How did welfare reform affect the health insurance coverage of women and children?
How did welfare reform affect the health insurance coverage of women and children?
复制标题
DOI：
10.1111/j.1475-6773.2005.00501.x
复制
发表时间：
2006-04-01
影响因子：
3.4
通讯作者：
Simon, KI
中科院分区：
文献类型：
--
作者：
Cawley, J;Schroeder, M;Simon, KI
Objective.衡量1996年福利改革（即设立贫困家庭临时援助或TANF）后美国妇女和儿童健康保险覆盖范围的变化。1992-1999年收入和方案参与调查的纵向数据与1996年后国家实施福利改革的时间数据合并。SIPP数据的两个关键优势是，它们允许每月将保险范围类型与各州的福利政策环境相匹配，并允许控制个人层面的固定效应。研究设计。我们衡量多少保险覆盖面改变后，福利改革使用的差异的方法，消除了时间不变的未观察到的个人异质性和全州的趋势，保险覆盖面的影响。模型还控制个人、州和年份固定效应、个人水平特征（如教育、年龄和子女数量）以及州水平变量（如真实的人均收入、真实的最低工资和医疗补助资格）。数据收集/提取方法。我们的分析仅限于访谈前一个月的SIPP数据;因此，我们对SIPP中的每个人进行了多达12次观察。本文使用了1992 - 1999年期间SIPP 1992 - 1996年面板的汇总数据。公开可用的国家标识符允许合并的国家政策和宏观经济变量与SIPP。TANF的实施与符合福利条件的妇女没有保险的概率增加8.1%有关。福利改革对儿童健康保险覆盖率的影响较小。例如，TANF的实施与符合福利条件的儿童缺乏健康保险的概率增加3.0%相关。福利改革的一个意外后果是对经济上弱势的妇女和儿童的健康保险覆盖面产生了不利影响，这种影响比以前文献所暗示的要大好几倍。
Objective. To measure the change in U.S. women and children's health insurance coverage as a result of welfare reform (i.e. the creation of Temporary Assistance for Needy Families or TANF) in 1996.Data Source. 1992-1999 longitudinal data from the Survey of Income and Program Participation (SIPP) merged with data on the timing of state implementation of welfare reform after 1996. Two key advantages of the SIPP data are that they permit matching type of insurance coverage to the welfare policy environment in each state in each month, and permit controlling for individual-level fixed effects.Study Design. We measure how much insurance coverage changed after welfare reform using a difference in differences method that eliminates the influence of time-invariant unobserved individual heterogeneity and of statewide trends in insurance coverage. Models also control for individual, state, and year fixed effects, individual-level characteristics such as education, age, and number of children, plus state-level variables such as real per capita income, real minimum wage, and Medicaid eligibility.Data Collection/Extraction Methods. We limit our analysis to the SIPP data specific to the month just completed prior to the interview; as a result, we have up to twelve observations for each individual in the SIPP. This paper uses pooled data from the 1992-1996 panels of the SIPP covering the period 1992-1999. Publicly available state identifiers permit the merger of state policies and macroeconomic variables with the SIPP.Principal Findings. TANF implementation is associated with an 8.1 percent increase in the probability that a welfare-eligible woman was uninsured. Welfare reform had less of an impact on the health insurance coverage of children. For example, TANF implementation was associated with a 3.0 percent increase in the probability that a welfare-eligible child lacked health insurance.Conclusions. An unintended consequence of welfare reform was to adversely impact the health insurance coverage of economically vulnerable women and children, and that this impact was several times larger than the previous literature implies.