnM.

          Hey, thanks for offering up a common sense solution. Sounds plausible to me. Anything has to be better than what we currently have.

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          1. Nordic_man

            Yeah, now of only we could get real support for the disabled who want to work but can’t for bullshit reasons the support they need….

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  5. Avatar photo
    Francesca

    Thanks for this.

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  6. Avatar photo
    O.W.L.

    Many of the problems we have with the safety net are related to this maniacal obsession with everybody having paid employment. If every able bodied adult is working, who is available to take care of the kids, the ill, and the elderly? Oh--now we need (expensive) government programs to do those things. I'm all in favor of two income families if that is what the family wants--but face it--most jobs are not more rewarding than taking care of your own kids or family members, and most jobs are not remunerative enough to make the hassles of raising a family while both holding town full times jobs worth it.

    In terms of removing the "complexity tax," take a look at the state of Washington, which has done an excellent job making it easier to get assistance. Their Apple Health program (Medicaid) is proactive. Without us even being aware of the program, the state reached out and enrolled my spouse in a program that wrapped around Medicare, and covered many common out of pocket Medicare costs.

    They also have an amazing Covid vaccine tracking database. Routine chores like driver's license renewals and licence tabs are available online. It is encouraging to see what competent government can do when it is in the business of serving its citizens.

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  7. Avatar photo
    Bel

    There was an author on the Ezra Klein podcast last week who recently released a book about poverty. He talked about a time tax that impacts the eligible from accessing benefits. Hours spent sitting in benefit offices, or being unable to do so because they are working, confusing layers of forms, the inhumanity of being interrogated as if they are about to commit fraud.

    He asked if this was an unintended consequence of our bureaucracy or an intentionally designed system for reducing costs by preventing access.

    FWIW, he thought the Covid child tax credits were more effective then a lot of other programs in alleviating poverty.

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  8. Token Liberal

    Government has always been torn between offering seamless assistance and preventing fraud. One problem is that when criminals find a weakness, they flock to it. Consider the great rush for unemployment benefits at the start of the pandemic. The government prioritized getting money out the door, and it successfully did that. There was also billions and billions in fraud. Sadly, fraud is only limited because of the systems in place to reduce it.

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  9. Pishposh

    All well and good, but if you want to go down this path you have to be willing to admit that the government might actually need to hire and train more actual employees and that those employees need to be competent which means you have to compete effectively with other employers. As it is right now we are politically allergic to hiring new feds, and yes the pay is not bad, until you realize that you can earn twice as much in the private sector. To make matters worse we have a habit of contracting out stuff just to hide the size of the workforce and in the process we probably pay more than we would just hiring someone while giving up to ability to actually command, control, and effectively oversee the workforce.

    I don't care about big government. I don't care about small government. Big and small are stupid words that say nothing meaningful. I care about efficient and effective government that accomplishes the mission we give it. That means proper requirements/mission selection and development, and smart resourcing. First decide what you REALLY want government to do, then people it effectively to meet the need. To me the word Conservative is best exemplified by ones ability to set and follow a budget that gets the job done.

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    1. Avatar photo
      O.W.L.

      This isn't necessarily true--automation can do a lot. Almost all of the interactions most people have with the government can be done online. There would be a big up front capital investment into building out the front end services and in integrating the data that the government keeps in various databases, but it is doable.

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      1. Karin

        You are talking to someone who spent over 6 hours yesterday dealing with state and federal websites to file required paperwork for a non-profit. There was nothing intuitive or user-friendly about any of it!

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        1. Avatar photo
          O.W.L.

          There's no excuse for that--it shouldn't be so difficult, and private businesses have made complex processes far easier online. It takes good design and good data management.

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          1. Karin

            I agree.

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  10. Joe1776

    "....a business can’t survive if it doesn’t provide real value to its customers. But too often, the government doesn’t treat the people it serves as though their needs are real and urgent...."

    This has always been the case and will always be the case. The Government can waste money all it wants and they just tax people forcing them to either pay more or go to prison.

    That is why traditional conservatives recommend we stop draining the private sector through over-taxing. Having the government try to do everything is the European model. It not only drains money that would be better spent on private charities, it also develops a mindset that people are not morally obligated to give to charities. That is one reason why European countries are considerably poorer then the US.

    https://trueandreasonable.co/2020/07/22/poor-europe/

    Finally I am not sure what this has to do with Dobbs. Were these government services suddenly mismanaged after Dobbs was handed down or something? I reject the notion that if we want to protect unborn humans we have some moral duty to grow the government.

