When Congress reformed welfare in 1996, states were allowed almost total discretion over how to use federal funding for the poor. Clinton proudly declared that welfare as we knew it had ended. He was more right than anyone could have guessed.

I am part of the welfare apparatus of a populous older state east of the Mississippi River. This state comprises an historic and diverse metropolis that is a showplace of economic inequality and systemic poverty, much heavy industry, and a large, almost exclusively white rural sector where poverty and sickness are hard facts of everyday life.