There is no money to be made selling blood anymore. It can, however, pay off to sell plasma, a component in blood that is used in a number of treatments for serious illnesses. It is legal to “donate” plasma up to two times a week, for which a bank will pay around $30 each time. Selling plasma is so common among America’s extremely poor that it can be thought of as their lifeblood.

But no one could reasonably think of a twice-weekly plasma donation as a job. It’s a survival strategy, one of many operating well outside the low-wage job market.

In Johnson City, Tennessee, we met a 21-year-old who donates plasma as often as 10 times a month—as frequently as the law allows. (The terms of our research prevent us from revealing her identity.) She is able to donate only when her husband has time to keep an eye on their two young daughters. When we met him in February, he could do that pretty frequently because he’d been out of work since the beginning of December, when McDonald’s reduced his hours to zero in response to slow foot traffic. Six months ago, walking his wife to the plasma clinic and back, kids in tow, was the most important job he had.

The first thing the 21-year-old does when she gets to the donation center is check in, and as a regular donor, she can bypass the initial, time-consuming health screening. She proceeds to a kiosk, rhythmically clicking the mouse to answer the required questions about her health. “When you get there, they have you fill out … 22 questions…They ask you about your health and, like, if you’ve had any recent tattoos or been in jail or had any piercings lately.” Her husband has too many tattoos and doesn’t remember the exact times and places he acquired all of them, details that the plasma center requires. He says he has been told he “need not come by” to donate.

After completing these initial steps, she sits in the waiting room, listening for her name to be called. She describes what happens after that: “They take your blood pressure and your temp. And then if everything is okay, you wait and get your finger pricked to test for your iron and your protein and stuff…Usually, it be during my time of the month that my iron really goes down.” Lately, the iron pills she has tried haven’t been working. This terrifies her, because “donating” is the bedrock of the family’s finances right now. The phlebotomist in charge of the finger pricking has told her that “if the iron pills don’t help, [it means] I could be, like, anemic.” Anemics are barred from donating.

Today, like other days, she’s nervous—what will happen if she is not allowed to give plasma? The family desperately needs the $30. They’re now nearly three months behind on the rent. Once she passes all the tests, she proceeds to the back room, where she’s directed to a recliner. Today she has brought along a Nicholas Sparks novel she checked out of the library. “I always bring a book with me,” she says.

A technician feels around for her vein with a plastic-gloved finger, rubs on some iodine with a Q-tip, positions an IV, and inserts a needle. For the usual donor, the procedure takes about 45 minutes, but for her it takes well over an hour, as she is just over the minimum weight of 110 pounds. “I get tired. Especially if my iron’s down, I get, like, really tired,” she says. The ritual takes roughly three hours, door to door. Even so, the payoff is relatively good: $10 an hour. As long as her iron, blood pressure, and temperature are okay, she’ll donate as often as she is legally allowed.

Later, she says the procedure makes her squeamish. “I can’t ever look at it. I never look at it when they do it. They do it right here,” she says, pointing to the obvious indentation at the crease in her arm, which looks somewhat like a drug track line. Many among the extreme poor bear these small scars from repeated plasma donations.

* * *

Before welfare died in 1996, a family of three couldn’t live solely on the $360 or so the program provided on average. Just prior to welfare reform, it took roughly $875 to meet such a family’s monthly expenses, but families could generally get only about three-fifths of that from the combination of cash welfare and food stamps.

To make matters worse, when a mother secured a job, she would lose about a dollar in welfare benefits for every dollar she earned. Often, she couldn’t afford to rely only on earnings from work in the formal economy. Work paid only a little more than welfare but cost a lot more in terms of added expenses for transportation, child care, health care, and the like. It was more expensive to go to work than stay on the welfare rolls.

Back then, neither welfare nor work could singlehandedly bring a poor family’s budget into balance, yet the ability to combine them legally was limited at best. How did these single mothers survive?

Some gleaned some sustenance through private charities, as the couple in Johnson City do now. In addition, at any given time, almost half of single mothers on welfare were secretly working. Some used a false identity to avoid detection, or hopped from job to job, since short stints wouldn’t typically get reported to the welfare office. Those without a formal job did hair, babysat, sold meals, cleaned homes, or, occasionally, resorted to fencing stolen goods or selling drugs or sex. Back before welfare reform, the strategies poor single mothers employed were hardly get-rich-quick schemes; they provided a few dollars here and there, often garnered with considerable effort. When combined with welfare, plus a lot of old-fashioned frugality, these strategies usually allowed for a bare-bones survival.

Today, a striking number of Americans live on extremely small incomes. As of early 2011, 1.5 million households (with roughly 3 million children) were surviving on cash incomes of no more than $2 per person, per day, during any given month. What’s different these days—and what affects the $2-a-day poor so profoundly—is that welfare can no longer be counted on to provide a floor of cash that families can depend on.

The variety of survival strategies used by today’s $2-a-day poor are variations on the same tactics poor families used a generation ago to get by: private charity, a variety of small-time, under-the-table schemes, and plain old thriftiness. Even those somewhat higher up the income ladder today, who have steady jobs, draw on such strategies from time to time when the money doesn’t quite stretch to the end of the month. But the degree to which people must resort to the riskiest strategies—those that can exact a sharp psychological, legal, and even physical toll—appears to be an order of magnitude greater for the virtually cashless poor than it is for poor families with some cash on hand.

Far from being passive, many among the $2-a-day poor take what few resources they have and try to “make the best out of a bad,” as the son of one cash-strapped parent put it. While the circumstances that they find themselves in may appear wholly un-American, in many ways their actions and outlooks are as American as they come: often surprisingly optimistic, creative, family-focused, scrappy, and imbued with a can-do spirit that belies their desperate circumstances. They may be officially jobless, but they are laboring intently. Their work can be grueling, and, at times, it’s work into which they’re literally pouring their blood, sweat, and tears.


This article has been adapted from Kathryn Edin and H. Luke Shaefer's book, $2.00 a Day: Living on Almost Nothing in America.