Health Care Coverage for Poor Women: Dwindling Support

Abstract

The major goals of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (P.L. 104-193) were to reduce the welfare rolls and to move poor people from welfare to work. Since its passage, it has been lauded as a success because the TANF caseloads did indeed become smaller. However the decline in TANF caseloads also resulted in a decline in Medicaid caseloads.The Urban Institute (2001) estimated that about 1.7 million children and 925,000 adults lost Medicaid coverage as a result of welfare reform (as cited in Mann, Hudman, Salganicoff, & Folsom, 2002). This reduction in Medicaid services left a significant number of poor women without health insurance. For many, their employment situation remains unstable too. In part, both increased risk of health problems and a lack of health insurance create barriers to stable employment (Romero, Chavkin,Wise, Smith, & Wood, 2002), which partially explains the work record. In addition, women transitioning off of TANF are more likely to be hired in minimum or low-wage jobs that keep them at or below the poverty line. Recent studies indicate that low-income women have poorer health (O'Campo & Rojas-Smith, 2000). In a study of single mothers receiving cash benefits in a Michigan county, results indicated that current and former welfare recipients had significantly higher rates of hypertension, obesity, elevated glycosylated hemoglobin levels, low HDLC levels, low peak expiratory flows, low levels of physical functioning, and higher levels of C-reactive protein compared with a national sample. Rates of current smoking were higher and rates of smoking cessation were lower as well. One of the remarkable aspects of this study is that despite the poor performance on health tests, there were fewer physician diagnoses associated with this sample (Kaplan et al., 2005). Their data suggest that the health of women of low socioeconomic status under welfare reform is poor and is consistent with a worsening of health status after welfare reform. Another study compared the health status of poor women with that of women with incomes above 200 percent of the federal poverty level. Findings indicated that poor women were more than three times as likely as nonpoor women to report fair or poor health.They were also significantly more likely to report such health conditions as hypertension, diabetes, arthritis, and heart disease. Thirty-four percent of research participants reported the presence of two or more health conditions compared with 23 percent of nonpoor women (Mead, Witkowski, Gault, & Hartmann, 2001). Another problem that has emerged from the research on the health status of low-income women, is that women who are poor have less access to health care and screening services (Kneipp, 2000). Holahan and Kim (2000) found that nearly half of the people who left TANF lacked health care coverage one year later. This is the case because recipients transitioning off of TANF obtain jobs without health insurance coverage or they experience job instability. Using data from the National Longitudinal Survey of Youth, Anderson and Eamon (2004) found that one-half of mothers with incomes below 200 percent of the poverty level had unstable health care coverage compared with 15.5 percent of people with incomes between 200 percent and 399 percent of the poverty line and 4.3 percent of the sample with incomes above 400 percent of the poverty level. Health care coverage also varied in relation to the number of hours worked and job stability. Fifty-five percent of the mothers in households who averaged fewer than 1,920 hours of work, had unstable coverage compared with 20.9 percent of those who averaged 1,920 to 3,840 hours of work, and 11.6 percent for people who averaged more than 3,840 hours of work (Anderson & Eamon). Job stability also had an impact. Study participants who changed jobs more than twice during a two-year period were more than three times more likely to have unstable coverage as those who kept the same job (Anderson & Eamon, 2004). …