In This Issue:
- Implementing JOBS
- The Economic Status of the Aged
- Boarder Babies and Abandoned Infants
- Employee Health Insurance Reforms
- State Implementation of the At-Risk Child Care Program
IMPLEMENTING JOBS: THE INITIAL DESIGN AND STRUCTURE OF LOCAL PROGRAMS
The Family Support Act of 1988 requires state and local governments responsible for administering Aid to Families with Dependent Children (AFDC) to also operate a welfare employment program which provides education, training, and employment services, in which they must enroll a minimum percentage of their AFDC caseload. The program, called the Job Opportunities and Basic Skills (JOBS), is mandatory for all states.
The report, Implementing JOBS: The Initial Design and Structure of Local Programs, examines local implementation of the federal mandate. Ten states were studied: Maryland, Michigan, Minnesota, Mississippi, New York, Oklahoma, Oregon, Pennsylvania, Tennessee, and Texas. In each of these states, three sites were studied: a metropolitan site, a mid-sized site, and a small or rural site.
JOBS clients are placed in job-readiness skills training programs or remedial or basic skills education programs, after screening. Other more specialized services, like job development or placement, job search, or work experience programs are also provided. The flexibility of the JOBS program allows states to structure programs according to local resources and needs. Some states "mainstream" JOBS clients into already existing programs, and use funding from other programs to subsidize JOBS. Other states implement wholly new programs to administer JOBS and allocated new funds for the program. Generally, local sites offer some services exclusively to JOBS clients, while allowing them to receive other programs' services. States usually give more attention to services such as education which are designed to increase earning capacity, rather than to moving people into immediate employment.
In conclusion, the report maintains that the JOBS program is well-designed, giving states the flexibility to create appropriate programs. Through JOBS, AFDC recipients participate in more meaningful education, training, and employment programs provided by a variety of organizations. However, although the program is well-funded at the federal level, the amount of variation in the levels of state matching funds reveals the differing priorities which states place on implementing the program. For example, in fiscal year 1991, states drew down vastly different percentages of federal funds, ranging from 99.6 percent in Oregon to 11.4 percent in Mississippi.
This study was performed by the Rockefeller Institute of Government and was sponsored by the Office of the Assistant Secretary for Planning and Evaluation. The study's project officer, Audrey Mirsky, may be reached at 202-690-7148. Copies of the Executive Summary, # 5110, are available from the Policy Information Center.
ASSESSMENT OF THE ECONOMIC STATUS OF THE AGED
Societal views of the aged and their economic status are based on both fact and belief. In previous years, the economic status of the aged was presumed to be low; this led to public sentiment for increases in government assistance. Currently, the aged are presumed to be well off, and calls for cutbacks in assistance for the aged are growing.
The report, An Assessment of the Economic Status of the Aged, discusses what is known about the economic status of the aged, how it compares to other age groups, how it has changed over time, and how it compares to that of the aged in several other industrialized countries. Compared with most other recent assessments, the report shows a less favorable status for the aged relative to other age groups and emphasizes what we do not know.
Subgroups of the aged differ greatly in their economic status. For example, aged married couples have higher median incomes than unmarried aged people, while persons aged eighty-five and older have lower median incomes than those aged sixty-five to sixty-nine. Poverty rates also vary greatly among different subgroups of the aged. Furthermore, interpretations of the well-being of the aged differ when certain kinds of measurements and data are used instead of others. For example, using median income, as opposed to mean income; and inclusion of resources other than cash income, such as Medicare benefits and wealth, alters evaluations of the well-being of the aged.
The report finds that the poverty rate for aged persons is above the rate for other adults, but below the rate for children. When non-cash income and wealth are considered, the economic status of the aged generally improves relative to that of the nonaged, but the amount of improvement is uncertain because of serious measurement problems. Finally, while the aged as a group are at least as well off as the aged in several other industrialized countries, their poverty rates tend to be relatively high.
This study was performed by the Office of Research and Statistics of the Social Security Administration. The study's author, Daniel Radner, may be reached at 202-282-7059. Copies of the Executive Summary, # 5087, are available from the Policy Information Center. A shorter version of the study appeared in the Fall 1992 issue of the Social Security Bulletin.
NATIONAL ESTIMATES ON THE NUMBER OF BOARDER BABIES, THE COST OF THEIR CARE, AND THE NUMBER OF ABANDONED INFANTS
In 1988, media attention resulted in Congress enacting the Abandoned Infants Assistance Act, which, in part, called for a study to determine the number of infants and young children abandoned in hospitals, their health status, and an estimate of the costs of their care.
The report, National Estimates on the Number of Boarder Babies, the Cost of Their Care, and the Number of Abandoned Infants, fulfills this congressional mandate.
Boarder babies are children under the age of twelve months who remain in the hospital past the date of medical discharge. They may be released to their parents' care or may be placed in alternative care. Abandoned infants are children under the age of twelve months who are unlikely to be released to their parents' custody upon medical discharge. In some cases, child welfare agencies believe that these children cannot be safely released to the care of their parents; in others, parents may be unwilling or unable to provide care.
