Price,Restrictions and Abortion Demand

This study uses pooled time-series data to estimate the effects of various restrictive abortion laws on the demand for abortion. This study differs from prior pooled time-series cross-section research in that it explicitly includes the price of an abortion in the abortion demand equation. State Medicaid funding is found to increase the abortion demand of women of childbearing age; while the price of an abortion, parental involvement, parental consent, and parental notification laws all have a negative effect on the demand for abortions. State mandatory waiting periods have no statistically significant impact on abortion demand. The empirical results remain robust for the abortion demand of teen minors.     

Medicaid matching formula, federal subsidies, and Medicaid payments

The federal government uses the Medicaid matching formula to distribute federal funds to states to finance various social welfare programs involving billions of dollars. How does the formula affect the distribution of federal money? How would that distribution change if a revised formula were used? This article presents the results of a regression analysis on Medicaid payments in the states and the federal subsidies for states to finance Medicaid. The findings indicate that under the current Medicaid matching formula, fewer federal subsidy dollars per poor person go to states with lower per capita incomes and to states with a higher percentage of African Americans than to states with the opposite characteristics. Even under the revised formula, states with lower per capita incomes would receive the same amount of federal matching dollars per poor person as would states with higher per capita incomes. The implications for policy are discussed.     

Abortion Policy and Vulnerable Women in the United States: A Call for Social Work Policy Practice

Repressive abortion policy in the United States creates undue burdens for groups of vulnerable women, including adolescents, women of color, women living in rural areas, and women with economic disadvantages. Repressive abortion policy creates a two-tiered system of access to reproductive health care that is a particular disadvantage to vulnerable women. In this study, current policy is discussed with examples of such policies outlined in three areas: insurance coverage and Medicaid restrictions, mandatory waiting periods, and mandated state counseling. Social workers' role in policy practice is emphasized in regard to advocacy and abortion policy.     

AN ECONOMIC ANALYSIS OF THE DEMAND FOR ABORTIONS

This study uses an economic model of fertility control to estimate the demand for abortions. The results show that the fundamental law of demand holds for abortions, with the price elasticity of demand equal to –.81. Abortions are a normal good with an income elasticity of demand equal to .79. The demand for abortions is also positively related to the labor force participation of women and to being unmarried. Catholic religion, education and the poverty status of women were found to have no statistically significant impact on the demand for abortions.     

History effaced: the International Defence and Aid Letters

The International Defence and Aid Letters, now in the Mayibuye Archives at the University of the Western Cape, South Africa, contain the responses of many South Africans, mainly women, who during the apartheid period and immediately afterwards received funds from the International Defence and Aid Fund via a large number of intermediaries in Europe and Canada. The letters were written to these intermediaries as receipts for funds sent to them. Partly for security reasons and partly because the recipients were often lonely as well as poor, they tended to send news of themselves and their families as well as thanks for the money which they needed. The letters now function as pieces of history of the private and domestic sufferings of families whose breadwinners were imprisoned or exiled, and who had been forced to leave wives and children without support. They are unique in that the writers would not under any other circumstances have written to describe their plight, and there is no other collection of letters which offers such an authentic picture of domestic heroism.     

Restrictiveness of Eligibility Determination and Medicaid Enrollment by Low-Income Seniors

Medicaid is an important source of supplemental health care coverage for low-income seniors, yet little is known about the effect of state policy on Medicaid enrollment by eligible elderly. Data from a nationally representative survey were used to examine Medicaid enrollment by elderly, low-income Medicare beneficiaries living in states that liberalize or restrict Medicaid eligibility criteria using the 1986 Omnibus Budget Reconciliation Act or provision 209(b) of the 1972 Social Security Act Amendment, respectively. Controlling for demographics and health status, residence in states applying these laws was significantly, though modestly, associated with Medicaid enrollment. Additionally, 73% of eligible elderly Medicare beneficiaries were not enrolled in Medicaid, and most have serious chronic health problems. These findings suggest that a significant number of eligible elderly are not enrolled in Medicaid and that liberalizing or tightening Medicaid eligibility criteria can have an impact on Medicaid enrollment by low-income elderly patients.     

