A reexamination of the impact of welfare reform on health insurance among less-skilled women

John Ham, Xianghong Li, Lara Shore-Sheppard

    Research output: Chapter in Book/Report/Conference proceedingChapter

    Abstract

    Introduction. The enactment of the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) in 1996 represented not only an “end to welfare as we know it” but the completion of a process begun in the late 1980s: the separation of Medicaid from cash assistance. Under the Aid to Families with Dependent Children (AFDC) program, receipt of Medicaid was automatic for welfare recipients, and to a large extent, leaving AFDC meant losing not only cash assistance but also Medicaid coverage. Recognizing the work disincentive inherent in this arrangement, the authors of PRWORA instructed states to set income standards for Medicaid that were related to AFDC standards in effect at the time of PRWORA's passage rather than to eligibility for the states' new Temporary Assistance for Needy Families (TANF) programs. Consequently, former welfare recipients would be permitted to keep their public health insurance even if they were not eligible for cash assistance. Despite this precaution, it is possible that welfare reform led to a loss of Medicaid coverage through a variety of channels. Indeed, case studies of 13 states done by researchers at the Urban Institute (Holahan, Wiener, and Wallin 1998) showed that declines in welfare caseloads were accompanied by declines in Medicaid enrollment. Women leaving welfare may have been unaware that they could keep their Medicaid coverage; potential applicants for welfare may have been deterred by the stricter welfare policies, missing Medicaid eligibility in the process; and in some states, the processes of applying for welfare and applying for Medicaid were sufficiently de-linked that a welfare applicant would need to go to a different office and provide different documentation in order to qualify for Medicaid.

    Original languageEnglish (US)
    Title of host publicationWelfare Reform and its Long-Term Consequences for America's Poor
    PublisherCambridge University Press
    Pages217-254
    Number of pages38
    ISBN (Electronic)9780511605383
    ISBN (Print)9780521764254
    DOIs
    StatePublished - Jan 1 2009

    Fingerprint

    Medicaid
    Health insurance
    Welfare reform
    Cash
    Reconciliation
    Personal responsibility
    Public health
    Precaution
    Documentation
    Enrollment
    Enactment
    Temporary Assistance for Needy Families
    Welfare policy
    Income

    ASJC Scopus subject areas

    • Economics, Econometrics and Finance(all)

    Cite this

    Ham, J., Li, X., & Shore-Sheppard, L. (2009). A reexamination of the impact of welfare reform on health insurance among less-skilled women. In Welfare Reform and its Long-Term Consequences for America's Poor (pp. 217-254). Cambridge University Press. https://doi.org/10.1017/CBO9780511605383.008

    A reexamination of the impact of welfare reform on health insurance among less-skilled women. / Ham, John; Li, Xianghong; Shore-Sheppard, Lara.

    Welfare Reform and its Long-Term Consequences for America's Poor. Cambridge University Press, 2009. p. 217-254.

    Research output: Chapter in Book/Report/Conference proceedingChapter

    Ham, J, Li, X & Shore-Sheppard, L 2009, A reexamination of the impact of welfare reform on health insurance among less-skilled women. in Welfare Reform and its Long-Term Consequences for America's Poor. Cambridge University Press, pp. 217-254. https://doi.org/10.1017/CBO9780511605383.008
    Ham J, Li X, Shore-Sheppard L. A reexamination of the impact of welfare reform on health insurance among less-skilled women. In Welfare Reform and its Long-Term Consequences for America's Poor. Cambridge University Press. 2009. p. 217-254 https://doi.org/10.1017/CBO9780511605383.008
    Ham, John ; Li, Xianghong ; Shore-Sheppard, Lara. / A reexamination of the impact of welfare reform on health insurance among less-skilled women. Welfare Reform and its Long-Term Consequences for America's Poor. Cambridge University Press, 2009. pp. 217-254
    @inbook{5046f3d8c4164afd9fa6d266d302f3ec,
    title = "A reexamination of the impact of welfare reform on health insurance among less-skilled women",
    abstract = "Introduction. The enactment of the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) in 1996 represented not only an “end to welfare as we know it” but the completion of a process begun in the late 1980s: the separation of Medicaid from cash assistance. Under the Aid to Families with Dependent Children (AFDC) program, receipt of Medicaid was automatic for welfare recipients, and to a large extent, leaving AFDC meant losing not only cash assistance but also Medicaid coverage. Recognizing the work disincentive inherent in this arrangement, the authors of PRWORA instructed states to set income standards for Medicaid that were related to AFDC standards in effect at the time of PRWORA's passage rather than to eligibility for the states' new Temporary Assistance for Needy Families (TANF) programs. Consequently, former welfare recipients would be permitted to keep their public health insurance even if they were not eligible for cash assistance. Despite this precaution, it is possible that welfare reform led to a loss of Medicaid coverage through a variety of channels. Indeed, case studies of 13 states done by researchers at the Urban Institute (Holahan, Wiener, and Wallin 1998) showed that declines in welfare caseloads were accompanied by declines in Medicaid enrollment. Women leaving welfare may have been unaware that they could keep their Medicaid coverage; potential applicants for welfare may have been deterred by the stricter welfare policies, missing Medicaid eligibility in the process; and in some states, the processes of applying for welfare and applying for Medicaid were sufficiently de-linked that a welfare applicant would need to go to a different office and provide different documentation in order to qualify for Medicaid.",
    author = "John Ham and Xianghong Li and Lara Shore-Sheppard",
    year = "2009",
    month = "1",
    day = "1",
    doi = "10.1017/CBO9780511605383.008",
    language = "English (US)",
    isbn = "9780521764254",
    pages = "217--254",
    booktitle = "Welfare Reform and its Long-Term Consequences for America's Poor",
    publisher = "Cambridge University Press",