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    1. Karin

      I read the article at the link. I was irked by their definitions/assumptions about the relative wealth of nations.

      As it happens, I just returned from a family reunion in Denmark. We came from Canada, Denmark, England, Israel, Italy, Scotland, Sweden, and the US.

      The 3 of us from the US may have had the most money, but IMO not the best lives in any sense.

      You should have seen me trying to explain the mission of the local grassroots non-profit that I work with to them - our mission is to provide ‘period kits’ for public elementary and middle schools. They simply could not understand why there was a need for this (trust me, there is) and at first assumed that we were sending these supplies to African countries!

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      1. Joe1776

        Karin
        The link does not have assumptions about the relative worth of countries it is based on world bank data.

        But you illustrate the difference between Europe and America. Europe expects the government to buy everything people need and on the converse they tend not to give to private charities.
        "Per capita, ­Americans voluntarily donate about seven times as much as continental ­Europeans."
        https://www.philanthropyroundtable.org/almanac/who-gives-most-to-charity/

        No doubt some American parents will not provide their children what they need for a variety of reasons(sometimes for reasons beyond their control). But to the extent you are doing social work you know Americans have many private social nets. No one starves in the US unless we are talking about mentally ill or addicted people that are unable to make rational choices for themselves or their family. Let's not pretend America suffers from poverty like African countries. It does not.

        I also enjoy European culture. But I do not like their finances and their reliance on Government. I prefer the US. But I think people can choose for themselves how much they want Government to redistribute their income. So if I liked their model more I would move there. I don't mean that like a crude love America or leave way at all. I mean I am happy the world offers people options. I don't think Europe needs to be like America but I also don't think America needs to be like Europe. I like that people have choices.

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        1. Karin

          Thank you for your measured response. I just read an Atlantic article, an interview of Derek Thompson, and I was struck by his comments on the US’s worsening mortality rates relative to other developed nations. Another good way of looking at the “true” wealth of nations:

          https://www.theatlantic.com/newsletters/archive/2023/04/americas-death-trap/673851/

          “ Kelli María Korducki: In your latest article, you repeat a turn of phrase that you used in a previous story, calling the U.S. a “rich death trap.” The rich part is pretty self-explanatory, but unpack the rest of it.

          Derek Thompson: The appropriate context is that, over the past 30 years or so, U.S. life spans have increased a little bit, but way behind the pace of similarly rich countries like Western Europe, Japan, South Korea, and Australia. This is a pretty shocking development because throughout economic history, people living in richer countries have generally lived longer. And yet in the U.S.—which is the richest country in the world—we're not getting the long lives that we would expect. So you could say that there is a mortality tax on being an American as opposed to being French or Japanese, for example.

          Kelli: When does this mortality tax emerge in the data?

          Derek: You start to see it in the 1980s, but it really picks up in the 1990s. That’s where we really start to see this life-expectancy divergence.

          Kelli: What might have happened in the 1980s and ’90s to stagnate life-expectancy increases here in the States but not abroad?

          Derek: You could look at guns. Clearly, we have more gun deaths here than in other countries. And you can look at car deaths, which we also have more of than in similarly rich countries. But gun deaths per capita and car deaths per capita haven’t clearly increased a lot in the past 30 years. So that leaves things like drug overdoses, obesity, and health inequalities. But the truth is that health-care access has actually probably gotten more equal in the past 30 years; we passed Obamacare, which has extended Medicaid and all sorts of health care to low-income individuals. My bet, then, is that the growing gap between American longevity and that of other rich countries, at least in the past 30 years, is being driven by our poor health, specifically, more drug addiction, more drug-overdose deaths, and a higher risk of obesity.

          Kelli: And despite Obamacare and broadly expanded health-care access, there’s also still a pretty significant health-care gap in the U.S.

          Derek: That’s absolutely the case, and health outcomes are much more unequal in the U.S. than in countries with universal health care, where you tend to see that life spans in poor areas and rich areas are pretty similar; in the U.S. they’re much more different. Where you’re born in the U.S., and how much income your parents have, is much more determinative of how long you’ll live.

          Kelli: What would it take to make America less of a death trap?

          Derek: It’s a really big question. I would say that this conversation needs to be about all of these things that are driving our mortality: thinking more about ways to reduce obesity in America and talking more about the importance of exercise for metabolic health. And we have to reduce synthetic opioid overdoses (primarily fentanyl), which kill more than 70,000 people in the U.S. every year.

