American social assistance programs are stingy and difficult to access because of an age-old suspicion of the poor. They are designed to be less attractive than work. One problem is that they are so miserly as to be impossible to live on. For a disabled person like Marcella, whose expenses will be greater than for an able-bodied person, the limits are truly problematic. And because insurance for the poor is the only source of the long-term supports and services the disabled need, they get caught up in the anti-poor dragnet as well.

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American social policy has a rotten core: incomplete protections from life’s risks. For Dave and Marcella, private insurance would have meant bankruptcy (while the Affordable Care Act removes annual and lifetime caps, large out-of-pocket expenses remain a possibility). Medi-Cal means dire financial straits for the rest of their lives. It’s instructive to read through the heartbreaking stories on other people’s online medical fund-raising pages — so many face similar horrible situations, including many who thought they had good health insurance until a catastrophic accident or expensive medical condition proved otherwise. When disaster strikes, the holes in the American system of social protections become woefully apparent.

More: How Medicaid Forces Families Like Mine to Stay Poor: ‘You’ll Have to Get Rid of Everything’ - Vox