10 Chapter 10: The Modern Era of Social Welfare

Section 10.1: Social Welfare in the Late 20th and Early 21st Centuries

Neoliberalism

The 1980s saw the emergence of neoliberalism, which placed a strong emphasis on free markets, individual accountability, and limited government involvement, greatly impacting social welfare policies. This era marked a transition from universal programs to more specific and income-based benefits. Concerns about the reliance on welfare, rising expenses, and perceived inefficiencies prompted calls for reform. In the United States, this led to the 1996 Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA), which established stricter eligibility criteria, work requirements, and lifetime limits for receiving welfare aid. Similar patterns were observed in other Western countries, with governments implementing austerity measures and restructuring social programs.

Globalization

The increased speed of globalization toward the end of the 20th century resulted in substantial transformations in the workforce. These transformations were characterized by the decline of manufacturing industries, the significant expansion of the service industry, and the intensification of global competition. As a consequence of these shifts, there were significant job losses in the manufacturing sector, while unstable and low-paying jobs experienced a surge in demand. These changes not only posed new challenges for social welfare systems but also rendered conventional forms of social protection obsolete. These systems were initially designed to cater to secure and long-lasting employment, making them less effective in meeting the needs of a workforce that was becoming increasingly flexible and uncertain about their future prospects. Consequently, the necessity to adapt and provide adequate support to an ever-changing workforce became increasingly apparent.

New Social Risks

The late 20th and early 21st centuries brought significant social challenges alongside economic changes. Aging populations strained pension and healthcare systems, requiring innovative approaches for their care. Declining birth rates led to restructuring of family dynamics, necessitating support for single-parent and dual-income households. Global issues like climate change, migration, and pandemics demanded immediate attention, with collaborative efforts implementing social welfare strategies. Research and evidence-based policies have been dedicated to finding effective solutions. Inclusivity is crucial for a socially sustainable future. Understanding and addressing these challenges can pave the way for a prosperous society. Continuous innovation and collaboration can build a resilient future that tackles social challenges.

Role of Civil Society

In the context of welfare state retrenchment, the role of civil society and the third sector in providing social welfare services experienced a significant expansion. It became apparent that non-governmental organizations (NGOs), community-based organizations, and faith-based institutions were increasingly stepping in to fill the gaps left by shrinking government programs. These organizations, driven by their deep commitment to community welfare, not only engaged in service delivery but also took on the responsibility of advocating for social justice. Their efforts were especially critical in ensuring that marginalized communities received the necessary support and opportunities for a better future. Consequently, civil society and the third sector emerged as vital pillars in the pursuit of an equitable society.

Technological Advancements

The rapid advancement of technology in the 21st century has greatly impacted social welfare. The internet and digital platforms have revolutionized information acquisition, service engagement, and community involvement. Furthermore, technological innovations have paved the way for enhanced collaboration between individuals, organizations, and governments, leading to comprehensive solutions for societal issues. Through advanced algorithms and data analysis, technology has the potential to streamline and optimize social welfare programs, making them more efficient and effective. Moreover, the widespread availability of smartphones and internet connectivity has facilitated greater accessibility to social welfare services, reaching individuals in even the most remote areas. However, it is essential to acknowledge the challenges that accompany this digital era. The digital divide, which refers to the unequal access to technology and the internet, must be diligently addressed to ensure that no one is left behind. Additionally, privacy concerns surrounding personal data collection and usage must be carefully navigated, enforcing stringent regulations and cybersecurity measures. By thoughtfully addressing these complexities, technology can be harnessed to create a more inclusive and equitable social welfare landscape, where individuals from all walks of life can benefit from innovative solutions and receive the support they need to thrive.

Section 10.2: Patient Protection and Affordable Care Act and its Implications

In 2010, President Barack Obama was finally able to sign into law “a near-universal guarantee of access to affordable health insurance coverage, from birth through retirement,” (Rosenbaum, 2011, p. 130). This act was similar in scope to the Social Security Act and has completely changed the health insurance landscape in America.

The Affordable Care Act, soon known as Obamacare, included several major components to ensure that everyone had access to affordable healthcare. First, the act expanded coverage. Traditional Medicaid was expanded to include all individuals with incomes up to 138% of the federal poverty level. Second, the ACA established health insurance marketplaces where individuals and small businesses could purchase health insurance. Financial assistance was also available. Finally, the act allowed children to stay on their parents’ private insurance until age 26.

Obamacare also made some changes to the insurance market in general. First, insurers were no longer allowed to deny coverage or charge more for pre-existing medical conditions. Second, the act established a set of essential health benefits that must be covered including hospitalization, prescription drugs and mental health services including substance abuse treatment. Further, the ACA required that insurers cover preventive services at no cost to the patient. Insures were also banned from setting lifetime and annual limits for coverage of the essential health services.

Not all of the original mandates in the ACA survived U.S. Supreme Court challenges. The individual mandate, penalizing those that chose not to get coverage was eliminated. The requirement that all states expand Medicaid coverage was also struck down. In 2014, 26 states elected to include the expanded coverage but by 2024, 40 states were offering the program.

The logic behind the ACA was that if more people had access to health insurance, the population would be healthier – especially with access to preventive care. The immediate impact, however, was a spike in healthcare spending. In addition, the reimbursement payments to providers were reduced. For Republicans and others who had been opposed to the Affordable Care Act in general, this provided an argument against fully implementing the law. In fact, Republican candidates for 2017 elections used “repeal and replace” as a campaign slogan. On President Donald Trump’s first day in office in 2017, he signed an executive order to do just that. But, despite repeated efforts, the ACA has remained largely intact. Almost 70% of the adult population views the ACA favorable, compared to 33% who view it unfavorably (KFF, 2025).

Figure 10.1 ACA Medicaid Expansion Improves Access to Care, Financial Security, Health

References

KFF (2025, June 17). KFF health tracking poll: the public’s views on the ACA. https://www.kff.org/interactive/kff-health-tracking-poll-the-publics-views-on-the-aca/#?response=Favorable–Unfavorable&aRange=twoYear.

McNutt, J. G. & Hoefer, R. (2021). Social welfare policy: responding to a changing world (2nd ed.). Oxford.

Lane, S. R., Palley, E. S. & Shdaimah, C. S. (2020). Social welfare policy in a changing world. Sage.

Ponzini, R. (2024). Examining social trends: health care coverage in the United States: a contemporary analysis through an historical lens. Economia Aziendale Online, 15(1), 97-111.

Popple, P. R. & Leighniner, L. (2011). Social work, social welfare and American society (8th ed.). Allyn & Bacon.

Rosenbaum S. (2011). The Patient Protection and Affordable Care Act: implications for public health policy and practice. Public health reports (Washington, D.C. : 1974), 126(1), 130–135. https://doi.org/10.1177/003335491112600118.

Segal, E. A. (2016). Social welfare policy and social programs (4th ed.). Cengage.

Toft, J., Lightfoot, E. B., Calhoun, M., Choy-Brown, M., Merighi, J. R., Renner, L. M., Soffer-Elnekave, R., Mendel, J., & Marsalis, S. (2023). Effects of Neoliberalism on Social Work Practice in the United States: A Scoping Review. Social Work Research, 47(2), 99–110. https://doi-org.libproxy.eku.edu/10.1093/swr/svad003