The effect of Medicaid eligibility expansions on births

In an effort to increase the use of prenatal care by pregnant women and the utilization of medical care by children, eligibility for Medicaid was expanded dramatically for pregnant women and children during the 1980s and early 1990s. By lowering the costs of prenatal care, delivery, and child health care for some individuals, Medicaid expansions may prompt some women to give birth who otherwise would not have children or lead some women to have more children than they otherwise would have. This study uses natality data from 1983 to 1996 to examine the relationship between a state's eligibility threshold for Medicaid and birth rates among various groups. The results suggest that expansions have significant and sizable effects on births. A 10 percentage point increase in the eligibility threshold is associated with a 1.4 percent increase in the birth rate among nonblack women and a 1.0 percent increase among black women. Between 1983 and 1996, the expansions appear to have led to an average increase in the birth rate of about 10 percent.Demography ; Welfare ; Public policy ; Medicaid

Health disparities and infertility: impacts of state-level insurance mandates

Infertility is more common for non-Hispanic black women, non-Hispanic other race women, and Hispanic women than for non-Hispanic white women, and both infertility and impaired fecundity are more common for high school dropouts and high school graduates with no college than for 4-year college graduates, and for older women compared with women 29 and younger. Older women, non-Hispanic white women, and women who are more educated (with at least some college) are more likely to have ever received treatment. No evidence has been found that the racial, ethnic, or education disparities are ameliorated by the health insurance mandates.Infertility treatment, infertility, impaired fecundity, health disparities, health insurance mandates

The Health and Nutrition Effects of SNAP: Selection into the Program and a Review of the Literature on Its Effects

The goal of this paper is to assess the existing state of knowledge about whether SNAP improves health and nutrition outcomes, and if so, which ones and by how much. In an era of fiscal crisis, knowing whether SNAP has any significant causal effect on health and nutrition is crucial for informing policy decisions and policy makers. In this review, I pay particular attention to the challenges researchers face in overcoming selection bias and identifying causal effects of the program, and I will assess the literature through that lens. The fundamental challenge in program evaluation in general and in assessing the impact of SNAP in particular is that participants are not selected at random from the population. Thus, comparisons of those who use SNAP and those who do not—even conditional on observable characteristics—may not be apples to apples comparisons. To the extent that those who choose to participate in SNAP are negatively selected—as one might expect— SNAP recipients are likely to be less healthy, and thus possible positive estimates of the effects of SNAP could be biased downward

The Consequences of Couples’ Pregnancy Intentions for Early Parental Behaviors and Infant Health: Does It Matter Who Is Asked?

Previous research has found that pregnancy intentions are predictive of some early parental behaviors and infant health outcomes. However, most studies have relied on mothers’ reports of pregnancy intentions and have examined only maternal behaviors which may affect children’s health. This analysis draws on baseline data from the Fragile Families and Child Wellbeing Study, a 20-city study of unmarried parents and their children, to examine the relationship between pregnancy intentions and early parental and child outcomes. The study takes advantage of data collected from fathers and mothers to look at an alternate measure of pregnancy intention whether either parent considered abortion at the time they learned of the pregnancy and whether it is associated with maternal and paternal behaviors during the pregnancy and with infant birth weight. Results from regression analyses show that mothers are less likely to initiate early prenatal care and fathers are less likely to make cash or in-kind contributions during the pregnancy when one or both parents considered abortion. Which parents’ intentions are influential varies by outcome as well as by which parent reported it. Having both parents or the mother only consider abortion is also negatively associated with mothers’ reports of all parental behaviors, while having both parents or the father only consider abortion is negatively associated with fathers’ reports of their in-kind contributions and both parents’ reports of fathers’ cash contributions. Parents’ considerations are not significantly associated with infant birth weight. For early initiation of prenatal care, mothers’ reports of having considered abortion are consequential but fathers’ reports are not. Fathers’ considerations matter for their reports of their own contributions, but these outcomes are even worse when both parents considered abortion. Because findings differ by each parent’s intentions and by which parent reported paternal contributions, future research examining the consequences of pregnancy intention should examine measures of pregnancy intention and paternal behaviors reported by both parents.

