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A city synonymous with the destructive effects of poverty could soon teach America a lesson in how to fight it.
The city is Flint, Michigan. You may remember the horrific circumstances that made it a focus of national attention: In late 2014, the city changed its drinking water source and failed to follow safety protocols. Water started corroding the city’s lead pipes, exposing residents to toxic levels of a substance that can have particularly devastating effects on the developing brains of children.
The tragedy was entirely preventable, as my colleague Arthur Delaney documented at HuffPost and as journalist Anna Clark later detailed in an award-winning book. Right after the switch, many of Flint’s relatively poor, majority Black residents had complained about water with a foul taste and smell. The state officials in charge ignored them, until scientists provided overwhelming evidence of the contamination.
One of those scientists was Mona Hanna-Attisha, an acclaime Flint pediatrician who was caring for some of those children and is still doing so today. Although tests now show lower levels of lead in the city’s water, she worries about all of the other hazards the kids in her clinic face, and in particular the hazards that come from growing up in deep poverty.
Hunger. Poor access to health care. Toxins from old, dilapidated housing. The list goes on ― and the effects linger, poisoning Flint’s children just as surely as lead in the water did. Research over the last two decades has linked these conditions to health problems later in life, and even to premature death.
“We’ve known that growing up in poverty is bad since the days of Charles Dickens,” Hanna-Attisha told me. “But now we know the science of why it is bad. We know how it messes up the brains of children, how it is implicated in chronic disease and injuries and life expectancy.”
Hanna-Attisha says she would like to protect her patients from poverty in the same way she protects them from infectious disease, malnutrition and other health hazards. Now she has teamed up with a high-profile researcher on a proposal to do just that, by providing direct, unconditional cash payments for every expectant mother and newborn.
They hope the program could be a model for elsewhere in the U.S. ― and, eventually, the country as a whole. But first they have to prove it works in Flint. And they can’t do that until they get enough money to launch it.
A Simple Proposal: Money For Newborns
Their project traces back to last year, when Michigan State University asked faculty to submit proposals for one big idea to promote better health. Hanna-Attisha, who is an MSU professor and author of her own award-winning book on the water crisis, decided to propose a child cash allowance for Flint, modeled on payments that other economically advanced nations have long provided for families.
The concept of offering child allowances (or similarly structured “guaranteed basic income” payments) was already familiar in the U.S., with experimental programs underway in cities like Atlanta, Denver and Los Angeles. But those were smaller, narrowly targeted initiatives. Flint’s version would make payments to all expectant parents and newborns within city limits, something feasible because of the city’s relatively small size.
Hanna-Attisha didn’t win the MSU competition. But she kept working on the proposal, refining it based on feedback from community leaders and parents, and eventually reached out to H. Luke Shaefer, a University of Michigan professor she’d seen quoted in articles on poverty.
Shaefer runs the university’s Poverty Solutions project, which both studies and develops anti-poverty initiatives, and he’s the co-author of a widely cited book on low-income Americans called “$2.00 a Day.” (He’s also an associate dean at Michigan’s Gerald R. Ford School of Public Policy, where I teach a one-semester class.)
“I’m really excited about ... the opportunity to do something that makes a statement that raising kids is expensive ― and that society has a reason to come alongside parents in that work.”
- H. Luke Shaefer, director of the Poverty Solutions project at the University of Michigan
As a longtime advocate for unconditional cash grants, Shaefer had watched with delight as a temporary version of the idea became reality as part of federal COVID-19 relief efforts, contributing to a dramatic and historic decline in child poverty. Then he watched with dismay as the initiative ended when Sen. Joe Manchin (D-W.Va.) refused to support an extension, effectively killing it in the Senate.
Shaefer was eager to find a way of reviving the idea ― and now Hanna-Attisha was approaching him with one.
The two got together with Eric Finegood, an MSU developmental scientist, at the downtown Flint farmers market that shares a building with Hanna-Attisha’s clinic. Over a lunch that included a Greek salad and a vegetarian Rueben half-sandwich, they hashed out a more detailed version of the concept with calculations that Shaefer made on the back of a napkin.
That discussion became the basis of a full-blown proposal for a program that would provide every expectant mother in Flint with $1,500 during pregnancy, followed by $500 a month for the first year of a newborn’s life, for a total of $7,500 per child.
A Prescription For Fighting Poverty
They have named the initiative “Rx Kids” (Hanna-Attisha likes to call it “an anti-poverty pill”) and have been pitching to funders intensely since January, in the hopes of raising enough money to start the full program in January 2024.
The proposal has gotten some attention in the local and state press, including a feature piece that just ran at the Michigan Advance. Last month, Hanna-Attisha and Shaefer landed a massive financial commitment when the Charles Stewart Mott Foundation, which is based in Flint, pledged $15 million.
Mott’s contribution would provide about half of what Hanna-Attisha and Shaefer say the program needs to run for three years. But it’s in the form of a matching grant. To get the money, Hanna-Attisha and Shaefer have to raise at least that much from other sources, and more still if they want to reach their goal of funding the program for five years.
