What Is the Most Significant Gap in the Social Safety Net for American Families?

The most significant gap in America’s social safety net is the one we never built for the workers who make care possible. I am a child care worker. For 32 years, children have called me Miss Cathy. I have helped raise generations of children who grew up, graduated and returned to care for their own communities. I love this work. But domestic workers like me — child care workers, home care workers and house cleaners — still lack a real path to fair wages, health care, paid leave or retirement.

I know that gap in my own body. For years, I managed Graves’ disease with a quick clinic visit when I could afford one, and nothing when I could not. Only at 65, when I became eligible for Medicare, could I finally receive real, consistent medical treatment for my condition. I am 66 now and still working because I cannot afford to retire. A country that depends on our care must finally build a safety net that cares for us, too.

Cathy Hooker is a child care worker in Georgia and a member of the National Domestic Workers Alliance.

The single most significant gap in the social safety net today is between the realities families face and the systems they are expected to navigate.

We see this in communities across the country: families trying to keep food on the table, older adults managing rising prescription costs, and people doing everything they can to make ends meet. These are the people the safety net is supposed to serve. Yet one confusing notice, missed deadline or broken website can mean losing critical support. Under H.R. 1 (the One Big Beautiful Bill), that risk is only growing.

Technology, including responsible AI, can keep people from falling through the cracks, but only if designed around real human needs. It can reduce paperwork, help people act on time and support caseworkers.

Government can work for everyone — and technology, done right, is one of the most powerful tools we have to make that real. The moment to build it that way is now.

Amanda Renteria is the CEO of Code for America.

As a doctor in a public hospital, I treated a man with cirrhosis. His decline unnerved him, eyes ochre in the mirror. He felt he couldn’t quit drinking abruptly, so he wanted a program to help him taper. But the waitlist stretched months, and he was unhoused and too poor to own a phone. I placed the referral mechanically, knowing he’d be unreachable when a spot opened. I expect he died.

The problem with our safety net is that, like all nets, any hole compromises the entire thing. Even if health care were no longer rationed as a luxury good, our system would still fail people who lack housing, educational access, nutritious food, support for disabilities or a livable income. As a physician, I want universal public health care. But even more, I want policies that are premised on the interdependence of human rights, that don’t seal one hole only to funnel people toward others.

Lindsay Ryan is a physician at Zuckerberg San Francisco General Hospital.

More than half of Americans turning 65 today will develop a serious disability requiring assistance with their personal care needs over an extended period of time. And while many assume that Medicare will cover the costs of meeting these needs, in reality Medicare covers very little, and less than 6% of older Americans are covered by private long-term care insurance. Medicaid fills some of the gap, but only after families have largely exhausted their savings.

The result is a risk that is common, catastrophic and largely uninsured. The average 65-year-old will face financial costs exceeding $120,000 — with almost $45,000 paid for out of pocket — and their unpaid family caregivers will supply care worth more than $90,000 in terms of home care worker wages. These average costs conceal enormous variation: Fourteen percent of older adults will spend $100,000 or more entirely out of pocket.

Retirement security is more than a certain level of resources or a fixed income stream — it is about individuals and families in different circumstances managing several sources of uncertainty over many years. Addressing the financial risks associated with long-term care needs would fill a significant gap in the social safety net for American families.

Gopi Shah Goda is the director of the Retirement Security Project, the inaugural Alice M. Rivlin Chair in Economic Policy, and a senior fellow in economic studies at The Brookings Institution.

Food is a basic human need and connects people from all walks of life, yet it remains increasingly out of reach in Maryland, where I work, and across America. SNAP cuts resulting from the budget reconciliation bill (H.R. 1) passed in July 2025 are already having a devastating impact on millions of families, limiting food access and adding red tape to one of our nation’s largest anti-hunger and anti-poverty programs. Meanwhile, rising food costs have made it harder for families to afford groceries. As a result, our neighbors are forced to make impossible trade-offs between food and other needs like housing, health care and transportation. Too often, food is sacrificed.

Claudet Miranda-Zambrano is a senior anti-hunger program associate at Maryland Hunger Solutions, an initiative of the Food Research & Action Center.

