Welfare reform and health insurance: consequences for parents

OBJECTIVES

We assessed the relation between the work promotion, welfare reduction, and marriage goals of welfare reform and the stability of health insurance of parents in transition from welfare to work.

METHODS

We analyzed a panel survey (1999-2002) of a stratified random sample of Illinois families receiving welfare in 1998 (n=1363).

RESULTS

Medicaid remains the foremost source of health insurance despite a significant decline in the proportion of parents with Medicaid. Regardless of work/welfare status in year 1, transitioning to work only or no work/no welfare increased the likelihood of having unstable health insurance in years 2 and 3 compared with those who remained on welfare only.

CONCLUSIONS

Parents who meet the welfare reform goals of work promotion and reduction of welfare dependence experience significant loss and instability of health insurance.

The largely untold story of welfare reform and the human services

Welfare reform has placed the lives of clients, the jobs of social workers, and the mission of agencies in jeopardy. Based on interviews with senior staff at 107 nonprofit human services agencies, this article documents the largely untold story of how nonprofit agencies' workers responded to the impact of welfare reform on their clients, their jobs, and the delivery of services. Workers reported less time for social services because of welfare-related regulations, penalties, work mandates, crises, and paper work. They also reported more service dilemmas including less control of the job, more ethical conflicts, less efficacy, and increased burn-out. Even so, workers felt that they were making a difference, and agencies indicated increased advocacy. Relying heavily on the voice of social workers, the article illuminates the experiences and feelings of agency staff as they try to do their best for clients in difficult times.

Welfare reforms and the cognitive development of young children

PURPOSE

To investigate whether the cognitive development of young children in poverty is affected by activities of their primary caregiver and by household income source, which are two components of family poverty experience that have been affected by recent welfare reforms.

METHODS

Bivariate and multivariate analyses were used to examine the relationships that caregiver activity, household income source, and family characteristics (family income adequacy, caregiver depressive symptoms, caregiver education) have with the cognitive development of 59 impoverished children less than three years old.

RESULTS

Of the three poverty experience variables included in the multivariate analysis, only employment as the exclusive source of household income had an independent relationship (positive) with children's cognitive development. Two of the family characteristics, income adequacy and caregiver education, also were associated with the children's cognitive score, and they were both better relative predictors than the employment-only income source variable. Income adequacy was positively associated and caregiver education was negatively associated with children's cognitive development.

DISCUSSION

Although recent welfare reforms, in combination with economic growth and declining unemployment, have changed the poverty experience of young families by increasing the proportion that secure at least part of their income from employment, our study provides preliminary evidence that these reforms have made little difference for most young impoverished children. Instead, our findings suggest that the cognitive development of young children is influenced as much by the actual amount of household income as by their parents' activity and source of income.

The unintended impact of welfare reform on the medicaid enrollment of eligible immigrants

BACKGROUND

During welfare reform, Congress passed legislation barring legal immigrants who entered the United States after August 1996 from Medicaid for five years after immigration. This legislation intended to bar only new immigrants (post-1996 immigrants) from Medicaid. However it may have also deterred the enrollment of legal immigrants who immigrated before 1996 (pre-1996 immigrants) and who should have remained Medicaid eligible.

OBJECTIVES

To compare the Medicaid enrollment of U.S.-born citizens to pre-1996 immigrants, before and after welfare reform, and to determine if variation in state Medicaid policies toward post-1996 immigrants modified the effects of welfare reform on pre-1996 immigrants.

DATA SOURCE/STUDY DESIGN

Secondary database analysis of cross-sectional data from 1994-2001 of the U.S. Census Bureau, Annual Demographic Survey of March Supplement of the Current Population Survey.

SUBJECTS

Low-income, U.S.-born adults (N=116,307) and low-income pre-1996 immigrants (N=24,367) before and after welfare reform.

MEASURES

Self-reported Medicaid enrollment.

RESULTS

Before welfare reform, pre-1996 immigrants were less likely to enroll in Medicaid than the U.S.-born (OR=0.55; 95 percent CI, 0.51-0.59). After welfare reform, pre-1996 immigrants were even less likely to enroll in Medicaid. The proportion of immigrants in Medicaid dropped 3 percentage points after 1996; for the U.S.-born it dropped 1.6 percentage points (p=0.012). Except for California, state variation in Medicaid policy toward post-1996 immigrants did modify the effect of welfare reform on pre-1996 immigrants.