ENHANCED CITIZENSHIP VERIFICATION AND CHILDREN'S MEDICAID COVERAGE

This article examines a potential unintended consequence of the mandated Medicaid citizenship verification requirements of the 2005 Deficit Reduction Act (DRA). We investigate whether or not these new rules led to an increase in the Medicaid exit rate among enrollees using state administrative data from Georgia. We do this by comparing the exit rate for children enrolled in Medicaid whose first coverage recertification occurs just after implementation of the DRA (which we refer to as a “high impact” first recertification) with those whose first recertification occurs just prior (which we refer to as a “low impact” first recertification). Our analysis suggests that children in the high‐impact first recertification group were about 2 percentage points more likely to exit Medicaid than those in the low‐impact group. Furthermore, these additional exits occurred in racial and ethnic groups more likely to be citizens than noncitizens and prereform estimates suggest that there were very few (roughly 0.10%) noncitizen Medicaid enrollees to begin with. Taken together, our results suggest that the DRA‐enhanced citizenship verification rules led to an increase in Medicaid disenrollment, and thus a reduction in coverage, among citizens. (JEL I18, I38, J13)     

Expanding health insurance for children: examining the alternatives

This Issue Brief examines the issue of uninsured children. The budget reconciliation legislation currently under congressional consideration earmarks $16 billion for new initiatives to provide health insurance coverage to approximately 5 million of the 10 million uninsured children during the next five years. Proposals to expand coverage among children include the use of tax credits, subsidies, vouchers, Medicaid program expansion, and expansion of state programs. However, these proposals do not address the decline in employment-based health insurance coverage--the underlying cause of the lack of coverage, to the extent that a cause can be identified. What is worse, some proposals to expand health insurance among children may discourage employers from offering coverage. Between 1987 and 1995, the percentage of children with employment-based health insurance declined from 66.7 percent to 58.6 percent. Despite this trend, the percentage of children without any form of health insurance coverage barely increased. In 1987, 13.1 percent were uninsured, compared with 13.8 percent in 1995. Medicaid program expansions helped to alleviate the effects of the decline in employment-based health insurance coverage among children and the potential increase in the number of uninsured children. Between 1987 and 1995, the percentage of children enrolled in the Medicaid program increased from 15.5 percent to 23.2 percent. Some questions to consider in assessing approaches to improving children's health insurance coverage include the following: If the government intervenes, should it do so through a compulsory mechanism or a voluntary system? Is the employment-based system "worth saving" for children? In other words, are the market interventions necessary to keep this system functioning for children too regulatory, too intrusive, and too cumbersome to be practical? In addition to reforming the employment-based system, what reforms are necessary in order to reach those families who have no coverage through the work place? Which approaches are both efficient and politically acceptable? Employment-based coverage of children will likely continue. The challenge for lawmakers is to find a way to cover more uninsured children without eroding employment-based coverage. Several current legislative proposals attempt to avoid this problem by excluding children who have access to employment-based coverage. Without such a requirement, the opportunity to purchase coverage at a discount would create incentives for some low-income employees to drop dependent/family coverage, which in turn could lead some employers to drop their health plans.     

Trends in health insurance coverage

This Issue Brief presents data on trends in health insurance coverage between 1987-1995. In 1995, 70.7 percent of the nonelderly population had private health insurance coverage, compared with 75.9 percent in 1987. During this period, the percentage of the nonelderly population with employment-based health insurance declined from 69.2 percent to 63.8 percent, while the percentage covered by Medicaid program increased from 8.6 percent to 12.5 percent. The percentage of the nonelderly population without any form of health insurance increased from 14.8 percent in 1987 to 17.4 percent, or 40.3 million individuals, in 1995. The percentage of nonelderly Americans with employment-based coverage fell for both individuals with coverage in their own name and those with coverage as dependents. In 1995, 32.7 percent of the nonelderly population had coverage in their own name, compared with 33.8 percent in 1987. Similarly, 31.1 percent of the nonelderly population had employment-based health insurance as dependents in 1995, compared with 35.4 percent in 1987. One of the most important determinants of health insurance coverage is work status and hours of work. While employment-based health insurance received directly from worker's employer decreased between 1987 and 1995 from 66.2 percent of 63.2 percent among full-time workers, the percentage of part-time workers with employment-based health insurance coverage in their own name increased from 17.2 percent to 20.1 percent. The percentage of workers with dependent coverage fell for both full-time and part-time workers, as did the percentage of nonworkers with dependent coverage. Workers in the manufacturing industry are most likely to have employment-based health insurance; they are also the workers most likely to have experienced a decrease in employment-based coverage between 1987 and 1995. In contrast, workers employed in most of the service sectors, experienced an increase in employment-based health insurance, self-employed workers experienced a decrease, and government workers experienced a slight increase. Cost is one of the primary factors contributing to the decline in employment-based health insurance coverage. While health insurance premium cost increases have slowed during the past three years, many health care analysts are predicting an increase in health insurance premiums during the next few years. Inflationary pressure may come from health care providers, health insurers, consumers, and/or policymakers. If inflationary pressure increases health insurance premiums, we are likely to see a continued decline in employment-based health insurance and a subsequent increase in both Medicaid and uninsured populations.     