          This is sort of an aside, but there are almost two separate opioid crises happening in the country right now. One is the opioid-prescription-addiction crisis with the Sackler family and Purdue Pharma at its center, and then there’s the fentanyl crisis. Nearly 17,000 people a year are dying of opioid-prescription addiction—that is, from the abuse of opioids that were prescribed by a doctor—and about 70,000 people died of fentanyl overdoses in 2021. So the fentanyl crisis is four times deadlier than the opioid crisis that we’re used to talking about, but it doesn’t really occupy that much attention from lawmakers. I think we could use some really hard thinking about how to bend the curve of fentanyl abuse.

          Kelli: What about the other American death drivers you mention in your article? Cars, guns?

          Derek: So far, it seems that a little bit more working from home is probably good for reducing car use and related deaths. More housing in downtown areas that would reduce the need for driving commutes would probably also be good. And when it comes to guns, I can think of some pretty clear policy ideas for reducing gun deaths but, man, I’m not particularly optimistic about their ability to be passed at the federal level.”

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          1. Joe1776

            "But the truth is that health-care access has actually probably gotten more equal in the past 30 years; we passed Obamacare, which has extended Medicaid and all sorts of health care to low-income individuals. My bet, then, is that the growing gap between American longevity and that of other rich countries, at least in the past 30 years, is being driven by our poor health, specifically, more drug addiction, more drug-overdose deaths, and a higher risk of obesity."

            Yes I agree with him. Obesity is a big problem. It leads to diabetes and a whole host of other health issues. It likely lead to our large number of deaths from Covid despite having a good health care system. I am just not sure the government can do much on this. We already try to warn people about calories and what foods are good and bad. It seems more of a cultural issue than a government or political issue to me.

            Same with drug addiction but I suppose there can be increased policing of certain dangerous drugs. It just seems we are going in the opposite direction politically.

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      2. Pohl

        Interesting anecdote. The Scandis have low childhood poverty, but Italy is up there at 17.3%, with Mexico and the US at the top, the latter with a 20.9% childhood poverty rate. Yeah, not good. I looked this up because of your post, so I may as well share it. (smile)

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        1. Joe1776

          https://www.census.gov/library/stories/2022/09/record-drop-in-child-poverty.html

          Look this is saying we have a 5.1% child "poverty" rate. The problem is when you have "relative poverty" you can have just about any result you want. If you say poverty is anyone that earns less than 50% of the average income then there will always be some poverty. But one country's "poor" might be another countries "middle class." That is the point of the link. Many of the poor in the US would be considered middle class in Europe.

          If you want to actually compare countries an absolute measure is best.
          https://www.economicshelp.org/blog/glossary/definition-of-absolute-and-relative-poverty/

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          1. Pohl

            Your link used an SPM measure. This Census link puts childhood poverty at 16.9% in 2021, using poverty thresholds:
            https://www.census.gov/library/stories/2022/10/poverty-rate-varies-by-age-groups.html

            I was earlier using data comparing the US to 26 OECD nations, mostly European. And, yes, using relative poverty, or half of the median national income for each country. The US was actually just behind Italy for the poverty gap, measuring the percentage from poverty of the average income of the poor. At any rate, comparing the US to other advanced countries has limitations but is still useful. And, I’m not ready to go the mat for this as I was making a point in passing to support the notion that things aren’t as bad as they can seem here. But that they are still bad for those suffering, naturally.

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          2. Karin

            “Many of the poor in the US would be considered middle class in Europe.”

            Can you support this assertion? I don’t think that it is correct.

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    2. Avatar photo
      O.W.L.

      It doesn't take a big government to just give money to pregnant women and young families. The child tax credit was up and running very quickly during Covid. And I'm sorry--if you didn't file a tax return how is the gov't supposed to know how to give you your monthly credit? It's not hard to file a 1040EZ. Basing an entire policy on edge cases (people who can't vote because they have no form of ID--how in the world do they secure employment, open bank accounts, or drive cars?) isn't good policy. Create a system that works for the 95%, and then have exceptions or workarounds for the 5%.

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    3. Rachael.A.Cooksey

      If pro-life is serious then we would prioritize programs that would help mothers decide not to abort instead of just banning procedures. If mothers have a safety net it helps encourage to keep their babies and not seek out abortion in the first place.

      From David French - https://thedispatch.com/newsletter/frenchpress/roe-is-reversed-and-the-right-isnt/
      The two sides of the great American divide are now staring at each other and asking, “Now what?” The answer from pro-life America should be clear and resounding—the commitment to life carries with it a commitment to love, to care for the most vulnerable members of society, both mother and child.