CONCLUSIONS

Federal laws limiting the Medicaid eligibility of specific subgroups of immigrants appear to have had unintended consequences on Medicaid enrollment in the larger, still eligible immigrant community. Inclusive state policies may overcome this effect.

Putting policy into practice? Poverty and people with serious mental illness

This paper addresses the effects of chronic poverty on people with serious mental illness. More specifically, we are concerned with the extent to which welfare restructuring, by deepening the poverty facing people with serious mental illness, undermines the expressed intent of mental health policy to improve the quality of life (QOL) of this population. The province of Ontario in Canada forms the setting for the study. The paper first examines recent trends in mental health care and social assistance policy in Ontario. While income support is consistently recognized as a core element of mental health care, welfare restructuring has led to a significant decline in the real value of income supports received by people with serious mental illness. The paper then examines the implications of this trend for the QOL of residential care facility tenants in Hamilton, Ontario. Here, the case study is explicitly connected to QOL scholarship. In addition, the study is grounded in an analysis of the broader transformation of the welfare state in Ontario. Interview data suggest that tenants experience chronic poverty that has a deleterious impact on multiple life domains including basic needs, family, social relations, leisure and self-esteem. Implications for research and policy are discussed.

Poverty and macroeconomic performance across space, race, and family structure

We examined the effects of macroeconomic performance and social policy on the extent and depth of poverty in America using state-level panel data from the 1981–2000 waves of the Current Population Survey. We found that a strong macroeconomy at both the state and national levels reduced both the number of families who were living in poverty and the severity of poverty. The magnitude and source of these antipoverty effects, however, were not uniform across family structures and racial groups or necessarily over time. While gains in the eradication of poverty, in general, were tempered by rising wage inequality, simulations indicated that female-headed families and families that were headed by black persons experienced substantial reductions in poverty in the 1990s largely because of the growth in median wages. An auxiliary time-series analysis suggests that the expansions in the federal Earned Income Tax Credit of the 1990s accounted for upward of 50% of the reduction in after-tax income deprivation.

Restrictions on undocumented immigrants' access to health services: the public health implications of welfare reform

The Personal Responsibility and Work Opportunity Reconciliation Act of 1996 greatly restricts the provision of many federal, state, and local public services to undocumented immigrants. These restrictions have prompted intense debates about the provision of free and discounted primary and preventive health care-services and have placed significant burdens on institutions that serve large undocumented immigrant populations. Intended to serve as a tool for reducing illegal immigration and protecting public resources, federal restrictions on undocumented immigrants' access to publicly financed health services unduly burden health care providers and threaten the public's health. These deleterious effects warrant the public health community's support of strategies designed to sustain provision of health services irrespective of immigration status.

Welfare reform and health insurance coverage of low-income families

We study whether welfare reform adversely affected the health insurance coverage of low-educated single mothers and their children. Specifically, we investigate whether changes in the welfare caseload during the 1990s were associated with changes in Medicaid participation, private insurance coverage, and the number of uninsured among single mothers and their children. Estimates suggest that between 1996 and 1999, the 42% decrease in the welfare caseload was associated with the following changes in insurance coverage among low-educated, single mothers: a 7-9% decrease in Medicaid coverage; an increase in employer-sponsored, private insurance coverage of 6%; and a 2-9% increase in the proportion uninsured. Among children of low-educated, single mothers, effects were somewhat smaller. Since welfare policy was responsible for only part (e.g. one-third) of the decline in the caseload, welfare reform per se had significantly smaller effects on the health insurance status of low-income families. However, we found limited evidence that changes in the caseload due to state and federal welfare policy had fewer adverse consequences on insurance status than changes in the caseload due to other factors. This implies even smaller effects of welfare reform.

Welfare reform, labor supply, and health insurance in the immigrant population

Although the 1996 welfare reform legislation limited the eligibility of immigrant households to receive assistance, many states chose to protect their immigrant populations by offering state-funded aid to these groups. I exploit these changes in eligibility rules to examine the link between the welfare cutbacks and health insurance coverage in the immigrant population. The data reveal that the cutbacks in the Medicaid program did not reduce health insurance coverage rates among targeted immigrants. The immigrants responded by increasing their labor supply, thereby raising the probability of being covered by employer-sponsored health insurance.

