Health Care Coverage for Poor Women: Dwindling Support (Personal Responsibility and Work Opportunity Reconciliation Act of 1996) (Editorial‪)‬

The major goals of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (P.L. 104-193) were to reduce the welfare rolls and to move poor people from welfare to work. Since its passage, it has been lauded as a success because the TANF caseloads did indeed become smaller. However the decline in TANF caseloads also resulted in a decline in Medicaid caseloads.The Urban Institute (2001) estimated that about 1.7 million children and 925,000 adults lost Medicaid coverage as a result of welfare reform (as cited in Mann, Hudman, Salganicoff, & Folsom, 2002). This reduction in Medicaid services left a significant number of poor women without health insurance. For many, their employment situation remains unstable too. In part, both increased risk of health problems and a lack of health insurance create barriers to stable employment (Romero, Chavkin,Wise, Smith, & Wood, 2002), which partially explains the work record. In addition, women transitioning off of TANF are more likely to be hired in minimum or low-wage jobs that keep them at or below the poverty line. Recent studies indicate that low-income women have poorer health (O'Campo & Rojas-Smith, 2000). In a study of single mothers receiving cash benefits in a Michigan county, results indicated that current and former welfare recipients had significantly higher rates of hypertension, obesity, elevated glycosylated hemoglobin levels, low HDLC levels, low peak expiratory flows, low levels of physical functioning, and higher levels of C-reactive protein compared with a national sample. Rates of current smoking were higher and rates of smoking cessation were lower as well. One of the remarkable aspects of this study is that despite the poor performance on health tests, there were fewer physician diagnoses associated with this sample (Kaplan et al., 2005). Their data suggest that the health of women of low socioeconomic status under welfare reform is poor and is consistent with a worsening of health status after welfare reform.