When Andrea Louise Campbell's sister-in-law, Marcella Wagner, was run off the freeway by a hit-and-run driver, she was seven-and-a-half months pregnant. She survived--and, miraculously, the baby was born healthy. But that's where the good news ends. Marcella was left paralyzed from the chest down. This accident was much more than just a physical and emotional tragedy. Like so many Americans--50 million, or one-sixth of the country's population--neither Marcella nor her husband, Dave, who works for a small business, had health insurance. On the day of the accident, she was on her way to class for the nursing program through which she hoped to secure one of the few remaining jobs in the area with the promise of employer-provided insurance. Instead, the accident plunged the young family into the tangled web of means-tested social assistance. As a social policy scholar, Campbell thought she knew a lot about means-tested assistance programs. What she quickly learned was that missing from most government manuals and scholarly analyses was an understanding of how these programs actually affect the lives of the people who depend on them. Using Marcella and Dave's situation as a case in point, she reveals their many shortcomings in Trapped in America's Safety Net. Because American safety net programs are designed for the poor, Marcella and Dave first had to spend down their assets and drop their income to near-poverty level before qualifying for help. The financial precariousness they endured even before the accident is all too common in America, where the prevalence of low-income work and unequal access to education have generated vast--and growing--economic inequality. The implementation of Obamacare has cut the number of uninsured and underinsured and reduced some of the disparities in coverage, but it continues to leave too many people open to tremendous risk. Behind the statistics and beyond the ideological battles are human beings whose lives are stunted by policies that purport to help them. In showing how and why this happens, Trapped in America's Safety Net offers a way to change it.

Some groups participate in politics more than others. Why? And does it matter for policy outcomes? In this book, Andrea L. Campbell argues that democratic participation and public policy powerfully reinforce each other. Through a case study of senior citizens in the United States and their political activity around Social Security, she shows how highly participatory groups get their policy preferences fulfilled, and how public policy itself helps create political inequality. Using a wealth of unique survey and historical data, Campbell shows how the development of Social Security helped transform seniors from the most beleaguered to the most politically active age group. Thus empowered, seniors actively defend their programs from proposed threats, shaping policy outcomes. The participatory effects are strongest for low-income seniors, who are most dependent on Social Security. The program thus reduces political inequality within the senior population--a laudable effect--while increasing inequality between seniors and younger citizens. A brief look across policies shows that program effects are not always positive. Welfare recipients are even less participatory than their modest socioeconomic backgrounds would imply, because of the demeaning and disenfranchising process of proving eligibility. Campbell concludes that program design profoundly shapes the nature of democratic citizenship. And proposed policies--such as Social Security privatization--must be evaluated for both their economic and political effects, because the very quality of democratic government is influenced by the kinds of policies it chooses.

Why are so many American social programs delegated to private actors? And what are the consequences for efficiency, accountability, and the well-being of beneficiaries? The Delegated Welfare State examines the development of the American welfare state through the lens of delegation: how policymakers have avoided direct governmental provision of benefits and services, turning to non-state actors for the governance of social programs. Utilizing case studies of Medicare and the 2009-10 health care reform, the authors argue that the prevalence of delegated governance reflects the powerful role of interest groups in American politics, the dominance of Congress in social policymaking, and deep contradictions in American public opinion. Americans want both social programs and small government, leaving policy makers in a bind. Contracting out public programs to non-state actors masks the role of the state and enlists private allies who push for passage. Although delegated governance has been politically expedient,enabling the growth of government programs in an anti-government political climate, it raises questions about fraud, abuse, administrative effectiveness, and accountability. In probing both the causes and consequences of delegated governance, The Delegated Welfare State offers a novel interpretation of both American social welfare politics and the nature of the American state.