Low-Income People Pay When Government Tech Contracts Sour

Earlier this year, the tech company Novo Dia Group announced it would not continue as a vendor with the U.S. Department of Agriculture, due to a switch in federal contractors. What seemed a run-of-the-mill business decision threw a very real wrench into the availability of locally-grown foods for low-income Americans.

The problem was that Novo Dia held the only keys to a USDA program dedicated to Supplemental Nutrition Assistance Program processing software and equipment for 1,700 farmers’ markets nationwide. Without Novo Dia providing this service, markets would have no way to accept SNAP — a disruption that would cost farmers income and SNAP recipients food.

If you’ve ever attempted to switch your cell phone provider but keep your actual device, you might be able to relate: Farmers’ markets had perfectly functional and expensive equipment that simply would not work with any other SNAP processing software. It’s the government equivalent of trying to keep your iPhone when you move from Verizon to AT&T.

This episode raised a lot of questions about the government’s relationship with tech companies tasked with administering public programs: How does it choose who to hire? How does it hold those companies accountable? And how do those decisions affect the daily lives of low-income Americans who rely on being able to access their benefits?

The answers are vitally important: Governments are increasingly relying on new technologies to sort applications, manage caseloads, and distribute benefits. How such technology is contracted, developed, and deployed will have real impacts on millions of low-income Americans.

Take, for instance, what happened in Washington, D.C. In the fall of 2016, the city’s Department of Human Services, along with the contractor Infosys Public Services Inc., replaced a computer system the District had been using since the early 1990s to enroll low-income residents in SNAP and cash assistance programs. The Food and Nutrition Service, the USDA agency responsible for administering the country’s nutrition assistance programs, issued a letter to the D.C. Department of Human Services, warning against launching the new system without having done adequate testing.

But two months later, D.C. rolled out the system anyway — to repeated outages and glitches, including benefits not being loaded onto Electronic Benefit Transfer cards.

Frustrations between agency employees and customers ran so high that there were physical altercations in some enrollment offices, causing the union representing the workers to issue a formal grievance. The union asked that the agency return to using the previous technology or distribute hazard pay to employees.

Rhode Island, meanwhile, has been struggling to serve its SNAP recipients since it rolled out a new $364 million computer system in 2016 — known as the Unified Health Infrastructure Project — causing delays in distribution by the thousands. Recently, the Food and Nutrition Service threatened to withhold more than $900,000 in federal reimbursements due to Rhode Island’s continued failure to address a list of nearly 30 items related to system functionality, issuance of benefits, backlogs, certification, and more.

In turn, state Department of Nutrition Services Director Courtney Hawkins blamed Deloitte Consulting, the company contracted to build the computer system saying, “This formal warning underscores the fact that Deloitte has not yet delivered a fully functioning system that works on behalf of Rhode Islanders.” In April, the company apologized for its disastrous roll-out.

To date, two federal class action lawsuits have been filed against Rhode Island over its SNAP program. Recently, it was reported that the total cost of its new computer system had reached “$647.7 million through the 2019-20 federal fiscal year, with $138 million of that amount to be covered by state taxpayers and the rest by the federal government.”

Part of the problem in developing these systems is how the government chooses which companies to hire, said Dave Guarino, director of GetCalFresh, a project of Code for America. He notes that there are only “a small number of vendors who know how to navigate the procurement process, and they’re the ones who get the contracts.”

Thus, the proposal and bidding process limits the amount of competition and creates stagnancy in the technology developed for government programs. It also leaves out newer, smaller, and more innovative companies.

In theory, this is because the government process is designed to decrease risk, given the high amount of sensitive and confidential information managed by these systems, so it’s the well-known contractors with a track record of managing large projects who ultimately get the gig.

But Guarino says that government technology crises, such as IT disasters for SNAP recipients, highlight the need for a true shift in thinking about risk and agility. “We should be demanding better software and better experiences,” said Guarino. “But if we want government to be able to act more nimbly and quickly, we also need to be able to say that government can take more risks.”

Short-sighted decisions and worse implementation of new government tech can adversely impact scores of people.

While risk-taking can have downsides, Guarino said the best practice is to test new ideas “on a really small scale in a way that minimizes risk, but maximizes learning” — a concept that could have helped to prevent harm caused by the failure of the D.C. system roll-out, as problems could have been spotted and fixed with a relatively small control group.

