rates of physical and psychological ailment; limited access to credit and wealth accumulation; higher prices for goods and services; and constrained access to job opportunities. As of 2013, 44% of America's poor are considered to be in "deep poverty", with an income 50% or more below the government's official poverty line. According to the US Department of Housing and Urban Development's Annual Homeless Assessment Report, there were around 554,000 homeless people in the United States on a given night, or 0.17% of the population. Almost two thirds stayed in an emergency shelter or transitional housing program and the other third were living on the street, in an abandoned building, or another place not meant for human habitation. About 1.56 million people, or about 0.5% of the U.S. population, used an emergency shelter or a transitional housing program between October 1, 2008, and September 30, 2009. Around 44% of homeless people are employed. The United States has one of the least extensive social safety nets in the developed world, reducing both relative poverty and absolute poverty by considerably less than the mean for wealthy nations. Some experts posit that those in poverty live in conditions rivaling the developing world. A May 2018 report by the U.N. Special Rapporteur on extreme poverty and human rights found that over five million people in the United States live "in 'Third World' conditions". Over the last three decades the poor in America have been incarcerated at a much higher rate than their counterparts in other developed nations, with penal confinement being "commonplace for poor men of working age". Some scholars contend that the shift to neoliberal social and economic policies starting in the late 1970s has expanded the penal state, retrenched the social welfare state, deregulated the economy and criminalized poverty, ultimately "transforming what it means to be poor in America". Health care Coverage The American system is a mix of public and private insurance. The government provides insurance coverage for approximately 53 million elderly via Medicare, 62 million lower-income persons via Medicaid, and 15 million military veterans via the Veteran's Administration. About 178 million employed by companies receive subsidized health insurance through their employer, while 52 million other persons directly purchase insurance either via the subsidized marketplace exchanges developed as part of the Affordable Care Act or directly from insurers. The private sector delivers healthcare services, with the exception of the Veteran's Administration, where