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Chicago Studies in American Politics
Trapped in America's Safety Net: One Family's Struggle
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. What’s more, to remain eligible, they will have to stay under these strictures for the rest of their lives, meaning they are barred from doing many of the things middle-class families are encouraged to do: Save for retirement. Develop an emergency fund. Take advantage of tax-free college savings. And, while Marcella and Dave’s story is tragic, 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.
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. What’s more, to remain eligible, they will have to stay under these strictures for the rest of their lives, meaning they are barred from doing many of the things middle-class families are encouraged to do: Save for retirement. Develop an emergency fund. Take advantage of tax-free college savings. And, while Marcella and Dave’s story is tragic, 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.
208 pages, Kindle Edition
First published September 8, 2014
49 people are currently reading
340 people want to read
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Displaying 1 - 29 of 29 reviews
March 22, 2021
Another great read for one of my politics classes that sheds light on the problematic way Americans view the poor and poverty as a whole compared to other countries. We lack the empathy and willingness to help our own, and lack the mindset of "it could be me tomorrow who needs help in some way." Instead we are invasive, skeptical, and turn our noses up at those who need help. In one terrifyingly quick second, Marcella and Dave's lives were turned upside down and they found themselves needing help from a system they had never looked too much into before, and were forced to face the grim realities of all the failures of our American welfare state.
October 1, 2025
Biggest takeaways- social assistance programs vary so much state by state. Social assistance programs can have so many regulations to keep people from ever getting off of the programs such as asset limits giving regulations against having retirement and savings accounts.
Policy can be dense so like that I learned some stuff through a story format.
Policy can be dense so like that I learned some stuff through a story format.
December 2, 2015
Another book that should be required reading in civics class.
This is the story of one family who was doing everything right, the pregnant wife was hit by an uninsured driver in a hit-and-run accident that led to the wife becoming quadriplegic and the end of the life the couple was building together. It was also the start of a life trapped in poverty, because in CA Medicaid recipients can't have retirement savings, a regular savings account, any money received on their behalf must go to the state. Also, family can't pay for any expenses, or it gets counted against the "cost of care." So a family of 3 (the baby boy was born premature but otherwise fine) must not have any savings, working income is also restricted.
The Medicaid rules differ from state to state, some allow savings, some don't, some allow recipients to work, some don't...it's all haphazard and created that way intentionally. I have studied a lot of public policy on healthcare, and this book was an eye opener for me. I want every elected official in the state and federal legislatures to read this book thoroughly and learn how easy, and fast, it is to go from making your own way to becoming trapped in poverty permanently.
This is the story of one family who was doing everything right, the pregnant wife was hit by an uninsured driver in a hit-and-run accident that led to the wife becoming quadriplegic and the end of the life the couple was building together. It was also the start of a life trapped in poverty, because in CA Medicaid recipients can't have retirement savings, a regular savings account, any money received on their behalf must go to the state. Also, family can't pay for any expenses, or it gets counted against the "cost of care." So a family of 3 (the baby boy was born premature but otherwise fine) must not have any savings, working income is also restricted.
The Medicaid rules differ from state to state, some allow savings, some don't, some allow recipients to work, some don't...it's all haphazard and created that way intentionally. I have studied a lot of public policy on healthcare, and this book was an eye opener for me. I want every elected official in the state and federal legislatures to read this book thoroughly and learn how easy, and fast, it is to go from making your own way to becoming trapped in poverty permanently.
March 11, 2016
This is an engaging case study. When Campbell's sister-in-law is paralyzed in a car accident and gives birth to her son in the hospital afterwards. Campbell, who is a policy expert already, decided to write a book using her brother's family's ordeal as a case study on making ends meet while seeking to necessary medical treatment. This is a damning critique of a host of inadequancies built into our limited "social safety net" in the United States. Ultimately, in order to receive necessary medical and assistance care from the state after the accident, the family is compelled by the state to work less and live in poverty. Rather than bringing people out of poverty, the most shocking thing is that these programs are designed to incentivize less work and even divorce as the most rational responses to medical catastrophes and sudden poverty. Highly recommended!
