Women and children are the first hurt by welfare reform

A study published in the latest issue of Health Services Research finds an unintended consequence of welfare reform. The reduction of insurance coverage is likely to decrease the quantity and quality of health care services of economically disadvantaged women and their children. The replacement of Aid to Families with Dependent Children (AFDC) with Temporary Assistance for Needy Families (TANF) is found to be associated with a little more than eight percent increase in the likelihood that a welfare-eligible woman was not insured, while TANF implementation was associated with a three percent raise in the probability that a welfare-eligible child lacked insurance.

The authors used data from 1992-1999. State welfare changes occurred in 1996. They specifically looked at mothers aged 16-44 who had 12 or fewer years of schooling. The women were split into two groups: women who were married and women who were never married. The study's results show that the percentage of women without health coverage was always higher in the never married group, but that gap increased after TANF was implemented. At some times, the children of mothers in both groups had identical rates of uninsurance. This occurred from 1992 until early 1997 and again from1998-2000. Then the gap widens to the detriment of those with single mothers. These trends suggest that welfare reform increased the rates of uninsurance among single, low-income mothers and children.


This study is publishing in the April issue of Health Services Research. Media wishing to receive a PDF, please contact [email protected]

Health Services Research (HSR) provides those engaged in research, public policy formulation, and health services management with the latest findings, methods, and thinking on important policy and practice issues. HSR is published by the Health Research and Educational Trust in cooperation with AcademyHealth.

John Cawley is an associate professor in the Department of Policy Analysis and Management at Cornell University. His primary field of research is health economics, including the economics of insurance. John has served on expert panels and advisory committees for the Institute of Medicine, Centers for Disease Control and Prevention, and the Food and Drug Administration. Dr. Cawley is available for media questions and interviews.

Kosali Simon is an assistant professor in the Department of Policy Analysis and Management at Cornell University. She is also a Faculty Research Fellow of the National Bureau of Economic Research and a Research Associate of the Census Bureau. Kosali is a health economist whose main research focus is investigating the impact of state regulations to ease the availability of private and public health insurance for vulnerable populations (through state 'small-group' reforms, public health insurance expansions, and Medigap rate regulations) on health insurance, health and labor market outcomes. Professor Simon is available for media questions and interviews.

Blackwell Publishing is the world's leading society publisher, partnering with 665 academic and professional societies. Blackwell publishes over 800 journals and, to date, has published more than 6,000 books, across a wide range of academic, medical, and professional subjects.

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