Guarino also noted the importance of working with a broad range of partners to develop and administer technology, as well as dividing up tasks to “the best firm for each job.”

His own project, GetCalFresh, is one such successful model. GetCalFresh offers online SNAP applications for 36 counties in California, and its technology was developed to measure and remove barriers that often prevent low-income people from accessing their benefits. Users can easily submit SNAP applications by mobile phone or computer, often in fewer than 10 minutes, and can also send verification documents securely via their phones. And by working with a wide range of partners, including Code For America, state and county agencies, and organizations, Guarino said the project is more successful than it would be with a single entity at the helm.

“These things often aren’t talked about as dimensions of why poverty persists and why some poverty solutions don’t reach everybody they could,” said Guarino, “But they’re a really huge deal.”

The thousands of farmers and customers affected by the Novo Dia debacle would likely agree. And as D.C., Rhode Island and surely other places have proven, short-sighted decisions and worse implementation of new government tech can adversely impact scores of people. Indeed, if we want innovative, effective poverty solutions in today’s digital landscape, we need to think hard about tech.


First Person

How Chicago Is Making its Own Affordable Housing Crisis Worse

For low-income people, a lot of our time is taken up by jobs that don’t give paid time off, children who need attentive parents, and relationships that require work. The gaps are filled in with everything else life brings. There’s no time left over to go on a treasure hunt just to find an affordable place to call home. In the winter of 2012, my move to Chicago would set me on the path to have to do just that.

I traded in my MetroCard for a CTA pass and moved to the Hyde Park neighborhood of Chicago. There was a creative black community, my $750 rent was affordable, and I still had enough money to get bottom-shelf whiskey if I went out. A new job opportunity took me from the beauty of the Southside to an $800 gem in Humboldt Park.

Things were going decently until the neighborhood — filled with “2 Flats,” an affordable Chicago housing staple — began to change. Moving trucks were constantly present, and I began to see a lot more white faces. A 2018 study from the Institute of Housing Studies at DePaul University states that due to gentrification, 2 Flats in neighborhoods like mine — which often house multiple generations — were being purchased and turned into single family homes, pushing out lower-income residents.

My building was purchased by a management company who slapped on a coat of fresh paint, put one washer/dryer set in the basement ($4 per load), and then slid a note under my door telling me they were raising my rent. Within three years, the rent went from $800 to $1,200. In August of 2017 I got another notice: the rent was going up to $1,475.

A single-person household in Chicago earning under $36,000 yearly is considered to be very low income — that was me. Factoring in transportation, bills, student loans, helping family, food and more, there was no way I could survive in this or many other Chicago neighborhoods. Survival included entertainment, such as seeing a film or treating myself to my favorite lunch spot, even though the world chastises poor people for trying to get moments of joy in our everyday lives.

I needed a place to live and fast. I had to stay in Chicago; I built a life here with relationships and a budding career. I couldn’t afford to start over. I scoured the internet and tucked away in the news tab of Google was an article about an initiative that I had never heard of. The Affordable Requirements Ordinance, as it’s called, requires developers to dedicate 10 percent of their units to affordable housing or pay into a low-income housing fund; most developments, unsurprisingly, opt to pay out. A new twist to the ordinance was being tested in the areas of Logan Square, Avondale, and West Town (The Hipster Triangle), along with some Near North/West areas. It required developers to commit 15 percent of new residential buildings to affordable rentals or build affordable housing within two miles of the development.

This sounded like my key to staying in Chicago, but getting that affordable housing would prove to be a difficult and time-consuming task. There was no list of participating properties, no one answered at the phone number I found, and the only contact email was for buyers of low-income units. I walked around the city and collected numbers from the temporary signage of 18 developing properties. With every phone call, my inquiries were met with exasperation, confusion, or false promises of a returned phone call.

Getting affordable housing would prove to be a difficult and time-consuming task.

After a few weeks, one building set me up with an interview to obtain an application. A leasing agent asked about my educational background, my work experience, and if I was in programs like LINK and Medicaid. I was being vetted to make sure I was the “proper” low-income resident. They didn’t want to make their wealthy future residents uncomfortable. They wanted someone who could not be clocked as poor on top of being black when they saw me checking my mail. After more interviews and massive amounts of paperwork that included a copy of my degree and character letters from my managers, I was offered a studio. I had played their game and three weeks later I moved in.