April 14, 2025
This book educated and informed me in so many ways and I’m very thankful that I read it. I would encourage every single American citizen to read this book, as it applies to everyone. The entire time I couldn’t stop thinking about when I learned about the Guilded Age in APUSH. This book shows that we never really exited that era. Instead, it continues, in a much more hidden and tricky way. People need to realize that government assistance programs are a lot more important than you think, and that we will ALL rely on them at some point in our lives. Something needs to fucking change cuz this shit is ridiculous
May 22, 2019
Brilliant. Clearly written and very informative.
May 22, 2017
"Trapped in the Safety Net" is shaped around a fairly novel conceit. The author--a social policy scholar--supports her brother and his wife after a tragic accident in which the wife becomes a quadriplegic. The wife's experience jumping through hoops to access health and personal care supports unveils surprising gaps in the author's knowledge of such programs. After level-setting by explaining the differences among social assistance, social insurance, and the "private welfare system" of employer provided benefits, the author highlights glaring inefficiencies and inequities in American social programs.
For instance, the benefits one receives are largely based on geography; a state's coffers or guiding ideology often determine how tightly woven their safety net is. Also, it is practically impossible to pay for personal care assistance--a critical support for those with ambulatory difficulties--without Medicaid. When Medicaid isn't enough, folks in need often end up in nursing homes, no matter their age. If you aren't poor enough for Medicaid, a means tested program, you must spend down your assets so that you can "pass" the test and begin treatment. This, of course, disincentivizes work and saving. They don't do it like this in Scandinavia!
A quick, eye-opening read. Pick it up.
For instance, the benefits one receives are largely based on geography; a state's coffers or guiding ideology often determine how tightly woven their safety net is. Also, it is practically impossible to pay for personal care assistance--a critical support for those with ambulatory difficulties--without Medicaid. When Medicaid isn't enough, folks in need often end up in nursing homes, no matter their age. If you aren't poor enough for Medicaid, a means tested program, you must spend down your assets so that you can "pass" the test and begin treatment. This, of course, disincentivizes work and saving. They don't do it like this in Scandinavia!
A quick, eye-opening read. Pick it up.
September 6, 2023
An eye-opener, no less.
I normally struggle to get through books assigned to me in college classes. They’re usually textbook oriented with pure facts and no intriguing aspects that keeps the audience hooked. But this one was unique in it’s storytelling aspect without shying away from implementing statistics and underlying research that backed up her point, succinctly and adequately educating me on America’s flawed welfare state, nonetheless. I felt entertained and wish I could have enjoyed it more without impending reading deadlines.
Through the heartbreaking story of her low-income relatives Dave and Marcella, the latter of whom was involved in an accident that condemned her to a disability status, Campbell accounts the struggles of their fight to get Medicaid and receive basic medical assistance all while raising a newborn son. Medicaid, or Medi-Cal in their case, subjects the couple to an inescapable life of poverty with no hope of leaving it unless they want to take huge risks. Every route they take, there is a loophole, a policy restriction, or another monetary condemnation. You know the phrase “how many people does it take to change a lightbulb?” You’d think applications for governmental assistance would be as easy as changing a lightbulb, but Campbell proves it is quite the opposite. Without the assistance of her family (who couldn’t even help her financially without threatening her Medi-Cal membership), I guarantee there is a policy/guideline she would have missed and suffered thereof. On top of that, she’s now disabled and requires long-term care; I couldn’t figure it out independently, let alone if I were physically disabled and under THAT kind of stress.
