Welfare Reform & the Health of Single Mothers
Objective: This dissertation explores the relationship between welfare reform and the health of single mothers with less than a high school diploma or GED (LESMS) by addressing six research questions: (1) what impact did welfare reform have on the health insurance coverage of LESMS, (2) what impact did welfare reform have on the annual medical provider contact of LESMS, (3) what impact did welfare reform have on the health outcomes of LESMS, (4) what impact did welfare reform have on the federal disability receipt of LESMS, (5) how has the relationship between welfare reform and these outcomes changed over time, and (6) does state-level variation in welfare reform policy stringency impact the relationships between welfare reform and these outcomes? Data: The data source was the Survey of Income and Program Participation, 1992, 1993, 1996, 2004 and 2008 panels. Methods: A difference-in-differences study design that exploited differences in welfare eligibility by marital status was used to identify the effect of welfare reform. The treatment group was LESMS and the comparison group was similarly educated married mothers (LEMMS). The primary statistical model was a state level fixed-effects ordinary least squares regression model, controlling for public health insurance generosity, state unemployment, federal and state earned income tax credits and individual-level demographics, with robust standard errors. Sensitivity analyses with linear time trends, sampling weights, an alternative comparison group and alternative statistical model specifications (logit and negative binomial regression models) were conducted. Results: This dissertation found a transient negative relationship between welfare reform and having no health insurance coverage, among LESMS. Welfare reform was also found to be consistently negatively associated with Medicaid coverage and consistently positively associated with private health insurance coverage over time, among LESMS. Welfare reform was also found to have a transient, positive and statistically significant impact on the annual medical provider contact of LESMS.
Welfare reform increased self-reported disability among LESMS but not federal disability receipt. There was no evidence that the magnitude of the relationship between welfare reform and any of these outcomes grew over time. There was also no relationship between welfare reform policy stringency and any outcome.