It’s not just the city that has a vendetta against its non-wealthy residents; it’s the surrounding suburbs as well. The 85 percent lily white and wealthy suburb of Tinley Park, for example, recently reached a settlement with the Department of Justice and Department of Housing and Urban Development after an affordable housing development that would have brought black and brown faces failed to get approval after being opposed by residents. This historically racist suburb is paying out over $2 million in damages. This didn’t happen on some very special episode of a 1960’s sitcom. This happened in real life in a place that is 45 minutes outside of Chicago.

Developers are cashing in when they pay into the aforementioned low-income housing fund instead of offering an affordable unit. They get about half of that $225,000 fee back in tax credits and that’s just one of the incentives the city offers; more than $4 million has gone missing from the fund. Chicago has to stop rewarding developers for opting out of helping the poor. These buildings need to increase the amount of units available to low-income people and be required to offer them, no buying your way out. They should then be required to help fund housing in forgotten communities, helping them to rebuild and thrive.

This Affordable Requirements Ordinance Pilot Project is one way to address housing affordability and segregation, but communication and access are key to making it work. A visit to the city’s website or an appointment at the local Department of Human Services should have residents well on their way to finding housing that they can afford and be proud to call home. Residents shouldn’t have to become a detective at the poorly proposed West Side police and fire academy to find proper housing.



Missouri Is Denying Parole to People Sentenced as Children

Tino Wedlow’s future ended in 1989, when at 17 years old he was sentenced to life in prison without the possibility of parole. After exhausting the appeal process, there was nothing left for him but to slowly age to death.

Finally, a recent major court decision opened the door to possible freedom for Wedlow and other Missourians who were sentenced to life without parole before they were old enough to vote. It also shined a light on how — despite a Supreme Court ruling that mandatory sentences of life without parole for juveniles are cruel and unusual — authorities have been slow in granting those prisoners their chance at freedom.

Wedlow, now 46, was sent away at a time when prison sentences — and prison populations — were skyrocketing. In 1992, there were about 12,500 people serving life without parole in the United States. By 2017, there were 53,000, including 2,200 who were convicted as children. These lengthy sentences for violent offenses are a major driver of mass incarceration.

Then a series of groundbreaking Supreme Court rulings rolled back the sentences that can be given to children. In 2012, Miller v Alabama banned mandatory sentencing schemes that give children life without parole. In 2016, Montgomery v Louisiana ruled that people already serving such sentences — such as Wedlow — must be given a “meaningful opportunity to obtain release.”

“Mandatory life without parole for a juvenile precludes consideration of his chronological age and its hallmark features — among them, immaturity, impetuosity, and failure to appreciate risks and consequences,” Justice Elena Kagan wrote in the 2012 ruling. “It prevents taking into account the family and home environment that surrounds him — and from which he cannot usually extricate himself — no matter how brutal or dysfunctional.”

To comply with the ruling, the Missouri legislature passed a law allowing Wedlow and about 90 others to petition for parole after 25 years. It instructed the parole board to consider specific factors at hearings for this group, including growth and rehabilitation, age and maturity at the time of the crime, and “the defendant’s background, including his or her family, home, and community environment.”

Wedlow watched the news about the decision on his cell mate’s television. “I was like, ‘Wow. God is good,’” he recalled. “That ruling gave all of us hope.”

But as Missouri’s juvenile lifers began going before the parole board in 2016, they were almost uniformly denied. At Wedlow’s February 2017 hearing, he was asked about the details of his 1989 crime for about 10 minutes over video conference. Afterwards, he received a one-page, boilerplate denial form stating his release “would depreciate the seriousness of the present offense.” His next hearing was set for February 2022 — five years in the future.

In May 2017, four Missourians serving juvenile life without parole who were similarly denied filed a federal class action lawsuit, alleging that this treatment was not what the Supreme Court had in mind when it ruled that those imprisoned as children deserve a chance at release. This October, U.S. District Judge Nanette Laughrey agreed, giving the Missouri Department of Corrections until Dec. 11 to come up with a plan that “should include revised policies, procedures, and customs designed to ensure that all Class members are provided a meaningful and realistic opportunity for release based on demonstrated maturity and rehabilitation.”

“Obviously, we’re really excited,” said Amy Breihan, Director of the St. Louis office of the Roderick & Solange MacArthur Justice Center, which represented the incarcerated plaintiffs. “This has been a long battle in Missouri to get some semblance of justice for these folks.”

