Uninsurance and Welfare Reform in Rural America

Funder:	Office of Rural Health Policy (ORHP)
Research center:	Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis Phone: 319.384.5121
Lead researcher:	Timothy D. McBride, PhD , 314.935.4356, tmcbride@wustl.edu
Project completed:	January 2006
Topics:	Health insurance and the uninsured Poverty

Former recipients of welfare are likely to face significant difficulties obtaining health insurance in rural areas, perhaps even greater than in urban areas, primarily because jobs in rural areas are less likely to offer health insurance but also because difficulties with the Medicaid program might be exacerbated in rural areas. The loss of health insurance coverage for mothers who leave welfare could impose a significant risk factor on their families, especially if the mother or children have health conditions or disabilities. Women who have made the transition to work but have lost their health insurance coverage because the job does not offer insurance coverage may return to Temporary Assistance for Needy Families (TANF) coverage, knowing that TANF will provide Medicaid coverage.

This project researched the following hypotheses:

• Transitions off of welfare are often not accompanied by the acquisition of private health insurance or the continuation of Medicaid coverage.
• Transitions off of welfare, accompanied by health insurance coverage, will lead to improved health status, and improved access to health care, for former welfare recipients.
• Transitions off of welfare, not accompanied by health insurance coverage, will lead to declines in health status, and declines in access to health care, for former welfare recipients.

This project proceeded in two phases. In the first phase, project staff used widely-accepted databases to examine the recent history of uninsurance rates in the U.S., focusing on the low-income population that could be eligible for welfare. In the second phase, the focus was on how welfare reform has impacted the health insurance coverage of welfare recipients and other low-income persons over the period of time when welfare reform was phased in.

Publications

• Impact of Welfare Reform on Health Insurance Coverage in Rural Areas
  Author(s): Timothy D. McBride, Courtney Andrews
  Report Number: Rural Policy Brief Vol. 10, No. 6 (PB2005-6 )
  Date: 12 / 2005
  Explores the impact of welfare reform on the health insurance coverage of welfare recipients and other low-income persons over the period when the reform was phased in. Key findings of this study showed that a substantial percentage of persons who left the Aid to Families with Dependent Children (AFDC) program after reform became uninsured, and former AFDC recipients in rural areas were more likely than urban counterparts to lose insurance coverage. Insurance loss was more likely for those who gained employment than for those who remained unemployed.