Mental disorders among non-elderly nursing home residents

Many Medicaid beneficiaries aged 22 to 64 with serious mental illness may be admitted to nursing facilities rather than psychiatric facilities as a result of Medicaid policies prohibiting coverage of inpatient psychiatric care in institutions of mental disease while requiring states to cover nursing facility care. Using nationwide Medicaid Analytic Extract claims from 2002, we found that nearly 16% of nursing home residents aged 22 to 64 had a diagnosed mental disorder, while 45.5% received antipsychotic medication, but these rates varied widely across states. Further research is necessary to determine whether, among the nation's youngest nursing home residents, care in nursing homes is potentially substituting for care in institutions for mental disease or community-based settings.     

Elders with Serious Mental Illness: Lost Opportunities and New Policy Options

This article reviews key federal Medicaid policies affecting older adults with serious, long-term mental illness: (a) the Medicaid exclusion of coverage for Institutions for Mental Diseases, (b) the Preadmission Screening and Resident Review Process, and (c) the Medicaid Home and Community Based Services waiver policy. Documenting the incentives and restrictions in these policies provides an historical context for understanding the current gaps in treatment for elders with mental illness. New federal options under the Deficit Reduction Act may provide opportunities for reducing the institutional bias for older adults with mental illness and for improving mental health services for elders under Medicaid.     

Mental Disorders Among Non-Elderly Nursing Home Residents

Many Medicaid beneficiaries aged 22 to 64 with serious mental illness may be admitted to nursing facilities rather than psychiatric facilities as a result of Medicaid policies prohibiting coverage of inpatient psychiatric care in institutions of mental disease while requiring states to cover nursing facility care. Using nationwide Medicaid Analytic Extract claims from 2002, we found that nearly 16% of nursing home residents aged 22 to 64 had a diagnosed mental disorder, while 45.5% received antipsychotic medication, but these rates varied widely across states. Further research is necessary to determine whether, among the nation's youngest nursing home residents, care in nursing homes is potentially substituting for care in institutions for mental disease or community-based settings.     

Children with serious emotional disturbance: the impact of poverty and receipt of public assistance on behavior, functioning, and service use

The present study examines the associations between poverty status, receipt of public assistance, service use, and children's mental health. Using a sample of children with serious emotional disturbances, findings from logistic regressions indicated that although no significant associations were found between poverty status and emotional or behavioral problems, families living below the poverty threshold were more likely to receive fewer services, even after controlling for receipt of Medicaid or SSI. Significant associations were also found for child's age, race/ethnicity, caregiver education, Medicaid and TANF receipt, child and family mental-health-risk factors. Poor families were more likely to have older children, be non-white, have fewer years of education, receive public assistance, and have more family mental-health-risk factors, but less child mental-health-risk factors. While a higher percentage of nonpoor families received medication management and residential treatment services, more poor families received support services such as transportation and flexible funds. Implications for the findings are discussed.     

The aborted sibling factor: A case study

The number of abortions in the world is steadily increasing, and there are now millions of children who have survived the abortion of a sibling. There is increasing evidence that even very young children may be aware of maternal abortions despite family attempts to maintain secrecy. For those children experiencing other powerfully unresolved conflicts, the abortion of a sibling may trigger a severe reaction. A case is presented in which it gradually became clear that a 5-year-old girl's withdrawn regression was related to her mother's multiple abortions and her own fear of being destroyed through maternal aggression.     

Everyday Restriction: Central American Women and the State in the Mexico‐Guatemala Border City of Tapachula

Media coverage and emerging scholarship have brought increasing international attention to the urgent humanitarian crisis facing Central American transmigrants as they navigate landscapes of violence in Mexico. While stories of Central American immigrants who remain in Mexico are largely absent from this coverage, there is arguably a “Central Americanization” occurring on the southern border through this permanent settlement. Central Americans choosing to establish themselves in the border state of Chiapas do so in a socio‐spatial and political context defined by the introduction of “progressive” state‐ and national‐level migration policies on the one hand and the persistence of discrimination and violence on the other. We know little about the implementation of these policies on the ground, namely how they are applied and the impacts they have on the immigrant experience in Mexico. To begin to fill this gap, this paper focuses on the experiences of Central American immigrant women living in the Mexico‐Guatemala border city of Tapachula. Employing a feminist geopolitical lens, which encourages conducting research and analysis at diverse scales, it examines their everyday interactions with low‐ to mid‐level representatives of the Mexican state as they seek to avail themselves of their legal and social citizenship rights, and the impacts of these interactions on their livelihoods. This article argues that low‐ to mid‐level officials’ actions reveal the importance of a form of extra‐official, subtle, yet pervasive regulation through which immigrant women are denied rights they are entitled to, inducing negative impacts to their livelihoods, which I term everyday restriction.     