However, Breihan noted that in Missouri, “It’s far from the end of the case.” She and her clients are waiting to see what remedy the Department of Corrections proposes by the deadline. “My hope is what that means is the board can no longer deny parole to these individuals based solely on the circumstances of the offense,” she said. “That’s something our clients have been saying all along doesn’t make sense in light of the spirit and language of Miller, and it doesn’t make sense to us either.” Earlier this month, Laughrey granted Breihan and her clients permission to create and file their own, competing plan for getting Missouri into compliance with the Supreme Court rulings.

People whose early life looks like Wedlow’s are disproportionately likely to wind up incarcerated.

“Compliance with Montgomery has varied significantly around the country,” the Campaign for Fair Sentencing of Youth reported in January. “Whether an individual serving [juvenile life without parole] has a meaningful opportunity for release depends foremost on the state in which he or she was sentenced.” In New York, a similar ongoing federal suit alleges that the parole board routinely denies release to people sentenced as children, in defiance of the Supreme Court rulings.

Wedlow hopes that at his next hearing, the parole board will be required to consider his successful prison record, the classes he has taken, and mitigating factors of his crime, including his age and family life. Wedlow entered foster care when he was seven, after a child care worker responding to a domestic violence report found food-bare cabinets filled with cockroaches, urine-soaked mattresses, and piles of reeking dirty clothes. At 16, after he refused to live with his mother at a family friend’s house, a juvenile court determined that his behavior was “injurious to his welfare” and he was sent to juvenile detention school, despite not being charged with any crime.

People whose early life looks like Wedlow’s are disproportionately likely to wind up incarcerated. Last March, the Brookings Institution linked incarceration records and IRS records, finding that boys born into households earning in the bottom 10 percent of income earners are 20 times more likely to be in prison in their early 30s than boys born into the top 10 percent. And these economic disparities have knock-on effects: According to an Equal Justice Initiative report from before the Supreme Court rulings, “kids who cannot afford competent counsel face a dramatically escalated risk of being sentenced to die in prison.”

If released, Wedlow plans to live in a halfway house and work for a family friend until he can save enough money to move into a one-bedroom apartment in a low-crime area outside Kansas City. He also wants to take night classes to get a trade job. And he looks forward to meeting his four nieces and nephews in person for the first time. His sister — who was just six when he went away — has never been able to bring them, since he is allowed just three visitors at a time.

Wedlow believes that if the parole board considers his background and circumstances, they will let him go: “Once they look at that and see that I was never in juvenile for no crime, that I was physically and verbally neglected and abused as a child, and in and out of foster care — not for juvenile delinquency but for my own safety and welfare — they’ve got to give me a date.”



Black Friday Isn’t the Only Time Workers Face Unfair Schedules

Some of the biggest retailers in the U.S., including Best Buy, Macy’s, and Target, will be opening their doors to shoppers directly on Thanksgiving this year, getting Black Friday — one of the year’s biggest shopping days — started early. That means employees at those stores will have to leave their families and turkey dinners aside in order to come to work.

In a 2016 survey, nearly half of retail workers reported having to work on Thanksgiving, and big employers are far more likely to have their workers on duty than are smaller ones. Those who refuse or complain can face retaliation, leaving many to decide that putting up a fight isn’t worth seeing their hours cut or losing their jobs entirely.

Every year there are a flurry of stories that question whether that practice is worth denying workers a holiday at home. However, long holiday hours are just one of the myriad abuses employees face when it comes to their work schedules.

Take, for instance, Aliyyah Miller, a housekeeping supervisor at a hotel in Philadelphia. She only receives her work schedule one day in advance, on Saturday for a workweek that begins on Sunday. “Literally, you know the day before which days you’re working,” she said. “You can’t make a doctor’s appointment because you don’t know if you’ll have the day off.”

The turnover at Miller’s hotel is high, and the housekeepers lose hours and income when they have to call out of shifts that conflict with their other responsibilities, thanks at least in part to the unpredictable nature of their schedules.

Nearly one in five workers experiences similarly unstable work hours, and those who are subjected to the worst abuses are disproportionately women and people of color, because they are more likely to work in the low-wage, part-time jobs that include the most haphazard scheduling.

Younger workers, too, are more likely to face abuses: According to research from the University of Chicago, nearly 40 percent of early-career workers receive one week or less of notice regarding their work schedules, with young part-time workers and workers of color experiencing rates even higher.

