The impact of welfare reform on the health insurance coverage, utilization and health of low education single mothers

Narain, Kimberly Danae Cauley; Bitler, Marianne P.; Ponce, Ninez A.; Kominski, Gerald F.; Ettner, Susan L.

doi:10.1016/j.socscimed.2017.03.021

Cited by 19 publications

(32 citation statements)

References 25 publications

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“…The findings presented here are consistent with those in the existing literature on this topic 23. Recent studies examining the impact of welfare reform in USA have reported that such measures were associated with adverse trends in the health of welfare recipients and other socioeconomically disadvantaged groups 18 20 22. Similar findings have also been reported among benefit recipients in the UK 19 21.…”

Section: Discussionsupporting

confidence: 90%

“…These developments have prompted concern among public health researchers and practitioners alike about the potential consequences of austerity and associated policy measures 15–17. Indeed, findings from a handful of studies investigating the health effects of welfare reform suggest that efforts to reduce benefit levels and render them more difficult to obtain have been harmful to the health of socioeconomically disadvantaged populations 18–22. Rigorous evidence to this effect is still limited, however, particularly in jurisdictions outside of the UK and USA 23…”

Section: Introductionmentioning

confidence: 99%

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The effect of welfare reform on the health of the unemployed: evidence from a natural experiment in Germany

Shahidi

Muntañer

Shankardass

et al. 2020

J Epidemiol Community Health

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BackgroundOver the past several decades, governments have enacted far-reaching reforms aimed at reducing the generosity and coverage of welfare benefits. Prior literature suggests that these policy measures may have deleterious effects on the health of populations. In this study, we evaluate the impact of one of the largest welfare reforms in recent history—the 2005 Hartz IV reform in Germany—with a focus on estimating its effect on the health of the unemployed.MethodsWe employed a quasi-experimental difference-in-differences (DID) design using population-based data from the German Socio-Economic Panel Study, covering the period between 1994 and 2016. We applied DID linear probability modelling to examine the association between the Hartz IV reform and poor self-rated health, adjusting for a range of demographic and socioeconomic confounders.ResultsThe Hartz IV reform was associated with a 3.6 (95% CI 0.9 to 6.2) percentage point increase in the prevalence of poor self-rated health among unemployed persons affected by the reform relative to similar but unaffected controls. This negative association appeared immediately following the implementation of the reform and has persisted over time.ConclusionGovernments in numerous European and North American jurisdictions have introduced measures to further diminish the generosity and coverage of welfare benefits. In line with growing concerns over the potential consequences of austerity and associated policy measures, our findings suggest that these reform efforts pose a threat to the health of socioeconomically disadvantaged populations.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

The effect of welfare reform on the health of the unemployed: evidence from a natural experiment in Germany

Shahidi

Muntañer

Shankardass

et al. 2020

J Epidemiol Community Health

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“…Table A2 in the Appendix provides the estimates for these additional state characteristics that can capture the role of welfare reforms on health status. While no statistically significant effects are noticeable for any of the welfare reform controls, the effects shown in Table 4 could potentially be lower bound effects since previous work has provided evidence for negative effects of welfare reform on health (Muennig et al 2013;Narain et al 2017). Table A2 also shows that Medicaid expansions have a negligible effect on health status and that controlling for them does not alter the main estimates.…”

Section: Resultsmentioning

confidence: 82%

“…A relatively small number of studies have so far examined whether the welfare reforms affected health outcomes of affected individuals. Using data from the Survey of Income and Program Participation (SIPP), recent work by Narain et al (2017) provides suggestive evidence that PRWORA led to a 7-percentage point increase in the probability with which low-educated white single mothers report to be in poor health. By examining changes to time limits in Florida during the 1990s, Muennig et al (2013) provide evidence that certain aspects of the welfare reforms can lead to increased mortality rates.…”

Section: Other Welfare Reforms During the 1990smentioning

confidence: 99%

The effects of income on health: new evidence from the Earned Income Tax Credit

Lenhart

2018

Rev Econ Household

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This study examines the relationship between income and health by using an expansion of the Earned Income Tax Credit (EITC), which increased benefits to households with at least two children, as a source of exogenous variations of earnings. The paper adds to previous work by: (1) estimating treatment effects on the treated using simulated EITC benefits and longitudinal data; (2) testing whether health effects vary across the three different parts of the EITC schedule; (3) examining the role of food expenditures and health insurance as potential mechanisms. The study finds that income improves the likelihood of affected heads of households reporting to be in excellent or very good health by 6.9 to 8.9 percentage points. The effects are largest in the plateau phase of the EITC schedule, where previous researchers have identified pure income effects of the program. The results are robust to several additional specifications, including a semi-parametric DD model and specifications that account for the potential endogeneity of sample. When examining potential channels underlying the relationship between income and health, I find that affected household increase their food expenditures by 10.5 to 20.3 percent and are 1.52 percent more likely to have health insurance coverage. Keywords Income • Health • Earned Income Tax Credit • Food expenditures JEL classifications I14 • I38 • J38

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“…For example, the Personal Responsibility and Work Opportunity and Reconciliation Act (PRWORA) of 1996, which limited the amount of welfare receipt and mandated work requirements, was found to have either no effect on or reduced health care utilization, perhaps due to changes in insurance coverage. [30][31][32][33][34] Others have found an increase in health care utilization in response to the 2008 Economic Stimulus Payments, with the increased demand potentially driven by worsened health due to increased substance use. 35 In this study, we tested the hypothesis that EITC refund receipt leads to changes in short-term health care expenditures, including multiple categories of provider visits, and that there are differential effects by insurance status.…”

Section: Hamad and Niedzwieckimentioning

confidence: 99%

The short‐term effects of the earned income tax credit on health care expenditures among US adults

Hamad

Niedzwiecki

2019

Health Services Research

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Objective To test the hypothesis that the earned income tax credit (EITC)—the largest US poverty alleviation program—affects short‐term health care expenditures among US adults. Data Sources Adult participants in the 1997‐2012 waves of the US Medical Expenditure Panel Survey (MEPS) (N = 1 282 080). Study Design We conducted difference‐in‐differences analyses, comparing health care expenditures among EITC‐eligible adults in February (immediately following EITC refund receipt) with expenditures during other months, using non‐EITC‐eligible individuals to difference out seasonal variation in health care expenditures. Outcomes included total out‐of‐pocket expenditures as well as spending on specific categories such as outpatient visits and inpatient hospitalizations. We conducted subgroup analyses to examine heterogeneity by insurance status. Principal Findings EITC refund receipt was not associated with short‐term changes in total expenditures, nor any expenditure subcategories. Results were similar by insurance status and robust to numerous alternative specifications. Conclusions EITC refunds are not associated with short‐term changes in health care expenditures among US adults. This may be because the refund is spent on other expenses, because of income smoothing, or because of similar refund‐related variation in health care expenditures among noneligible adults. Future studies should examine whether other types of income supplementation affect health care expenditures, particularly among individuals in poverty.

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The impact of welfare reform on the health insurance coverage, utilization and health of low education single mothers

Cited by 19 publications

References 25 publications

The effect of welfare reform on the health of the unemployed: evidence from a natural experiment in Germany

The effect of welfare reform on the health of the unemployed: evidence from a natural experiment in Germany

The effects of income on health: new evidence from the Earned Income Tax Credit

The short‐term effects of the earned income tax credit on health care expenditures among US adults

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