Sources of health insurance and characteristics of the uninsured: analysis of the March 2000 Current Population Survey

This Issue Brief provides summary data on the insured and uninsured populations in the nation and in each state. It discusses the characteristics most closely related to an individual's health insurance status. Based on EBRI estimates from the March 2000 Current Population Survey (CPS), it represents 1999 data--the most recent available. In 1999, for the first time since at least 1987, the percentage of Americans with health insurance increased: 82.5 percent of nonelderly Americans (under age 65) were covered by some form of health insurance, up from 81.6 percent in 1998. The percentage of nonelderly Americans without health insurance coverage declined from 18.4 percent in 1998 to 17.5 percent in 1999. The main reason for the decline in the number of uninsured Americans is the strong economy and low unemployment. Between 1998 and 1999, the percentage of nonelderly Americans covered by employment-based health insurance increased from 64.9 percent to 65.8 percent, continuing a longer-term trend that started between 1993 and 1994. In 1999, 34.1 million Americans received health insurance from public programs, and an additional 15.8 million purchased it directly from an insurer. Twenty-five million Americans participated in the Medicaid program, and 6.5 million received their health insurance through the Tricare and CHAMPVA programs and other government programs designed to provide coverage for retired military members and their families. Despite expansions in the State Children's Health Insurance Program (S-CHIP), public health insurance coverage did not increase overall between 1998 and 1999. The percentage of nonelderly Americans covered by Medicaid and other government-sponsored health insurance coverage did not change between 1998 and 1999, though some children benefited from expansions in government-funded programs. The percentage of children in families just above the poverty level without health insurance coverage declined dramatically, from 27.2 percent uninsured in 1998 to 19.7 percent uninsured in 1999. Some of the decline can be attributed to expansions in Medicaid and S-CHIP, but it appears that expansions in employment-based health insurance and individually purchased coverage had an even larger effect than expansion of S-CHIP. Even though the number and percentage of uninsured declined substantially between 1998 and 1999, more than 42 million Americans remain uninsured. As long as the economy is strong and unemployment is low, employment-based health insurance coverage will expand and the uninsured will decline gradually. If the economy continues to soften or comes close to a recession, the number of uninsured would easily and quickly start to increase again as unemployment rises. Should a severe downturn in the economy occur, causing the uninsured to represent 25 percent of the nonelderly population, 63 million Americans would be uninsured.     

The Effects of Unemployment on Prenatal Care Use and Infant Health

Do recessions improve birth outcomes? This study investigated the relationship between unemployment fluctuations, prenatal care utilization and infant health. Analyzing the US Natality Detail Files for the period 1989–1999 aggregated by county, year, and race, I found the overall effects of unemployment to be beneficial but concluded that at least some of the apparent benefits are attributable to the Medicaid “safety net.” In supplementary analyses stratified by socioeconomic status, Medicaid played the largest role among economically disadvantaged (single and less educated) women. Thus, unemployment seems to be good for at least some pregnancies—provided Medicaid steps in.     

Race and gender differences in the distribution of home and community-based services in Florida

This article examines the distribution of home and community-based services (HCBS) under Florida's Medicaid waiver program. Controlling for personal and community characteristics, it was found that gender and race significantly affect the access of the disabled adult population to HCBS services, with women and nonwhites significantly more likely to be receiving HCBS services. At the county level, the likelihood of one's being in the waiver program is contingent on the racial composition and level of segregation of the county. People residing in counties with substantial proportions of nonwhites are less likely to receive HCBS services--whatever their race. However, the higher the rate of racial segregation in the county, the higher the probability that the Medicaid disabled adult population will receive HCBS services. The Medicaid waiver program allows older, disabled black women to remain in their home neighborhoods rather than having to move to predominantly white areas where nursing homes are concentrated. Thus, the HCBS program not only provides them with a form of care that is preferred by most older people but also resolves market problems stemming from the lack of nursing homes in segregated areas by taking advantage of support systems in black households.     

The Effects of Recent Welfare and Immigration Reforms on Immigrants' Access to Health Care1

This study investigates the impact of the Personal Responsibility and Work Opportunity Reconciliation Act and the Illegal Immigration Reform and Immigrant Responsibility Act, both passed in 1996, on the use of health‐care services in immigrant communities in five Texas counties. The study presents findings of interviews with public agency officials, directors of community‐based organizations, and members of 500 households during two research phases, 1997–1998 and 1998–1999. In the household sample, 20 percent of U.S. citizens and 30 percent of legal permanent residents who reported having received Medicaid during the five years before they were interviewed also reported losing the coverage during the past year. Some lost coverage because of welfare reform restrictions on noncitizen eligibility or because of changes in income or household size, but many eligible immigrants also withdrew from Medicaid “voluntarily.”