But it’s not only about healthcare and Medicaid - the couple also have their young son, who they want to raise free of financial strain. They don’t want that kind of childhood for their son, of course. American healthcare systems don’t have universal daycares or preschools, which was yet another obstacle they had to deal with throughout all of this stress. Campbell intelligently extended her rhetoric to other fleeting social programs in America: Social Security, food stamps, Long Term Care, the Affordable Care Act, and more. It is all a big cycle that, as Campbell establishes, very much benefits the wealthy and entraps the poor. All of these programs are threatened by ever-changed legislature that can take away the meager programs we have now.. in the name of cutting government spending. Because THAT’S what we need to cut from the budget right now, as if millions of people aren’t suffering right under our noses.
Bottom line: for Marcella, there was no way out of impoverishment.
Middle and upper class folk may have a harder time realizing the issue at hand, but the crisis is more urgent than ever and desperately begs to be addressed. It was easy for me to empathize with the situation simply because I’m an empathetic person. Unfortunately, most people don’t easily carry this personality trait and prioritize saving their own money (via taxes, etc.) and upholding harmful social tiers of American society for their own benefit, at the expense of others. America has a long way to go to match competing countries with similar wealth statuses, and Campbell’s work highlights the deeply rooted problems of our healthcare system that keep the poor trapped in an endless cycle of poverty, instead of helping the needy like it claims to. What an inspiring book for change. I feel a lot of emotions about it.
I normally struggle to get through books assigned to me in college classes. They’re usually textbook oriented with pure facts and no intriguing aspects that keeps the audience hooked. But this one was unique in it’s storytelling aspect without shying away from implementing statistics and underlying research that backed up her point, succinctly and adequately educating me on America’s flawed welfare state, nonetheless. I felt entertained and wish I could have enjoyed it more without impending reading deadlines.
Through the heartbreaking story of her low-income relatives Dave and Marcella, the latter of whom was involved in an accident that condemned her to a disability status, Campbell accounts the struggles of their fight to get Medicaid and receive basic medical assistance all while raising a newborn son. Medicaid, or Medi-Cal in their case, subjects the couple to an inescapable life of poverty with no hope of leaving it unless they want to take huge risks. Every route they take, there is a loophole, a policy restriction, or another monetary condemnation. You know the phrase “how many people does it take to change a lightbulb?” You’d think applications for governmental assistance would be as easy as changing a lightbulb, but Campbell proves it is quite the opposite. Without the assistance of her family (who couldn’t even help her financially without threatening her Medi-Cal membership), I guarantee there is a policy/guideline she would have missed and suffered thereof. On top of that, she’s now disabled and requires long-term care; I couldn’t figure it out independently, let alone if I were physically disabled and under THAT kind of stress.
But it’s not only about healthcare and Medicaid - the couple also have their young son, who they want to raise free of financial strain. They don’t want that kind of childhood for their son, of course. American healthcare systems don’t have universal daycares or preschools, which was yet another obstacle they had to deal with throughout all of this stress. Campbell intelligently extended her rhetoric to other fleeting social programs in America: Social Security, food stamps, Long Term Care, the Affordable Care Act, and more. It is all a big cycle that, as Campbell establishes, very much benefits the wealthy and entraps the poor. All of these programs are threatened by ever-changed legislature that can take away the meager programs we have now.. in the name of cutting government spending. Because THAT’S what we need to cut from the budget right now, as if millions of people aren’t suffering right under our noses.
Bottom line: for Marcella, there was no way out of impoverishment.
Middle and upper class folk may have a harder time realizing the issue at hand, but the crisis is more urgent than ever and desperately begs to be addressed. It was easy for me to empathize with the situation simply because I’m an empathetic person. Unfortunately, most people don’t easily carry this personality trait and prioritize saving their own money (via taxes, etc.) and upholding harmful social tiers of American society for their own benefit, at the expense of others. America has a long way to go to match competing countries with similar wealth statuses, and Campbell’s work highlights the deeply rooted problems of our healthcare system that keep the poor trapped in an endless cycle of poverty, instead of helping the needy like it claims to. What an inspiring book for change. I feel a lot of emotions about it.
This entire review has been hidden because of spoilers.