They say they’ve already identified some prospects, both private and public. The first time I heard about their efforts, in early March, they’d just returned from a whirlwind trip to Washington, where they met with White House officials and four Michigan lawmakers on Capitol Hill. But every prospective donor has other potentially worthy projects to fund, and there’s only so much money to go around.
When making the pitch for Rx Kids, Hanna-Attisha emphasizes the importance of reaching expectant parents and newborns ― and how, in a world of limited resources, it makes sense to focus initially on that first year of life.
“Babies need stuff ― they’re expensive,” Hanna-Attisha said. “Child care is expensive. Parental leave policies are limited. So this is when poverty spikes and, once again, this is maddening as a pediatrician, because this is when child development is the most critical. It is in this year of life that the brains double in size.”
She and Shaefer also point to the connection with health care specifically. Expectant and new parents would have a variety of ways to enroll, but the hope is that most would sign up through their primary care doctors, providing extra incentive to get prenatal and newborn care.
One other selling point is that Rx Kids would provide an opportunity to test the concept at a scale not available through the smaller, more narrow pilot programs already in operation.
“I’m really excited about not doing a lottery, and having the opportunity to do something that makes a statement that raising kids is expensive ― and that society has a reason to come alongside parents in that work,” Shaefer said.
“I’m just really grateful to be able to do something like this in Flint,” he added.
A New Idea, Some Old Debates
There’s a trade-off to making an allowance available to all families: Some of the benefits will end up going to relatively affluent households.
But in Flint, at least, that percentage is bound to be small, given that 60% of kids live in poverty. And with no income test, giving out the money becomes a lot simpler, both for whoever is giving out the money and for whoever is getting it.
That is no small thing. Research on other government assistance programs has shown consistently that people eligible for benefits frequently don’t get them when government agencies make it difficult to declare and verify eligibility.
“There’s no means test,” Shaefer said. “People don’t have to worry, ‘Am I above or below the [income] line?’”
A more fundamental criticism of the concept is one conservatives in particular have raised over the years ― namely, that unconditional cash payments to poor people will discourage them from working.
“Living in poverty has been normalized, and I really feel like a lot of families do not believe that they are worthy of living a better life.”
- Alison Littlejohn, Flint social worker and parent
The Wall Street Journal editorial page raised this possibility in 2021, warning that Democratic proposals to extend the temporary COVID-era payments would lead to “a life of diminished opportunity” for children. They cited, as evidence, projections from University of Chicago economists showing a decline in labor participation.
But even that study found a modest reduction in child poverty. It also assumed that new cash assistance would replace some existing programs, altering work incentives. Subsequent studies of the effects of the COVID-era assistance, including one that Shaefer co-authored, found no major effects on labor participation.
Rx Kids could provide more definitive evidence of what unconditional cash payments would mean in practice. The proposal sets aside a small share of funding to conduct ongoing research into the benefit’s effects, not just on metrics like income and health care utilization but also on community-wide measures like economic development and even faith in government.
If the results line up with the evidence from smaller pilot programs and the temporary pandemic assistance, they would provide some of the most compelling arguments yet for introducing similar initiatives on a broader scale, even nationally.
New Possibilities For Flint
Still, the most immediate and maybe the most important impact would be on the residents of Flint.
“I’ve been sharing the idea with patients, which is so hard because it hasn’t started yet ― I feel guilty sharing it with babies already born,” Hanna-Attisha said. “But there’s this reaction of, ‘Oh my gosh, this would help me pay for my groceries and my rent. I would buy books and we would sign them up for summer camp and then child care.’ There’s just real joy.”
Ashley Dozier, a lifelong Flint resident who works at a nonprofit service organization, agrees with all of that ― and says the assistance can be especially important when families face a crisis, as hers did when her youngest daughter was born premature at 25 weeks.
Dozier had to take an early and extended leave from work, which meant less income, while she and her husband took turns commuting to the University of Michigan’s children’s hospital, an hour away in Ann Arbor, where their baby was getting intensive care. Suddenly they were dealing with reduced income and new expenses, including gas and extra care for their three older kids.
“This is when poverty spikes ... This is maddening as a pediatrician, because this is when child development is the most critical.”
- Dr. Mona Hanna-Attisha, Flint pediatrician and Michigan State University professor
Dozier said they got by with help from family and friends. But as she conveyed to Hanna-Attisha as part of the group providing feedback, many parents can’t depend on that kind of support.
“Any extra help makes a difference,” Dozier told me. “The program is a great asset for those that have it all together. And it’s extremely helpful for those that are struggling.”
Alison Littlejohn, a Flint social worker and parent who also offered feedback on the proposal, said she thinks it could have broader, more psychological effects, especially for Black families like hers.
“Living in poverty has been normalized, and I really feel like a lot of families do not believe that they are worthy of living a better life,” Littlejohn said. “I think that this is an opportunity for a lot of families to experience what it’s like to have money to be able to be responsible, to take care of their basic needs ― that elevates their confidence, and their self-worth and their value.”