Workers report weekly earnings fluctuating by 34 percent or more

Other scheduling problems include the inability to ask for time off when it’s needed; split shifts, wherein workers have unpaid hours in the middle of their shifts; and being dismissed early when businesses isn’t high enough, meaning they aren’t paid for hours they were banking on. On-call work, when workers are put on notice that their services may be needed between particular hours, requires them to reserve time for which they may not be compensated.

The income volatility that comes with an unpredictable work schedule can lead to all sorts of adverse outcomes. After all, monthly bills stay the same no matter your hours, whereas service workers report weekly earnings fluctuating by 34 percent or more. Erratic schedules also make it difficult to commit to other paying work in order to make those ends meet.

Unpredictable scheduling also makes securing child care difficult, as it has to be done on short notice. It makes it harder for workers to access the health care system, as Miller noted, or to invest in themselves via more education, which requires predictability in order to choose and attend classes.

Unsurprisingly, then, workers who face schedule volatility are more stressed and experience more health problems, as do their children.

But it doesn’t have to be that way. When Miller previously worked as a kitchen manager, she knew that her staff members had lives outside of work. So she ensured they had regular schedules that were planned out ahead of time.

“We would rotate weekends and everyone had one day off during the week to take care of things,” she said. “I had zero turnover. Everyone was happy because they could attend to their children, they could have a life.”

Some national chains, such as Walmart and Starbucks,  have taken steps toward improving scheduling practices, even if they fall short of what workers and activists have demanded. According to a study done in 2015-2016 at Gap stores, more regular schedules result in more productivity and higher sales. That finding jives with other data showing pro-worker policies improve the performance of the businesses at which they work.

Still, fair scheduling isn’t common practice. So cities and states have stepped in.

San Francisco was the first locale to pass a fair work schedule law, followed by New York City, Seattle, Emeryville, California, and others. Oregon has a statewide fair scheduling law. Though they differ in the details, the general thrust of all of them is to provide workers with some level of predictability, including knowing their schedules more than a week in advance, and providing compensation for erratic or unfair scheduling, such as paying workers for some portion of their time if a shift gets canceled.  (There was also a federal bill introduced in 2017 by Rep. Rosa DeLauro (D-CT) and Sen. Elizabeth Warren (D-MA) that never received a vote in the Republican-controlled Congress.)

Miller’s home of Philadelphia could be next. At the end of the month, the city council is expected to vote on a measure that would require employers at large firms to give their workers 10-days notice of their schedules (increasing to 14 days in 2021) and for those firms to compensate workers for last-minute schedule changes. If it becomes law, the legislation is expected to affect about 130,000 workers. According to a 2018 survey by the Shift Project, a joint effort between the University of California, Berkeley and the University of California, San Francisco, two-thirds of Philadelphia service sector workers report having unpredictable work schedules. More than a third say they receive less than one week’s notice regarding when they’re going to be on duty. Miller and her housekeeping staff, then, have a lot of company.

Philadelphia City Councilmember Helen Gym, who introduced the bill, described one Philadelphia worker she met who quit school because his ever-shifting schedule didn’t allow him to attend classes, and another who sat around all-day, paying for child care, while waiting for on-call hours that never materialized.

“I am trying to do more than pass a bill. I’m trying to change people’s understanding of a problem we’ve got and why this matters, and why this shouldn’t be left to the purview of the market,” Gym said.

No new law is going to help those employees who are stuck working on Thanksgiving this year, but far scheduling efforts like the one in Philadelphia can, hopefully, ensure that next year turns out better.




Crowdfunding Is a Symptom Of America’s Sick Health Care System

“I nearly went to the hospital for the 22nd time in 7 months. As you can imagine this has depleted all of my money,” writes Tara. She continues: “My family has done so much and will help me once I’m there, but I need to move on my own…So look, I’m a responsible girl, I’ve been holding it down for 16 years while feeling like I could be taken at any time.”

Tara is running a campaign  on the popular crowdfunding site GoFundMe. She has fibromyalgia and a host of complications, and needs to relocate to access health care. She started fundraising in March 2017, and a year and a half later, she’s raised less than a quarter of what she needs. She’s not alone. Medical expenses are already the leading crowdfunding cause and donations can’t keep up with demand; a 2017 study showed that 90 percent of medical crowdfunding campaigns failed to reach their goals.

