Health Coverage Instability for Mothers in Working Families‪.‬

As women have entered the labor force in large numbers, they increasingly have gained access to the employer-based coverage that dominates the U.S. health care system (Mishel, Bernstein, & Schmitt, 2001). Yet, several studies have shown that many working women lack access to employer-based coverage (Currie & Yelowitz, 2000; Hoffman & Scholbohm, 2000; Van Loon, Borkin, & Steffen, 2002), and public health coverage options are limited by rigid income eligibility restrictions (Guyer, Broaddus, & Dude, 2002). The implementation of welfare reforms may have exacerbated this problem, as both work requirements and lifetime limits on welfare receipt have contributed to many women leaving welfare for low-paying jobs and then quickly exhausting transitional Medicaid benefits (Anderson & Gryzlak, 2002; Garrett & Holahan, 2000a). Globalization of the marketplace, increasing use of contingent and contractual labor, and rising health care premiums cast doubt on the future adequacy of employer-based coverage for working women (Davis, Aguilar, & Jackson, 1998; Keigher & Lowery, 1998; Kuttner, 1999). In these dynamic economic and social policy environments, the extent to which mothers have access to either private or public health care coverage requires continuing scrutiny. We examined health insurance stability for a sample of mothers not receiving welfare when TANF programs were being implemented to determine prevalent health insurance coverage patterns for mothers as they experience varying employment and income scenarios. This was useful in ascertaining the health care situations of mothers in working families generally and in predicting coverage prospects for women less able to obtain Medicaid as welfare reform programs mature. We used a measure of health coverage stability, as opposed to coverage estimates at a single point in time, to provide a fuller picture of the health coverage disruptions experienced by women over time.