How Effective Are Different Welfare-to-Work Approaches? Five-Year Adult and Child Impacts for Eleven Programs. Public Versus Private Coverage for Respondents

12/01/2001

Table 8.2 presents coverage more generally, not as it relates to employment status. Respondents were considered to be covered by public health insurance if they reported receiving Medicaid in the month prior to interview or if they were receiving welfare or SSI. They were considered to be covered by private health care if they had accepted their employer's plan or had coverage from another private source.

 

Table 8.2
Impacts on Health Care Coverage for Respondents at the End of Year 5

Site and Program

Sample Size Program Group (%) Control Group (%) Difference (Impact) Percentage Change (%)

Has health care coverage

Atlanta Labor Force Attachment 1,071 71.0 72.4 -1.4 -1.9
Atlanta Human Capital Development 1,146 74.0 72.4 1.6 2.2
Grand Rapids Labor Force Attachment 1,097 75.1 77.7 -2.6 -3.3
Grand Rapids Human Capital Development 1,109 77.8 77.7 0.1 0.2
Riverside Labor Force Attachment 1,219 78.3 80.3 -2.0 -2.5
Lacked high school diploma or basic skills 657 82.7 80.0 2.7 3.4
Riverside Human Capital Development 778 80.3 80.0 0.3 0.4
Portland 504 74.7 80.6 -6.0 -7.4

Has public health care coverage

Atlanta Labor Force Attachment 1,071 46.5 51.7 -5.2* -10.1
Atlanta Human Capital Development 1,146 50.3 51.7 -1.4 -2.7
Grand Rapids Labor Force Attachment 1,097 41.2 42.5 -1.2 -2.9
Grand Rapids Human Capital Development 1,109 43.2 42.5 0.7 1.7
Riverside Labor Force Attachment 1,219 55.8 59.4 -3.6 -6.1
Lacked high school diploma or basic skills 657 65.3 66.4 -1.1 -1.7
Riverside Human Capital Development 778 63.4 66.4 -3.1 -4.6
Portland 504 43.2 47.0 -3.7 -7.9

Has private health care coverage

Atlanta Labor Force Attachment 1,071 28.6 24.1 4.5* 18.5
Atlanta Human Capital Development 1,146 27.4 24.1 3.3 13.5
Grand Rapids Labor Force Attachment 1,097 41.8 40.7 1.1 2.7
Grand Rapids Human Capital Development 1,109 41.3 40.7 0.5 1.3
Riverside Labor Force Attachment 1,219 26.9 25.7 1.2 4.7
Lacked high school diploma or basic skills 657 20.9 18.0 2.9 16.4
Riverside Human Capital Development 778 23.9 18.0 5.9* 33.1
Portland 504 39.0 37.8 1.2 3.2
SOURCE:  MDRC calculations from the Five-Year Client Survey.
NOTES:  See Appendix A.2

As the upper panel of Table 8.2 shows, coverage levels for the control group ranged from 72 percent in Atlanta to 81 percent in Portland, meaning that 20 to 30 percent of respondents were uninsured at the end of year 5. The percentage uninsured is higher than it is for the nation as a whole but lower than it is for low-income individuals. A recent study reported that 16 percent of all adults with children were uninsured; among those with incomes below poverty, 42 percent were uninsured.(9) A later section in this chapter will look more closely at the respondents who no longer had coverage at the time of the survey.

The middle and lower panels of Table 8.2 show that the majority of the coverage is from public sources. In Portland, for example, 80 percent of control group members had any coverage, 47 percent had public coverage, and 38 percent had private coverage. This extent of public coverage makes sense, considering that 20 to 40 percent of sample members were still on welfare at the five-year point and that those who left welfare shortly before that were probably still receiving Transitional Medicaid (data on the take-up of Transitional Medicaid are shown in a later section). In Riverside, for example, nearly 40 percent of control group members were still receiving welfare at the end of year 5, which explains why the extent of public coverage is relatively high in this site. In Portland, the extent of public coverage is also related to Oregon's OHP, since about 20 percent of control group members were receiving welfare at the five-year point.

None of the programs produced a statistically significant impact on coverage (upper panel of Table 8.2). Levels of coverage were about the same for program group members as for control group members. This result is encouraging since the expectation was that many welfare recipients would lose insurance as they went from welfare to work.

The impacts on types of coverage (middle and lower panels of Table 8.2) show that the programs may have led to a shift from public to private sources. Although few of the impacts are statistically significant, the general pattern is that program group members were less likely to have public coverage and more likely to have private coverage than control group members. For the Atlanta LFA program, this shift in coverage is statistically significant; the program reduced public health care coverage by 5 percentage points and increased private coverage by 5 percentage points. This is consistent with the program's moving more welfare recipients to work.