    }

    TY - CHAP

    T1 - A reexamination of the impact of welfare reform on health insurance among less-skilled women

    AU - Ham, John

    AU - Li, Xianghong

    AU - Shore-Sheppard, Lara

    PY - 2009/1/1

    Y1 - 2009/1/1

    N2 - Introduction. The enactment of the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) in 1996 represented not only an “end to welfare as we know it” but the completion of a process begun in the late 1980s: the separation of Medicaid from cash assistance. Under the Aid to Families with Dependent Children (AFDC) program, receipt of Medicaid was automatic for welfare recipients, and to a large extent, leaving AFDC meant losing not only cash assistance but also Medicaid coverage. Recognizing the work disincentive inherent in this arrangement, the authors of PRWORA instructed states to set income standards for Medicaid that were related to AFDC standards in effect at the time of PRWORA's passage rather than to eligibility for the states' new Temporary Assistance for Needy Families (TANF) programs. Consequently, former welfare recipients would be permitted to keep their public health insurance even if they were not eligible for cash assistance. Despite this precaution, it is possible that welfare reform led to a loss of Medicaid coverage through a variety of channels. Indeed, case studies of 13 states done by researchers at the Urban Institute (Holahan, Wiener, and Wallin 1998) showed that declines in welfare caseloads were accompanied by declines in Medicaid enrollment. Women leaving welfare may have been unaware that they could keep their Medicaid coverage; potential applicants for welfare may have been deterred by the stricter welfare policies, missing Medicaid eligibility in the process; and in some states, the processes of applying for welfare and applying for Medicaid were sufficiently de-linked that a welfare applicant would need to go to a different office and provide different documentation in order to qualify for Medicaid.

    AB - Introduction. The enactment of the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) in 1996 represented not only an “end to welfare as we know it” but the completion of a process begun in the late 1980s: the separation of Medicaid from cash assistance. Under the Aid to Families with Dependent Children (AFDC) program, receipt of Medicaid was automatic for welfare recipients, and to a large extent, leaving AFDC meant losing not only cash assistance but also Medicaid coverage. Recognizing the work disincentive inherent in this arrangement, the authors of PRWORA instructed states to set income standards for Medicaid that were related to AFDC standards in effect at the time of PRWORA's passage rather than to eligibility for the states' new Temporary Assistance for Needy Families (TANF) programs. Consequently, former welfare recipients would be permitted to keep their public health insurance even if they were not eligible for cash assistance. Despite this precaution, it is possible that welfare reform led to a loss of Medicaid coverage through a variety of channels. Indeed, case studies of 13 states done by researchers at the Urban Institute (Holahan, Wiener, and Wallin 1998) showed that declines in welfare caseloads were accompanied by declines in Medicaid enrollment. Women leaving welfare may have been unaware that they could keep their Medicaid coverage; potential applicants for welfare may have been deterred by the stricter welfare policies, missing Medicaid eligibility in the process; and in some states, the processes of applying for welfare and applying for Medicaid were sufficiently de-linked that a welfare applicant would need to go to a different office and provide different documentation in order to qualify for Medicaid.

    UR - http://www.scopus.com/inward/record.url?scp=84866175567&partnerID=8YFLogxK

    UR - http://www.scopus.com/inward/citedby.url?scp=84866175567&partnerID=8YFLogxK

    U2 - 10.1017/CBO9780511605383.008

    DO - 10.1017/CBO9780511605383.008

    M3 - Chapter

    SN - 9780521764254

    SP - 217

    EP - 254

    BT - Welfare Reform and its Long-Term Consequences for America's Poor

    PB - Cambridge University Press

    ER -