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Welfare Reform and Indirect Impacts on Health

  • Marianne Bitler
  • Hilary W. Hoynes

The stated goals of welfare reform are to increase work, reduce dependency on welfare, reduce births outside marriage, and to increase the formation of two parent families. However, welfare reform may also have indirect impacts on health. We provide a comprehensive review of the literature on the impacts of welfare reform on health. We illustrate the main findings from the literature by presenting estimates of the impact of reform on health insurance, health utilization, and health status using data from five state waiver experiments. The most consistent finding is that welfare reform led to a reduction in health insurance coverage. The impacts on health care utilization and health status tend to be more mixed and fewer are statistically significant. While the results are not conclusive, they suggest that welfare-to-work programs need not have large negative health effects.

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File URL: http://www.nber.org/papers/w12642.pdf
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Paper provided by National Bureau of Economic Research, Inc in its series NBER Working Papers with number 12642.

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Date of creation: Oct 2006
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Publication status: published as Schoeni, R., J. House, G. Kaplan, and H. Pollack (eds.) Making Americans Healthier: Social and Economic Policy as Health Policy. New York: Russell Sage, 2008.
Handle: RePEc:nbr:nberwo:12642
Note: HC HE PE
Contact details of provider: Postal: National Bureau of Economic Research, 1050 Massachusetts Avenue Cambridge, MA 02138, U.S.A.
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  1. Rebecca M. Blank, 1999. "What Goes Up Must Come Down? Explaining Recent Changes in Public Assistance Caseloads," JCPR Working Papers 78, Northwestern University/University of Chicago Joint Center for Poverty Research.
  2. Bitler, Marianne P. & Gelbach, Jonah B. & Hoynes, Hilary W., 2005. "What Mean Impacts Miss: Distributional Effects of Welfare Reform Experiments," IZA Discussion Papers 1728, Institute for the Study of Labor (IZA).
  3. Rebecca M. Blank, 2001. "Declining caseloads/increased work: what can we conclude about the effects of welfare reform?," Economic Policy Review, Federal Reserve Bank of New York, issue Sep, pages 25-36.
  4. Thomas M. Fraker & Christine M. Ross & Rita A. Stapulonis & Robert B. Olsen & Martha D. Kovac & M. Robin Dion & Anu Rangarajan, 2002. "The Evaluation of Welfare Reform in Iowa Final Impact Report," Mathematica Policy Research Reports 141009950a384270bd20bf714, Mathematica Policy Research.
  5. Currie, Janet & Grogger, Jeffrey, 2002. "Medicaid expansions and welfare contractions: offsetting effects on prenatal care and infant health?," Journal of Health Economics, Elsevier, vol. 21(2), pages 313-335, March.
  6. Currie, Janet & Gruber, Jonathan, 1996. "Health Insurance Eligibility, Utilization of Medical Care, and Child Health," The Quarterly Journal of Economics, MIT Press, vol. 111(2), pages 431-66, May.
  7. Price V. Fishback & Michael R. Haines & Shawn Kantor, 2007. "Births, Deaths, and New Deal Relief during the Great Depression," The Review of Economics and Statistics, MIT Press, vol. 89(1), pages 1-14, February.
  8. Marianne P. Bitler & Jonah B. Gelbach & Hilary W. Hoynes, 2005. "Welfare Reform and Health," Journal of Human Resources, University of Wisconsin Press, vol. 40(2).
  9. Rebecca M. Blank, 2002. "Evaluating Welfare Reform in the United States," NBER Working Papers 8983, National Bureau of Economic Research, Inc.
  10. Robert Kaestner & Won Chan Lee, 2005. "The effect of welfare reform on prenatal care and birth weight," Health Economics, John Wiley & Sons, Ltd., vol. 14(5), pages 497-511.