The state of the safety net in the post-welfare reform era

The passage of the 1996 welfare reform bill led to sweeping changes to the central U.S. cash safety net program for families with children. Importantly, along with other changes, the reform imposed lifetime time limits for receipt of welfare de facto ending the entitlement nature of cash welfare for poor families with children in the United States. Despite dire predictions about poverty and deprivation, the previous research shows that caseloads declined and employment increased, with no detectible increase in poverty or worsening of child-well-being. We re-evaluate these results in light of the severe recession which began in December 2007. In particular, we examine how the cyclicality of the response of program caseloads and family wellbeing has been altered by the implementation of welfare reform. We find that use of food stamps and non-cash safety net program participation have become significantly more responsive across economic cycles after welfare reform, going up more after reform when unemployment increases. By contrast, there is no evidence that cash welfare for families with children is more responsive after reform, and some evidence that it might be less so. There is some evidence that poverty increases more with the unemployment rate after reform (and no evidence that poverty increases less with unemployment after reform). We find that reform has led to no significant effects on the cyclical responsiveness of food consumption, food insecurity, health insurance, household crowding, or health.Public welfare ; Welfare

Welfare Reform and Indirect Impacts on Health

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.

Utilization of Infertility Treatments: The Effects of Insurance Mandates

Over the last several decades, both delay of childbearing and fertility problems have become increasingly common among women in developed countries. At the same time, technological changes have made many more options available to individuals experiencing fertility problems. However, these technologies are expensive, and only 25% of health insurance plans in the United States cover infertility treatment. As a result of these high costs, legislation has been passed in 15 states that mandates insurance coverage of infertility treatment in private insurance plans. In this paper, we examine whether mandated insurance coverage for infertility treatment affects utilization. We allow utilization effects to differ by age and education, since previous research suggests that older, more educated women should be more likely to be directly affected by the mandates than younger women and less educated women, both because they are at higher risk of fertility problems and because they are more likely to have private health insurance which is subject to the mandate. We find robust evidence that the mandates do have a significant effect on utilization for older, more educated women that is larger than the effects found for other groups. These effects are largest for the use of ovulation-inducing drugs and artificial insemination.

Immigrants, Welfare Reform, and the U.S. Safety Net

Beginning with the 1996 federal welfare reform law many of the central safety net programs in the U.S. eliminated eligibility for legal immigrants, who had been previously eligible on the same terms as citizens. These dramatic cutbacks affected eligibility not only for cash welfare assistance for families with children, but also for food stamps, Medicaid, SCHIP, and SSI. In this paper, we comprehensively examine the status of the U.S. safety net for immigrants and their family members. We document the policy changes that affected immigrant eligibility for these programs and use the CPS for 1995-2010 to analyze trends in program participation, income, and poverty among immigrants (and natives). We pay particular attention to the recent period and examine how immigrants and their children are faring in the “Great Recession” with an eye toward revealing how these policy changes have affected the success of the safety net in protecting this population.

Welfare Reform and Health

We investigate the relationship between welfare reform and health insurance, health care utilization, and self-reported measures of health status for women aged 20-45, using nationally representative data from the Behavioral Risk Factor Surveillance System. We present estimates from both difference-in-difference models (applied to single women and single women with children) and difference-in-difference-in-difference models (using married women and single women without children as comparison groups). We find that welfare reform is associated with reductions in health insurance coverage and specific measures of health care utilization, as well as an increase in the likelihood of needing care but finding it unaffordable. We find no statistically significant effects of reform on health status. Overall, effects are somewhat larger for Hispanics compared to blacks and low educated women.

What Mean Impacts Miss: Distributional Effects of Welfare Reform Experiments

Labor supply theory predicts systematic heterogeneity in the impact of recent welfare reforms on earnings, transfers, and income. Yet most welfare reform research focuses on mean impacts. We investigate the importance of heterogeneity using random-assignment data from Connecticut's Jobs First waiver features key elements of post-1996 welfare programs. Estimated quantile treatment effects exhibit the substantial heterogeneity predicted by labor supply theory. Thus mean impacts miss a great deal. Looking separately at dropouts and other women does not improve the performance of mean impacts. Evaluating Jobs First relative to AFDC using a class of social welfare functions, we find that Jobs First's performance depends on the degree of inequality aversion, the relative valuation of earnings and transfers, and whether one accounts for Jobs First's greater costs. We conclude that welfare reform's effects are likely both more varied and more extensive than has been recognized.