The use of crowdfunding to pay not just for medical care but adjacent costs, such as lost work associated with being ill, caregiving costs for ill family members, utilities, travel and lodging costs to access care, and other externalities, is growing common. For low-income people who are under and uninsured, these cost burdens can be particularly high.

Faced with urgent financial needs, some may turn to payday lenders and other high-interest, high-risk “alternative financial services.” An increasing number are looking to crowdfunding, but Lauren S. Berliner and Nora Kenworthy at the University of Washington Bothell, authors of the 2017 study finding that these campaigns often fall short, discovered success can hinge on things like socioeconomic networks, media literacy, and the ability to translate needs into a compelling and understandable narrative. Campaign success can also be contingent on the nature of the ask; asking for help with ongoing caregiving costs, for example, is less straightforward than requesting assistance with the costs of a specific medical procedure.

Perusing crowdfunding sites reveals ample glossy, well-prepared pleas for help that are netting healthy proceeds, like “Join Oscar’s Village,” featuring a baby with acute flaccid myelitis, a brief, emotive story, and pictures of a happy family. Other campaigns have few to no donations and haven’t been optimized for an audience, like Tara’s: rambling, poorly-punctuated pleas for help, lengthy and apologetic stories, and blurry photos that don’t catch the eye of visitors. It’s a brave new world of health care financing in which those with socioeconomic privilege are better positioned for success than others.

Berliner and Kenworthy fear crowdfunding may be exacerbating socioeconomic inequalities. “Crowdfunding normalizes a means of health care financing that runs counter to a more rights-based system of values,” says Berliner. “

It normalizes the idea that individuals should make decisions about who does and doesn’t deserve care.

” Their work finds that crowdfunding promotes “hyper-individualized accounts of suffering” — the kind of tearjerker personal stories that get picked up in the media, like the widow of a shooting victim who needed help with his lung disease or the woman who saved her husband’s life with CPR while 39 weeks pregnant — that depend on individual ability to leverage media platforms. Crowdfunding sites themselves are also pulled into this debate as they become “an arbiter for public problems,” they say, developing the algorithms that can determine success or failure, verifying high-profile campaigns, and making decisions about what gets highlighted.

With crowdfunding occupying a growing role in the health care landscape, it should be noted that campaigners may also not be aware of the financial implications of participation, including tax liabilities or jeopardizing eligibility for need-based programs like Medicaid. Those most in need of advice on these issues may be least able to access it, lacking attorneys and accountants in their friend networks and unaware that they may need to consult a professional for advice.

The rise of medical crowdfunding demonstrates that insured and uninsured alike are struggling with health care expenses, especially among low-income people. In states without Medicaid expansion, medical debt is particularly high. Medical debt may be ubiquitous, but the amount of debt is often surprisingly small. A 2018 Health Affairs study discovered over half of medical bills sent to collections were under $600. Still, that’s much more than most Americans can pay. In 2017, the Federal Reserve found that 40 percent of people would struggle with an unexpected expense of $400 or more.

Far from being a grassroots solution to disparities in health care access, crowdfunding may just be making the problem worse by foregrounding personal responsibility over institutional accountability. It’s an extension of the argument we saw during the Affordable Care Act fight, put succinctly by Republican Representative Steve King when he said “I think a national health care act substitutes for a lack of personal responsibility.” The belief that the ACA was a handout rather than a hand up is ubiquitous among Congressional Republicans, who enjoy a comprehensive and very affordable health care plan as part of their jobs.

But more and more, we’re seeing voters disagree. Health care affordability was certainly on the minds of voters last week as they turned out to vote for Medicaid expansion in three states, Democratic governors who can drive Medicaid expansion like Laura Kelly in Kansas, and members of Congress who made health care part of their platform.

Stabilizing the Affordable Care Act and moving to protect Medicaid and Medicare may help bring some direct health care costs under control for currently vulnerable groups. This includes those in states currently without Medicaid expansions and moderate-income people who don’t qualify for subsidies or have high-deductible employer-sponsored insurance.

In the meantime, those facing high health care costs and associated expenses will have to keep turning to the internet for help. “I’m white knuckling it to California in a thyroid storm and was just told I need a biopsy now! It may be a long journey, if I have a surge it’s a hospital or hotel! Please pray and god bless you all!,” says Tara in her last update, featuring a photo of her in a hospital bed. It was posted 18 months ago.