How Effective Are Different Welfare-to-Work Approaches? Five-Year Adult and Child Impacts for Eleven Programs. Loss of Coverage by the End of Year 5

12/01/2001

Section III of this chapter showed that 20 to 30 percent of respondents no longer had health coverage at the end of year 5. Were these families less likely to work, did they work in lower-quality jobs, or did they earn too much to qualify for public programs? Although an extensive analysis of the uninsured is beyond the scope of the chapter, this section presents a comparison of adults who had coverage and those who did not have coverage at the end of the five-year follow-up.

Figure 8.1 presents coverage status for respondents at the end of year 2 and at the end of year 5.(14) The figure shows that between 70 and 80 percent of respondents had coverage at the end of year 5. Also, among those who were uninsured at that point, most had lost coverage after year 2.

Figure 8.1
Health Care Coverage for Respondents Over Five Years

Health Care Coverage for Respondents Over Five YearsHealth Care Coverage for Respondents Over Five Years

SOURCES: MDRC calculations from the Two-Year Client Survey and Five-Year Client Survey.
NOTES: See Appendix A.2.

Table 8.5 compares uninsured and insured control group members. The first two rows show that the uninsured were equally if not more likely to have been working at the end of the five-year follow-up than the insured, but they were much less likely to have been offered coverage by their employers. In Grand Rapids, for example, 69 percent of the uninsured were working at the end of the follow-up, but only 20 percent were working and were offered employer-provided coverage. In contrast, 66 percent of insured control group members were working at the end of the follow-up and 43 percent of them were offered coverage through their jobs.

 

Table 8.5
Characteristics of Control Group Members With and Without Health Care Coverage at the End of Year 5
Site Respondent Covered at End of Year 5 Respondent Not Covered at End of Year 5

Atlanta

Employed at end of year 5 (%) 54.4 67.8
Employed and offered coverage from employer (%) 36.5 19.9
Earnings in last quarter ($) 1,729 1,597
Ever received Transitional Medicaid (%) 39.4 50.7
Covered at end of year 2 (%) 92.1 83.8
All children covered at end of year 5 (%) 95.5 54.3
Sample size 406 146

Grand Rapids

Employed at end of year 5 (%) 65.7 68.9
Employed and offered coverage from employer (%) 42.7 19.7
Earnings in last quarter ($) 2076.5 1364.6
Ever received Transitional Medicaid (%) 48.2 54.1
Covered at end of year 2 (%) 89.2 77.7
All children covered at end of year 5 (%) 90.9 48.2
Sample size 440 122

Riverside

Employed at end of year 5 (%) 49.4 47.5
Employed and offered coverage from employer (%) 25.4 9.2
Earnings in last quarter ($) 1,181 1058.9
Ever received Transitional Medicaid (%) 26.4 22.7
Covered at end of year 2 (%) 92.2 76.5
All children covered at end of year 5 (%) 94.2 32.5
Sample size 579 141

Portland

Employed at end of year 5 (%) 60.8 59.5
Employed and offered coverage from employer (%) 43.1 9.5
Earnings in last quarter ($) 1745.0 1165.1
Ever received Transitional Medicaid (%) 50.3 50
Covered at end of year 2 (%) 92.1 85
All children covered at end of year 5 (%) 86.5 43.2
Sample size 181 42
SOURCE:  MDRC calculations from the Five-Year Client Survey.
NOTES:  See Appendix A.2.

The uninsured on average earned less than the insured in the last quarter of follow-up. This difference is consistent with the lower rate of employer-provided coverage and suggests that the uninsured may have been working in lower-quality jobs, including more part-time work. The lower earnings also suggest that the lack of coverage is not due to the fact that these workers were earning too much to qualify for public programs serving low-income families. In Portland, for example, average earnings in the last quarter of year 5 were $1,165 for the uninsured, which is less than $5,000 on an annual basis. The OHP provides coverage to families who are not eligible for Medicaid but have incomes below the poverty line. Although coverage rates were generally higher in Portland than in the other sites (see Table 8.2), many eligible people probably did not receive benefits. The low earnings also suggest that the children of uninsured respondents were probably eligible for Medicaid or other public health programs. Nonetheless, only between one-third and one-half of them were covered. In Riverside, for example, only 33 percent of uninsured adults had coverage for their children.

Finally, the uninsured were at least as likely as the insured to have received Transitional Medicaid during the follow-up period. This suggests that they were not more likely to immediately lose coverage when they made the transition from welfare to work, but that they were unable to replace Medicaid when their transitional benefits expired.