The report estimates that there are almost 10,000 boarder babies and almost 12,000 abandoned infants annually. Over three-fourths of these children are drug-exposed; almost one-half are premature; over one-half of boarder babies and over three-fourths of abandoned infants are of low-birthweight; and eight percent of boarder babies and six percent of abandoned infants are HIV (+). Annual costs of caring for boarder babies range from $22.3 million to $125 million, depending upon whether costs measured are direct hospital costs only or are inclusive of ancillary care, and upon whether mean or median lengths of stay are used.
This study was performed by James Bell Associates, and was sponsored by the Administration for Children and Families. Copies of the Executive Summary, # 5136, are available from the Policy Information Center.
EMPLOYMENT IMPACTS ASSOCIATED WITH EMPLOYEE HEALTH INSURANCE OPTIONS
An estimated 30 to 35 million Americans are without any form of health insurance, although almost 15 million of this population is employed at least part-time. Furthermore, the high cost of premiums can prevent those most in need of medical care from being insured. Recent political attention to the need for health insurance reform has inspired several different options for providing health insurance to the uninsured.
The report, Employment Impacts Associated with Employee Health Insurance Options, explores the characteristics and impacts of four of these proposals: the Managed Competition Act of 1992, introduced to the House of Representatives by Representative Cooper of Tennessee; HealthAmerica: Affordable Health Care for All Americans, introduced to the Senate by Senator Mitchell of Maine; the California Health Care System for the 21st Century; and the 21st Century American Health System, devised by the Jackson Hole Group. The proposals have in common improved accessibility to health care insurance, equitable financing, expanded gathering, analysis, and sharing of information, cost-containment, and streamlined administration. In addition, each proposal attempts to expand the role which industry plays in providing and paying for employee health care insurance. However, these proposals differ in the impacts they will have on employment.
The House proposal attempts to induce employers to voluntarily pay for their employees' health insurance by making it less expensive. It would have the smallest impact upon employment. In contrast, the Jackson Hole proposal would have the largest impact upon employment, requiring employers to pay a specified percentage of their full-time employees' health care insurance premiums, and to pay a tax equal to a specified percentage of the wages of all their part-time employees.
The report estimates that almost 1/5th to 1/3rd of all private sector employees will be adversely affected if one of these plans goes into effect, and that the number of those who will be severely adversely affected ranges from a few hundred thousand to more than 20 million. Moreover, those workers who will be adversely affected are those who currently are most at risk of being uninsured: workers under eighteen years of age, female workers, Black and Hispanic workers, unmarried workers, workers with at most a high school education, and workers who earn less than $5000 annually.
This report was performed by Consad Research Corporation, and was sponsored by the Health Care Financing Administration. The study's project officer, Gerald Riley, can be reached at 410-966-6699. Copies of the Executive Summary, # 5135, are available from the Policy Information Center.
THE AT-RISK CHILD CARE PROGRAM
The At-Risk Child Care Program, administered on the state level and overseen by the Administration for Children and Families, is designed to help low-income working families who are at risk of becoming dependent upon federal assistance programs obtain the child care they need if they are to secure or maintain employment.
The report, The At-Risk Child Care Program, examines states' implementation of the program, and their successes and problems with it.
The report finds that, in the thirteen sample states, there was a marked increase in the use of federal funds, as well as in state expenditures between fiscal year 1991 and 1992. States also report serving more children in FY 1992 than in FY 1991.
States have considerable freedom to serve those families they consider most at risk. Responding states estimate that most of the families participating in the program have annual incomes between $10,000 and $15,000, despite a wide variation in state income ceilings. States may determine which families are of low-income and at-risk, and may determine their own sliding scales for calculation of the amount families must pay for child care. States can also allow families substantial leeway in their choice of child care provider.
The same state agency which administers Aid to Families with Dependent Children (AFDC) also oversees this program, ensuring streamlined management. States generally use the same income eligibility and payment rates for this and other subsidized child care programs. As a result, states feel that they are providing seamless child care services, so that families may control delivery of their child care, regardless of how, and by whom, it is subsidized. However, differences in regulations and funding among the several funding streams make them difficult to coordinate and to administer.
On the whole, then, states have been successful in their implementation of the program, increasing participation and funding, and delivering streamlined, seamless child care services to families at risk.
This report was performed by the Office of Inspector General of the Department of Health and Human Services. The study's project officer, Joseph L. Corso, may be reached at 212-264-1998. Copies of the Executive Summary, # 5118, are available from the Policy Information Center.
Recently Acquired Reports
- School-Based Health Centers and Managed Care
- Evaluation of the New York State PACS Project: Final Synthesis Report
- Medical Malpractice: Maine's Use of Practice Guidelines to Reduce Costs
- Microsimulation and Public Policy: A Synopsis of Developments in Modeling and the Role of Policy Analytic Needs
- National Center for Service Integration: Directory of Federally Funded Resource Centers, 1993
SERVICES AVAILABLE FROM THE PIC
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