Chapter 28 — Exercises

These exercises ask you to translate the chapter's frameworks into concrete data work. Several use the Democracy Audit project for your congressional district, which has been a running thread since Chapter 1. Others use national datasets directly. Most require nothing more than a web browser; a few suggest a spreadsheet.

Cite your sources. Note the date you accessed each dataset. State the methodology limits you encountered. The exercise is partly the data and partly the discipline of producing answers a reader can check.

Exercise 1 — The total federal social-policy budget

Pull the most recent Congressional Budget Office Budget and Economic Outlook (cbo.gov; published annually in late winter, with periodic updates). Locate the "outlays by category" table.

For the most recent fiscal year:

1. What was total federal spending? What was total mandatory spending?
2. List the spending on each of: Social Security, Medicare, Medicaid (federal share only), other major income-security programs (SNAP, EITC, CTC refundable portion, SSI, unemployment insurance, child nutrition).
3. What share of total federal spending do these "social safety net" categories together account for?
4. What share of GDP do they account for?
5. What is CBO's projection for 2034? Which categories grow fastest?

Write a one-page memo summarizing what you found, in language an interested but non-specialist citizen could follow.

Exercise 2 — Your state's Medicaid expansion

Visit the Kaiser Family Foundation state health-facts site (kff.org/statedata) or Medicaid.gov. For your state of residence:

1. Did your state adopt the ACA Medicaid expansion? If so, in what year? If not, has the question been politically active in recent legislative sessions?
2. What is your state's current Medicaid enrollment? Per capita? Compare to the national average.
3. What is your state's federal medical-assistance percentage (FMAP)? How does it compare to the national average?
4. If you live in an expansion state, what was your state's uninsurance rate before expansion (use 2013 data) and most recently (2023 or 2024)? If you live in a non-expansion state, what is the estimated coverage-gap population?

Then assess: in your state's politics, who has been the public face of the Medicaid expansion debate (governors, state legislators, hospital associations, advocacy groups)? In a paragraph: what arguments have been made on each side, and how do they map to the steel-mans in the chapter?

Exercise 3 — ACA enrollment in your state

Visit the Centers for Medicare and Medicaid Services Marketplace Open Enrollment Period reports (cms.gov; "Marketplace Open Enrollment" reports are published annually after each enrollment period).

For your state:

1. How many people enrolled in ACA Marketplace coverage during the most recent open enrollment?
2. What share received premium subsidies? What share received cost-sharing reductions?
3. How has enrollment changed since 2014? Plot the trajectory (use a simple line chart; spreadsheet is fine).
4. Does your state run its own exchange or use Healthcare.gov?
5. Calculate average premium and average premium net of subsidy. How do these compare nationally?

A short note: the 2021 ARPA / 2022 IRA enhanced subsidies dramatically affected enrollment. Note the discontinuity in your time-series chart and explain it.

Exercise 4 — Steel-man and counter-steel-man on Medicare for All

This is a writing exercise, not a data exercise. Produce two essays of roughly 600 words each.

Part A: Steel-man Medicare for All. Drawing on the strongest available evidence, write the case for replacing the American multi-payer system with a single-payer national health insurance program. Use cross-national data, the administrative-cost literature, and the coverage-gap argument. Cite Theda Skocpol's analytic framing if useful. Avoid straw-manning the opposition; you may concede counterarguments where appropriate, but the essay should be the strongest version of the affirmative case.

Part B: Steel-man multipayer reform as the alternative. Drawing on the strongest available evidence, write the case for the German / Swiss / Dutch approach: regulated multi-payer systems with universal coverage, achieved through the existing ACA architecture extended (public option, automated enrollment, drug-pricing reform) rather than through single-payer replacement. Cite Avik Roy's FREOPP work, Jacob Hacker's earlier proposals, and the comparative-systems evidence. Again, no straw-manning.

Then write a one-paragraph reflection: which argument, on the strongest version of each, do you find more persuasive? Why? Which empirical or normative premise is the load-bearing one for your judgment?

Exercise 5 — Democracy Audit: social policy in your district

Building on prior chapters' Democracy Audit work, produce a profile of safety-net program reach in your congressional district.

Sources you will need: Census Bureau ACS 5-year estimates (data.census.gov), Tax Policy Center EITC/CTC data by congressional district, your state Medicaid agency's county-level enrollment data, HUD's Picture of Subsidized Households, USDA's SNAP state directory.

For your district:

1. Number of Medicare beneficiaries (use ACS Table B27006 or similar; cross-check with CMS).
2. Number of Medicaid recipients (use state agency county-level data, aggregating to district).
3. Number of SNAP recipients.
4. Approximate number of households claiming EITC (Tax Policy Center publishes this by congressional district).
5. Estimated number of households receiving Section 8 vouchers.
6. Veteran population (ACS Table S2101).

Then look up your representative's voting record on the most recent major safety-net legislation (use govtrack.us or congress.gov). Identify three or more relevant votes — for example, votes on the IRA's drug-pricing provisions, ACA-related amendments, SNAP appropriations, the 2021 ARPA, the 2017 mandate-zeroing tax law.