Welfare to what? A policy agenda

The Ohio Works First Program went into effect on October 1, 1997. In October 2000 the first round of individuals will be terminated from receiving cash assistance due to passage of the Personal Responsibility and Work Opportunity Act of 1996. The purpose of this study was to identify barriers/hindrances to self-sufficiency among a selected sample of welfare consumers. Describing a portion of those who are in a self-sufficiency program in Northeast Ohio, the study indicates specific obstacles to self-sufficiency such as unemployment and underemployment, transportation, housing, child care, self-efficacy, and county sanctions. Recommendations for policy makers along with a policy agenda and recommendations for service agencies are included.

[Invalidity in the general health scheme]

THE CONTEXT OF ATTRIBUTION: The invalidity insurance is aimed at providing financial assistance to working people aged under 60 years of age and who have lost more than 2/3 of their capacity to work or earn a living, following a non-occupational disease or accident or due to "premature ageing of the organism". THREE CATEGORIES OF INVALIDITY: Depending on the extent of the reduction in earning capacity, distinction is made between invalid persons capable of earning a living, those totally incapable of working and persons incapable of working but who also are obliged to rely on help of a third person to perform ordinary daily functions. THE ATTRIBUTION CRITERIA: The evaluation is made by the counselling physician of the social security system, who must take into account not only the medical but also professional and social criteria. The invalidity can be revised. Since the pension is attributed temporarily, it can be suspended or withdrawn. ASSISTANCE IN THE CASE OF REFUSAL: There are 3 routes of assistance, depending on whether the refusal is administrative, medical due to a non-stabilised affection, or medical due to a stabilised affection with incapacity inferior to 2/3.

Charitable Choice regulations applicable to states receiving Substance Abuse Prevention and Treatment Block Grants, Projects for Assistance in Transition from Homelessness formula grants, and to public and private providers receiving discretionary grant funding from SAMHSA for the provision of substance abuse services providing for equal treatment of SAMHSA program participants. Final rule

On December 17, 2002, the Department of Health and Human Services (HHS) published a Notice of Proposed Rulemaking (NPRM) to implement the Charitable Choice statutory provisions of the Public Health Service Act, applicable to the Substance Abuse Prevention and Treatment (SAPT) Block Grant program, the Projects for Assistance in Transition from Homelessness (PATH) formula grant program, insofar as recipients provide substance abuse services, and to SAMHSA discretionary grants for substance abuse treatment or prevention services, which are all administered by the Substance Abuse and Mental Health Services Administration (SAMHSA) of the U.S. Department of Health and Human Services. The Secretary requested comments on the NPRM and gave 60 days for individuals to submit their written comments to the Department. The Secretary has considered the comments received during the open comment period and is issuing the final regulation in light of those comments.

Motivated but fearful: welfare reform, disability, and race

The Personal Responsibility and Work Opportunity Reconciliation Act (1996) instituted reforms in welfare that focused on mandatory work requirements. It imposes strict requirements and lifetime limits that force non-exempt individuals to work or risk sanctions. The law particularly impacts persons with disabilities because of the substantial numbers who believe they are unable to work. This article uses findings from a research study to discuss barriers faced by individuals with physical disabilities who are forced to find work under welfare reform. It highlights the experiences of African Americans who have the added burden of health disparities because of discriminatory and differential practices in diagnoses, treatment, access, and utilization. It also presents practice implications.

Predicting weekly earning for consumers with severe disabilities: implications for welfare reform and vocational rehabilitation

This 1999 research analyzed selected descriptive variables for consumers with significant disabilities, who were successfully employed. The goal was to investigate employment outcomes for consumers whose cases were closed as successfully employed. Human capital theory provided the theoretical underpinnings for evaluating the findings. This study empirically assessed factors which contributed to increased weekly earnings for consumers of state vocational rehabilitation services with severe disabilities. The variables included in this study were weekly earnings at closure, correlated with year last employed, highest grade completed, and birth year. The study found that 17.2% of variability in weekly earnings of the significantly disabled consumers can be predicted by these variables. Education, age, and work experience were found to be predictors of potential earning power. These findings can be used to provide the foundation for the development of reliable program evaluation as well as clinical interventions. This study links outcomes to the services provided. It further provides the data necessary to support policy development in the areas of rehabilitation and welfare reform.

