Poor Families in America's Health Care Crisis

Abstract

Poor Families in America's Health Care Crisis examines the implications of the fragmented and two-tiered health insurance system in the United States for the health care access of low-income families. For a large fraction of Americans their jobs do not provide health insurance or other benefits and although government programs are available for children, adults without private health care coverage have few options. Detailed ethnographic and survey data from selected low-income neighborhoods in Boston, Chicago, and San Antonio document the lapses in medical coverage that poor families experience and reveal the extent of untreated medical conditions, delayed treatment, medical indebtedness, and irregular health care that women and children suffer as a result. Extensive poverty, the increasing proportion of minority households, and the growing dependence on insecure service sector work all influence access to health care for families at the economic margin.

Mitigating Material Hardship: The Strategies Low‐Income Families Employ to Reduce the Consequences of Poverty*

“…What am I supposed to do?” Our interviews make clear that these mothers worried a lot about maintaining insurance, usually Medicaid, even if that meant staying on welfare. Such concerns are echoed in other studies of health and health care among welfare‐reliant and working‐poor families (Angel, Lein, and Henrici 2006; Seccombe and Hoffman 2007).…”

Maternal employment and the health of low-income young children

“…This is consistent with findings from a Canadian study of an earnings supplement program (called the Self-Sufficiency Project) that also increased employment and income among welfare recipients and improved children’s health status (Morris and Michalopoulos, 2003). A body of qualitative research also that documents mother’s concerns about potential loss of health insurance coverage during their welfare to work transitions (Angel, Lein, and Henrici, 2006; Hartley, Seccombe, and Hoffman, 2005; Polit, London, and Martinez 2001; Seccombe and Hoffman, 2007), a phenomenon that the MFIP program avoided because of the earnings disregard, which allowed families to remain on welfare while working.…”

“…Low-income mothers are often employed in poor quality jobs, characterized by low wages, instability, limited employee benefits, and nonstandard hours (Guyer and Mann, 1999; Johnson and Corcoran, 2003), all of which could exacerbate parents’ stress and reduce their ability to do the carework that is necessary to address children’s health and health care needs (Parcel and Menaghan, 1994; Parcel and Menaghan, 1997; Presser, 2003; Presser and Cox, 1997; Scott et al 2004). Family resources and health insurance coverage can actually decline and become less stable as welfare-reliant mothers move from government assistance to paid employment (Angel et al, 2006; Bitler et al, 2005; Heflin, 2006; Kaestner and Kaushal, 2003; Seccombe and Hoffman, 2007) as a result of administrative links between programs, the high marginal tax rates associated with income eligibility rules (Holt and Romich, 2007), and the fact that many low-wage jobs do not provide access to private health insurance as a benefit or an affordable option.…”

Social Stability and HIV Risk Behavior: Evaluating the Role of Accumulated Vulnerability

“…A synthesis of existing literature and theory on social stability points to the following as central characteristics of social stability: housing, employment, income, lack of incarceration, residential stability, and having a steady partner [25]. Stability has been discussed as the central determinant of well-being among women receiving welfare [26]. In contrast, social instability has been described as the most challenging barrier to providing healthcare services among injection drug users [27].…”

“…There are a variety of pathways through which the combined effect of social stability may impact HIV risk behaviors. Some have posited that instability produces a context of constrained rationality, in which health-promoting decision making cannot be disentangled from one’s daily environmental stressors and the reality of limited options [26]. Within impoverished communities, HIV is but one of many social issues and often does not command immediate attention [28].…”