Our existing safety net sensibly prioritizes families with children, given that our future well-being depends on the next generation. The most accurate research on the groups reached by the safety net indicates that essentially all low-income families receive substantial government benefits. But the evidence also shows that one group is not reached by the safety net and includes many with extremely low incomes: single individuals, mostly men. These individuals, someone’s son or daughter, father or mother, disproportionately have very low incomes and spells of homelessness. While most individuals experiencing homelessness engage in some work, their earnings tend to be low and variable. This population also disproportionately suffers from mental illness and substance abuse. While literal homelessness tends to be transitory, long-term low income and precarity lasts decades. There is no simple solution for this group, but intensive job-search assistance and health care with access to behavioral health services is a start, combined with housing for the neediest.

Bruce D. Meyer is the McCormick Foundation Professor at the University of Chicago and a nonresident senior fellow at the American Enterprise Institute.

America’s social safety net suffers from a glaring omission: It fails to recognize caregiving as labor deserving time off, payment and retirement credit. Every year, tens of millions of Americans care for children, aging parents and disabled family members without being paid. Caregivers are disproportionately women, and the financial drawbacks of this work are disproportionately experienced by Black and Hispanic caregivers.

Caregiving is essential, yet our policies penalize it. We lack universal paid family leave, properly understood as caregiving infrastructure rather than just medical leave coverage. Medicaid payments for caregivers vary by state, and Social Security treats unpaid caregiving as a zero-value activity. This systemic exclusion manufactures poverty in old age for those who sacrifice their own careers to sustain our families.

Unlike other wealthy democracies, we have built an economy that relies on unpaid, unrecognized labor. To close this gap, we must implement federal paid family leave, establish a federal floor for family caregiver compensation and introduce Social Security caregiving credits. The American care economy shouldn’t rely on the invisible, unpaid labor of family caregivers; it should support it.

Maya Rockeymoore Cummings is the founder and CEO of Global Policy Solutions LLC, a social change strategy firm, and HyperVigilant Inc., an AI-driven health technology company. She is the author of “RAGEISM: Racism, Ageism, and the Quest for Liberation Democracy.”

In communities from Alabama to Alaska, we hear the same thing: We are in the middle of an affordability and care crisis. Families can’t find affordable child care so parents can keep their jobs, children can get their best start and businesses can hire the workers they need. For families whose children have disabilities, it’s even more challenging.

The caregiving crisis isn’t just about child care: Elder and disability care are also often unaffordable. We are one of the only countries without some form of paid family and medical leave after a new baby arrives or a serious health crisis strikes. Low wages for care professionals are driving high turnover and shortages. And families are being further destabilized by Republicans’ devastating cuts to health care, SNAP and other essential programs.

Kristin Rowe-Finkbeiner is executive director and CEO of MomsRising, an on-the-ground and online grassroots movement of 3.7 million moms and people who love them.

While coverage is universal among our peer nations, our safety net has a gap in meeting this most basic need. Today, an estimated 30 million Americans are uninsured, and those with incomes below the poverty line or just above it are most likely to lack coverage. Health insurance is both the means by which people access the health care system and also a critical protection from catastrophic financial costs. Individuals without coverage struggle to afford basic health maintenance and life-sustaining medications — and are far more likely to forgo needed care due to cost compared to those with coverage. They are also vulnerable to medical debt. The federal law that requires emergency departments to treat people regardless of ability to pay is often misunderstood: While hospitals must stabilize patients, they can bill patients, and charity care is not guaranteed.

The gaping health care hole in the safety net is only growing wider. The Big Beautiful Bill that President Trump signed last year slashed more than $900 billion from Medicaid and will increase the number of uninsured Americans by 10 million over the next decade.

Emily Gee is the senior vice president for economy policy and a senior fellow for health policy at the Center for American Progress.

The safety net lifts millions out of poverty, but its most significant gap is its failure to deliver benefits to all the people eligible for them. According to Urban Institute calculations, there are 45.9 million people in poverty, and many of them cannot access services due to limited funding and Byzantine rules across seven major safety net programs. If people received those benefits, the national poverty rate would be 34% lower.

Closing this gap requires reimagining the safety net for the 21st century. The safety net must reflect the complexities of today’s labor market and the challenges that many people face, especially those with disabilities. Already, poverty is a very low bar for well-being: Over 40% of people in families with an adult working full time all year cannot meet the costs required to live with dignity. A reimagined safety net must recognize this reality while promoting stable families and rewarding hard work.

Ideally, a 21st century safety net would address the mounting affordability crisis facing American families and make sure benefits reach all eligible people. Policymakers should take advantage of the AI revolution to reduce administrative costs and increase efficiency so that the safety net can respond to the varied and layered challenges American families face while promoting responsibility, autonomy and dignity.

Greg Acs is the vice president of the Tax and Income Supports Division at the Urban Institute.