July 1, 2024
i truly loved this book and the narrative style that it adopts. one of the best 'investigative' style books that i have ever read and will likely read. tends to get a tad repetitive at times (the book could be maybe 1/3 shorter than it is), but the repetition could also be intentional with how complicated the various social safety net programs are (and the number of acronyms).
-- i read this book for pbpl 05 (introduction to public policy)
-- i read this book for pbpl 05 (introduction to public policy)
January 17, 2024
A super fascinating look at a side of the American welfare state that the majority of people ignore, to their own detriment. This book changed my views on means-tested social programs. However, the book probably could have been a little shorter had Campbell been a little more to the point and repeated less information.
September 24, 2025
First book finished for grad school 😎 4 stars bc I hate nonfiction tbh but this was such a well-written book and case study that made me sort of understand insurance ?? Which is a hard feat. If you’re into public policy or want to know more about welfare/insurance and how fucked it is, this is a great place to start !!
March 16, 2024
now what?
What has happened since this was written? Difficulty for all Americans to find adequate information about health benefits, public and private programs, insurance, understanding options seems to be getting more challenging.
What has happened since this was written? Difficulty for all Americans to find adequate information about health benefits, public and private programs, insurance, understanding options seems to be getting more challenging.
November 17, 2024
good book that is a really important look at public policy but unfortunately i had the worst time reading it bc i learned that public policy is just so incredibly boring to me even when it's interesting.
the essay was due yesterday.
the essay was due yesterday.
December 14, 2017
Lucid manifesto decrying the state of government assistance for the disabled in the US, with a very personal touch. Well worth a read.
May 21, 2019
An honest look at America's failed welfare state. Everyone should read and be aware of its truth.
October 28, 2020
This book truly highlights how America’s safety net (aka any type of means-tested government assistance) keeps poor people vulnerable and on the edge of economic disaster.
May 7, 2022
Very interesting, a little dense for me but worked great for my paper
August 20, 2024
Wow, horrifying!
November 25, 2024
educational, but outdated
February 14, 2025
Read for Econ seminar lowks boring but interesting…. America is fucked up……
September 29, 2025
Highly recommend for anyone who still believes in the American dream
This entire review has been hidden because of spoilers.
December 20, 2017
This is an important book for every American to read. While we claim to be the wealthiest country, we are failing at taking care of our citizens when tragedy strikes. Most of us are one accident or illness away from bankruptcy. And we think that the government will be there to get us back on our feet, but this is a lie. This book explains how the poor must remain poor to have basic needs met. It's virtually impossible to work hard enough to pull yourself up by your boot straps.
A mind blowing book about the troubles of capitalism. Highly recommend.
A mind blowing book about the troubles of capitalism. Highly recommend.
November 7, 2015
A case study written on behalf of a family's struggle through a tragic accident leaving the author's sister paralyzed, and the medical ordeal struggling with the insurance/medicaid system that provides care.
Make family live in poverty in order to recieve medical care, can only have $10,000 in assets or get no medical coverage.
Give valuable real-life experience on how to navigate the awful road of life-long medical care.
Make family live in poverty in order to recieve medical care, can only have $10,000 in assets or get no medical coverage.
Give valuable real-life experience on how to navigate the awful road of life-long medical care.
September 27, 2016
Puts skin on the policies
I liked that the author was able to put skin on the stories and discussions around social policy. Sometimes I got lost in the stats weeds, which may speak more to the complicated world of the welfare state and its impact on American society than the writing itself.
I liked that the author was able to put skin on the stories and discussions around social policy. Sometimes I got lost in the stats weeds, which may speak more to the complicated world of the welfare state and its impact on American society than the writing itself.
March 28, 2016
I feel everyone should read this book......a true depiction of how healthcare and the poor and disabled really is in the US and how it differs depending on which state you live in. Truly unbelievable!
March 19, 2025
i fear every politician needs to read this one
September 23, 2025
Really important information, easy to understand, but the book could be much shorter
June 20, 2015
A look at one family's struggle to get adequate care after a debilitating accident.
Displaying 1 - 29 of 29 reviews