Write a 600-word memo: how does the safety-net footprint of your district compare with the national average? How does your representative's voting record align with that footprint? Where are there potential mismatches between district interest and representative position?

Exercise 6 — The 2021 Child Tax Credit experiment

Read Center on Budget and Policy Priorities and AEI / R Street analyses of the 2021 Child Tax Credit expansion (both perspectives — left-of-center and right-of-center). Find the original IRS data on payments and Census's monthly Household Pulse Survey data on hardship measures.

1. Plot child poverty (Supplemental Poverty Measure) for 2019, 2020, 2021, 2022, 2023.
2. Plot Census's measures of food insufficiency in households with children for the same period.
3. From the literature: what was the estimated effect of the 2021 expansion on labor-supply? (Find at least two estimates, ideally one from a center-left and one from a center-right researcher; note the methodology and identification strategy.)
4. What did Senator Manchin object to in the proposed permanent extension? What did Senator Romney's Family Security Act propose as an alternative? How do they differ?

Write a 700-word policy memo to a senator who is genuinely undecided about supporting permanent CTC expansion. Lay out the strongest evidence on each side. Recommend a position with reasons. Be honest about the tradeoffs.

Exercise 7 — Comparative healthcare outcomes

Visit the OECD Health Statistics database (oecd.org/health) or the Commonwealth Fund's Mirror Mirror report.

Pull data for the United States and at least five comparable democracies (suggested: Canada, United Kingdom, Germany, France, Switzerland, Australia, Japan).

For each country:

1. Total health spending as a share of GDP.
2. Per-capita health spending (PPP-adjusted).
3. Life expectancy at birth.
4. Infant mortality per 1,000 live births.
5. Maternal mortality per 100,000 live births.
6. Out-of-pocket spending as a share of total health spending.

Then:

1. Sketch the system-design type for each (single-payer / regulated multi-payer / hybrid).
2. Where does the United States rank on each metric?
3. Identify two country-specific factors that may confound a pure system-design interpretation (e.g., Japan's older population structure, U.S. firearm-mortality contribution to life expectancy, Switzerland's high incomes).

Write a 500-word memo: what does this comparison tell us about the relationship between system design and outcomes? Where does it support universal-system advocates' claims? Where does it support market-mechanism advocates' claims?

Exercise 8 — TANF then and now

Pull the Center on Budget and Policy Priorities' annual TANF and Related Programs tracker (cbpp.org). Also pull the HHS Office of Family Assistance TANF financial and caseload data.

1. What was the AFDC caseload in 1996, the year before the 1996 reform took effect? What is the TANF caseload today?
2. What is the "TANF-to-poverty ratio" — share of poor families with children receiving TANF cash assistance — in 1996 and in the most recent year? In your state?
3. The TANF block grant has been frozen at $16.5 billion since 1996. Adjust for inflation: what would the 1996 funding level be in current dollars?
4. In your state, what share of TANF block-grant funding currently goes to direct cash assistance? What share goes to other allowable uses?

Reflect: what changed about American cash welfare between 1996 and now? Is the change primarily a result of the law itself, of state administrative choices, of changes in the labor market, or of demographic shifts? Make the strongest case for each interpretation in turn.

Exercise 9 — The trust-fund arithmetic

Visit the Social Security Administration Office of the Chief Actuary (ssa.gov/oact). Locate the most recent Trustees' Report and the actuarial-balance estimates for proposed reforms.

For three of the major reform options discussed in the chapter — eliminating the payroll-tax cap, raising the full-retirement age to 70, and progressive price indexing — report:

1. The estimated share of the long-run actuarial deficit each option would close.
2. The projected effect on benefits for a low earner, a median earner, and a high earner.
3. The political coalition that has historically supported and opposed each option.

Then propose your own reform package combining at least two options to close the projected deficit. Show the math. Explain the political coalition you would need to assemble. Be honest about who pays what under your plan.

A note on this exercise: the reform-arithmetic is, by professional consensus, well-understood. The political deadlock is not an empirical disagreement; it is a values disagreement layered on a coordination problem. Your goal is not to find the "right" answer but to make explicit the tradeoffs that any actual reform must confront.

Exercise 10 — Bonus: ride along with the data

If you can spend two hours: visit your county's social-services office (or the equivalent) during posted public hours. Observe (without intruding) the public-facing waiting area. Read the posted notices. Pick up the application forms for SNAP, Medicaid, and any state cash assistance. Note: how many forms are required? How long are they? In how many languages? What documents must an applicant produce?

Optional: if you know someone who has applied for any of these programs, ask if you can interview them about the experience (with their consent and on record only with permission). What worked? What didn't? How long did it take? What did the experience reveal about the gap between policy as enacted and policy as administered?

This exercise will not appear on any quiz. It will give you an embodied understanding of the safety net that no statistic can replicate. Many of the most enduring policy insights come from this kind of close-in observation; statistical and field knowledge complement rather than substitute for each other.