Interorganizational relationships among nonprofits in the aftermath of welfare reform

Although it is widely acknowledged that nonprofit agencies are critical actors in the nation's social service arena, few studies to date have investigated how the 1996 welfare reform legislation affected them. This article reports on one component of a research project in southeast Michigan that explored how the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 transformed the interorganizational environment of private nonprofit social services providers. The study found that smaller agencies and those that focus on clients' emergency needs appeared to be particularly vulnerable in today's climate. Private nonprofit providers, however, are critical to the survival of low-income individuals and families, particularly TANF recipients, and to the ultimate success of welfare reform.

Welfare leavers' use of Medicaid transitional medical assistance in California, 1993-1997

Using administrative and survey data, we estimate participation rates in Transitional Medical Assistance (TMA) for the period 1993-97 by California welfare leavers during their first six months post-welfare. We find that although many welfare leavers were eligible for TMA (35% to 47% of exiters), only 26% of eligible people were enrolled in the TMA program. Another 14% were covered by non-TMA Medicaid for the entire six months. Most TMA-eligible exiters had Medicaid coverage (all of it non-TMA) for less than six months (49%) or no Medicaid coverage at all (11%). Supplementary analyses using data from the National Survey of America's Families indicate that if fully implemented, TMA could have substantially reduced uninsurance among welfare leavers.

Were NZ's structural changes to the welfare state in the early 1990s associated with a measurable increase in oral health inequalities among children?

OBJECTIVE

To test the hypothesis that the 1990-91 social and economic policy changes in New Zealand were associated with a subsequent increase in socioeconomic and ethnic inequalities in the dental caries experience of five-year-old children.

METHOD

Dental caries data from the School Dental Service treating the greater Wellington area were analysed for the period 1995-2000. Multivariate models were developed for deciduous caries prevalence (logistic regression) and severity (negative binomial regression).

RESULTS

In the years 1995, 1996, 1997, 1998, 1999 and 2000, complete data were available for 2,627, 3,335, 4,404, 4,155, 3,154 and 2,804 children, respectively. Ethnic and socio-economic differences in caries prevalence and severity were substantial and persistent during the observation period. Where caries severity was concerned, there was a significant interaction between time and Maori ethnicity, indicating that (on average) the oral health of Maori children deteriorated in comparison to their European counterparts.

CONCLUSIONS

The early-1990s social and economic policy changes were associated with an apparent widening of ethnic inequalities in caries severity among five-year-old children.

IMPLICATIONS

Economic rationalism appears to have oral health disadvantages for non-European children. Before implementation of proposed major social and economic policy changes, policymakers should consider their health implications.

Employment barriers among welfare recipients and applicants with chronically ill children

OBJECTIVES

This study evaluated the association of chronic child illness with parental employment among individuals who have had contact with the welfare system.

METHODS

Parents of children with chronic illnesses were interviewed.

RESULTS

Current and former welfare recipients and welfare applicants were more likely than those with no contact with the welfare system to report that their children's illnesses adversely affected their employment. Logistic regression analyses showed that current and former receipt of welfare, pending welfare application, and high rates of child health care use were predictors of unemployment.

CONCLUSIONS

Welfare recipients and applicants with chronically ill children face substantial barriers to employment, including high child health care use rates and missed work. The welfare reform reauthorization scheduled to occur later in 2002 should address the implications of chronic child illness for parental employment.

What social workers need to know about the earned income tax credit

Over the past decade, the federal earned income tax credit (EITC) has become the largest antipoverty program in the United States. For the 2002 tax year, working families with children can receive as much as $4,140 in EITC benefits. Although families may arrange to receive benefits throughout the year (through their paychecks), most receive a lump sum after filing federal income taxes. Research suggests that many families use the credit to purchase big-ticket items, to move, to pay for educational expenses, or to set aside savings. Thus, the credit may promote long-term household development as well as help families with basic expenses. Research also suggests that EITC encourages work among single-parent families, an outcome that is consistent with one goal of welfare reform. Social workers can be involved in outreach efforts that help low-income workers claim EITC benefits and inform them about advance-payment options. Social workers can also support efforts to increase EITC benefits for larger families and link tax refunds to saving programs.