Second, plausible causes are those that are proximate and have been empirically linked. These are the controlling variables that should be actionable in the short run. For example, studies have linked poverty with resistance to work. If the causation is valid, one policy solution would be to use work fare incentive programs with tight monitoring standards and controls; the presumed incentives would be both monetary and non monetary (self-esteem). Other studies have found that health coverage for the elderly and access to Medicaid assistance was often provided at the expense of another class of poor people: families with children. A policy solution might be to expand Medicaid coverage to women with children. The results could be improvements in health care equity but at the price of higher program costs (Johnson 1997,20) . In fact, states now have the option to provide in kind assistance through the flexible Medicaid block grant structure to poor women with children (Fisher 2007, 600). While equity has improved, Medicaid costs and expenditures have increased as predicted, but not simply because of this limited program expansion.