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That would create a poverty premium for those who wanted to use cash to budget, as well as for vulnerable groups such as people with learning difficulties and the elderly.

The Affordable Care Act used Medicaid to cover the poorest uninsured Americans, those with incomes up to 138% of the federal poverty level, or about $21,597 this year.

Other challenges include poverty levels that remained "unacceptably high".

"So it remains shocking, the wealth of these churches around us and the poverty of the people sleeping on their doorsteps."

Children detained at the border are often fleeing persecution, violence or poverty in their home countries, and are trying to reunite with family who had come earlier.