Predictors of Health Insurance Coverage after Welfare Exit. Abstract andExecutive Summary of a Dissertation

摘要

The enactment of the Personal Responsibility and Work Opportunity ReconciliationAct of 1996 will undoubtedly affect aspects of the safety net. Using a multi-method approach, this study addresses how welfare reform affects health insurance for low-income families. Primary data were collected in three cities from 30 in-depth interviews with TANF caseworkers and local welfare office administrators. In addition, data from the National Survey of America's Families (INSAF), supplemented with state-level policy variables, were analyzed. The main findings show that welfare reform has had unintended and negative effects on health coverage for families. Generosity of a state's Medicaid does not alone explain former welfare recipients, health coverage. Welfare policies, especially diversion policies such as mandatory job search, and time limit policies play a significant, yet negative role in the ability of families who have left crash assistance to maintain Medicaid. Furthermore, administration of Medicaid and welfare were found to make a difference in health coverage-welfare messages spill over to Medicaid. Finally, findings show that the frontline personnel implementing welfare reform play a very important role in families' health coverage.