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In Their Own Words
What Makes Cash Transfer Programs Work?
LDI Experts Point to Four Conditions Grounded in Global Evidence
Print:
This op-ed originally appeared in The Atlantic on February 28, 2026.
Of all the ways that governments can try to help people, cash transfers can seem like one of the most straightforward. Their popularity has been growing: Over the past decade, dozens of American cities have launched cash-transfer pilots. During the coronavirus pandemic, governments worldwide dramatically expanded their own programs’ reach. And as AI reshapes work, the idea of guaranteed income—a specific kind of recurring, no-strings-attached cash payment—is moving into the mainstream.
Yet while the provision of cash has saved many lives in dozens of low- and middle-income countries, it has seemingly produced only modest health gains in the United States. Guaranteed-income pilots also haven’t delivered the dramatic health improvements associated with cash-transfer programs elsewhere. Why does cash save lives in Tanzania but barely move the needle in Texas?
From our work studying cash-transfer programs across 37 countries, we’ve come to see a consistent logic behind why cash succeeds in some places and falls short in others. Cash transforms health when four particular conditions are met. Most U.S. cash-transfer pilots have lacked them. But one major American policy does come close: the federal food-assistance program SNAP. Its success offers a road map for what effective cash assistance can look like in this country, if we choose to build on it.
Read the full op-ed here.
Authors
Aaron Richterman, MD, MPH
Assistant Professor of Infectious Disease and of Medical Ethics and Health Policy, Perelman School of Medicine
Harsha Thirumurthy, PhD
Division Chief of Health Policy and Professor of Medical Ethics and Health Policy, Perelman School of Medicine
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