  11. Robert Kaestner & Elizabeth Tarlov, 2006. "Changes in the welfare caseload and the health of low-educated mothers," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 25(3), pages 623-643.
  12. Jonathan Gruber, 1997. "Health Insurance for Poor Women and Children in the U.S.: Lessons from the Past Decade," NBER Chapters, in: Tax Policy and the Economy, Volume 11, pages 169-211 National Bureau of Economic Research, Inc.
  13. Jacob Alex Klerman & Steven J. Haider, 2004. "A Stock-Flow Analysis of the Welfare Caseload," Journal of Human Resources, University of Wisconsin Press, vol. 39(4).
  14. Jeffrey R. Kling & Jeffrey B. Liebman, 2005. "Experimental Analysis Of Neighborhood Effects On Youth," Working Papers 249, Princeton University, Woodrow Wilson School of Public and International Affairs, Center for Health and Wellbeing..
  15. Busch, Susan H. & Duchovny, Noelia, 2005. "Family coverage expansions: Impact on insurance coverage and health care utilization of parents," Journal of Health Economics, Elsevier, vol. 24(5), pages 876-890, September.
  16. Jeffrey R. Kling & Jeffrey B. Liebman & Lawrence F. Katz, 2005. "Experimental Analysis of Neighborhood Effects," NBER Working Papers 11577, National Bureau of Economic Research, Inc.
  17. Currie, J. & Cole, N., 1992. "Welfare and Child Health: the Link Between AFDC Participation and Birth Weight," Working papers 92-9, Massachusetts Institute of Technology (MIT), Department of Economics.
  18. James Hines & Hilary Hoynes & Alan Krueger, 2001. "Another Look at Whether a Rising Tide Lifts All Boats," Working Papers 833, Princeton University, Department of Economics, Industrial Relations Section..
  19. Anna Aizer & Jeffrey Grogger, 2003. "Parental Medicaid Expansions and Health Insurance Coverage," NBER Working Papers 9907, National Bureau of Economic Research, Inc.
  20. Borjas, George J., 2003. "Welfare reform, labor supply, and health insurance in the immigrant population," Journal of Health Economics, Elsevier, vol. 22(6), pages 933-958, November.
  21. David Card & Carlos Dobkin & Nicole Maestas, 2004. "The Impact of Nearly Universal Insurance Coverage on Health Care Utilization and Health: Evidence from Medicare," NBER Working Papers 10365, National Bureau of Economic Research, Inc.
  22. Steven J. Haider & Alison Jacknowitz & Robert F. Schoeni, 2002. "Welfare Work Requirements and Individual Well-being: Evidence from the Effects on Breastfeeding," Working Papers 02-01, RAND Corporation Publications Department.
  23. Moffitt, Robert A., 2002. "Welfare programs and labor supply," Handbook of Public Economics, in: A. J. Auerbach & M. Feldstein (ed.), Handbook of Public Economics, edition 1, volume 4, chapter 34, pages 2393-2430 Elsevier.
  24. Janet Currie & Aaron S. Yelowitz, 1999. "Health Insurance and Less Skilled Workers," JCPR Working Papers 63, Northwestern University/University of Chicago Joint Center for Poverty Research.
  25. Jeffrey R. Kling & B. Jeffrey Liebman, 2004. "Experimental Analysis of Neighborhood Effects on Youth," Working Papers 862, Princeton University, Department of Economics, Industrial Relations Section..
  26. Currie, Janet & Gruber, Jonathan, 1996. "Saving Babies: The Efficacy and Cost of Recent Changes in the Medicaid Eligibility of Pregnant Women," Journal of Political Economy, University of Chicago Press, vol. 104(6), pages 1263-96, December.
  27. Thomas DeLeire & Judith A. Levine & Helen Levy, 2006. "Is Welfare Reform Responsible for Low-Skilled Women’s Declining Health Insurance Coverage in the 1990s?," Journal of Human Resources, University of Wisconsin Press, vol. 41(3).
  28. Steven Haider & Alison Jacknowitz & Robert Schoeni, 2003. "Welfare work requirements and child well-being: Evidence from the effects on breast-feeding," Demography, Springer, vol. 40(3), pages 479-497, August.
  29. Michael Anderson, 2005. "Uncovering Gender Differences in the Effects of Early Intervention: A Reevaluation of the Abecedarian, Perry Preschool, and Early Training Projects," HEW 0509008, EconWPA, revised 26 Sep 2005.
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