varying levels of service, the program differs from state to state.

In the past, a common problem has been that many low-paying jobs pay enough to a breadwinner so that a

family could lose its eligibility for Medicaid, yet the job does not offer health insurance benefits. A parent

considering such a job might choose not to work rather than lose health insurance for their children. In this

way, health insurance can become a part of the poverty trap. Many states recognized this problem in the 1980s

and 1990s and expanded their Medicaid coverage to include people earning up to 135% or even 185% of the

poverty line. Some states also guaranteed that children would not lose coverage if their parents worked.

These expanded guarantees cost the government money, of course, but they also helped to encourage those on

welfare to enter the labor force. As of 2014, approximately 69.7 million people participated in Medicaid. Of
370 15 • Poverty and Economic Inequality
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