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      1. Joe1776

        I think pro life people likely do donate more for pregnancy centers and to support young families then pro choice people. I know my church does many collections for such charities. But I am just wondering why your view on abortion should change this.
        A mother has expenses for a child at any age. Is it a sliding scale? The earlier person thinks women should no longer kill their babies the more money they need to donate to charity? So if you are fine with partial birth abortion then morally you have to pay the least?

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      2. Avatar photo
        Cthocas

        Except pro-lifers already give a great deal of time and money to running pregnancy resource centers, food banks, and other local NGOs to directly help mothers within their communities. Meanwhile Democrats do their best to either sue these organizations out of existence or literally burn them to the ground.

        These things pro-lifers are supposed to show they're pro-"whole life" are already being done. But because they're not the ungainly, inefficient government programs Democrats prefer, pro-lifers are accused of doing nothing. Which is a lie.

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        1. Karin

          This is a very unfair comment. I am pro choice, but I also support local ministries that work directly with mothers and babies in need.

          Maybe try a less broad brush?

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          1. Joe1776

            I agree we should have some data. But you can google for yourself and the data I see suggests conservatives give more to charity. Now a lot of that goes to churches but I know as a Catholic there is always prominent support for these care of infants birthing centers and diapers etc. But I am not aware of a straight up comparison of pro life versus pro choice. I hope both sides act more charitably to others.

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      4. Avatar photo
        Kmregan7

        But that bumps up into the "if they didn't want to have a baby, they shouldn't have spread their legs. Why should *I* pay for the irresponsible?" attitude that many (but not all) conservatives have. Ignoring whether women even want to be mothers at all, let's assume they would all choose to keep a pregnancy if they had healthcare and financial help, etc. There's a reason that those on the left and who are pro-choice continually have the cliche that people are only pro-life up to birth....because when taxes and money come into it, there are two battling ideals - that of fiscal responsibility/small government and that of anti-abortion.....if anti-abortion takes precedence, then you get pro-lifers, who will consider bigger government if it means "saving babies" because they care more about life than money. Buy more often you get those who are anti-abortion. They don't want abortions, want to save babies, just so long as it doesn't cost them more taxes (in fairness, many would and do give to charities that help mothers but that just isn't enough.

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        1. Joe1776

          "...let's assume they would all choose to keep a pregnancy if they had healthcare and financial help..."
          They pretty much do all have healthcare and financial help. If a person is too poor to buy their own health insurance there are government options and charitable care organizations. And American provides considerable financial help for families through the government and through private charities.

          How much is "enough" and compared to what other country? I mean you can talk about a tiny Scandinavian country all you want but America is a big diverse country and if you look closer at places like Sweden you can see their model is not working so well.
          https://www.usnews.com/news/best-countries/articles/2022-12-30/sweden-once-welcoming-to-immigrants-shifts-course

          Do you want the government to provide for everyone or do you want your country to be able to take on immigrants from all over the world. It seems you have to choose. I think America should continue down the route of private charities as opposed to government that way more people can come here and experience the prosperity we offer.

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        2. Rachael.A.Cooksey

          Pretty gross comment which makes many assumptions. And the quote below still applies as a response.

          From David French - https://thedispatch.com/newsletter/frenchpress/roe-is-reversed-and-the-right-isnt/
          The two sides of the great American divide are now staring at each other and asking, “Now what?” The answer from pro-life America should be clear and resounding—the commitment to life carries with it a commitment to love, to care for the most vulnerable members of society, both mother and child.

          There’s a lot of research that shows that most people on the left do not view abortion as a good thing. And we don’t have to make it about big government. Pro-life groups should focus on supporting mothers and children through private organizations instead of banning procedures. You’d make a bigger impact on the problem.

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          1. Joe1776

            I like David French but he is not always entirely logical.

            "The answer from pro-life America should be clear and resounding—the commitment to life carries with it a commitment to love, to care for the most vulnerable members of society, both mother and child."

            Of course, I believe we should all have a commitment to love and to care for the most vulnerable members of society, both mother and child. (and I am not sure why it would be limited to mothers and children) But it is a non sequitur to say those commitments should be lower to the extent you think abortions should be allowed to happen later in the unborn baby's life. Does that make sense?

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            Kmregan7

            Not at all an assumption - I've heard and read comments myself that are literally "they shouldn't have had sex if they didn't want to chance pregnancy" or "why should *I* pay for - insert basically anything that doesn't directly impact that person. That's also why I said not all, and added that many would and do give to charities.
            David French is right - the commitment to life carries with it a commitment to love and CARE FOR the most vulnerable members of society. It doesn't say anything about "but only if it doesn't actually cost you anything in taxes." Private organizations are great.....but they don't have the reach of government. It should be a mix.

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