Verifying a workers’ income for government health insurance, and Equifax’s capture of that function, is just one illustrative component of the Rube Goldberg machine that comprises America’s rigorously means-tested safety net and its vulnerability to corporate capture. Complex eligibility rules and administrative hurdles to determine who deserves coverage and who does not are fractured across government agencies and jurisdictions. Many research studies, magazine spreads, and books have documented how this complexity keeps millions of eligible people from accessing billions of dollars in benefits they are entitled to – the unemployed are locked out of their unemployment insurance, the uninsured are never enrolled in their health coverage, and the hungry are denied food assistance. Vice President Harris’ announcement of “a student loan debt forgiveness program for Pell Grant recipients who start a business that operates for three years in disadvantaged communities” is perhaps the best recent caricature of how increasingly complex eligibility rules have failed to deliver for millions of Americans. And this labyrinth of eligibility rules doesn’t just fail the intended beneficiaries – the administrative complexity they create presents an enormous opportunity for profit by government contractors. After the COVID-19 Public Health Emergency was ended by Congress in 2023, I led a government team at the United States Digital Service to help fix state Medicaid systems that had fallen into crisis. As we rushed to put out fires in Red and Blue states alike we encountered the same problem – entrenched government contractors like Deloitte had charged millions to build error–prone systems that state governments had no capacity to fix. Billing by the hour, growing the complexity and incomprehensibility of these systems proved profitable. Changes that my team could make in minutes were quoted as requiring hundreds of billable hours. When we discovered that nearly 500,000 children had lost their health coverage improperly because of software errors, many system contractors were painfully slow to reinstate coverage for those children and fix the errors.

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Again, new work requirements for Medicaid highlight the profits to be made from adding complexity to the safety net. Since Georgia implemented work requirements in 2020, they have spent twice as much on Deloitte consultants and administrative costs as on healthcare for people. As the other 55 states and territories are now forced to join Georgia and implement new work requirements, millions will lose their healthcare and Deloitte will cash in.

MS Ferguson 6, c. 1500–1600, University of Glasgow Library, Special Collections