Children Living With Uninsured Family Members: Differences by Family Structure

Despite increased access to insurance through the Patient Protection and Affordable Care Act of 2010, uninsurance rates are expected to remain relatively high. Having uninsured family members may expose children to financial hardships. Eligibility rules governing both private and public health insurance are based on outdated expectations about family structure. Using 2009–2011 data from the National Health Interview Survey (N = 65,038), the authors investigated family structure differences in family‐level insurance coverage of households with children. Children living with married biological parents were the least likely to have uninsured family members and most likely to have all family members covered by private insurance. Controlling for demographic characteristics and income, children in single‐mother families had the same risk of having an uninsured family member as children in married‐parent families. Children with cohabiting biological parents had higher rates of family uninsurance than children with married biological parents, even accounting for other characteristics.     

Child Support Obligations and Low‐Income Fathers

Using the 1994–1998 waves of the Current Population Survey—Child Support Supplement (N =5,387), the aims of this study are to document child support obligation rates of nonresident fathers, to examine the effect of the obligation rate on child support compliance, and to calculate the trade‐off between fathers’ financial responsibility and children's well‐being, paying particular attention to low‐income fathers. The results indicate that low‐income fathers have high child support obligation rates, which significantly reduce their child support compliance. Although lowering the obligation rate for these fathers may improve their compliance, it does not fully offset the lowered obligation amounts and leads to a 30% net payment loss for welfare mothers and a 43% loss for nonwelfare mothers. Policy implications are discussed.     

Sources of health insurance and characteristics of the uninsured: analysis of the March 1997 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 individuals' health insurance status. Based on EBRI analysis of the March 1997 Current Population Survey, it represents 1996 data--the most recent data available. In 1996, 82.3 percent of nonelderly (under age 65) Americans had private or public health insurance. Seventy-one percent had private insurance, 64 percent through an employment-based plan. Sixteen percent had public health insurance. The percentage of uninsured Americans has been increasing since at least 1987. In 1987, 14.8 percent of the nonelderly population was uninsured, compared with 17.7 percent in 1996. However, the erosion of employment-based health benefits cannot fully explain this increase since 1993. Instead, the decline in public sources of health insurance would partly explain it. It may be that, while the percentage of individuals with employment-based coverage is rising, individuals previously covered by Medicaid and CHAMPUS/CHAMPVA are not being fully absorbed into the employment-based health insurance market. Between 1995 and 1996, the percentage of nonelderly Americans without health insurance coverage increased from 17.4 percent to 17.7 percent. Further examination indicates that children completely accounted for this increase. In 1995, 13.8 percent of children and 19 percent of persons ages 18-64 were uninsured, compared with 14.8 percent of children and 18.9 percent of persons ages 18-64 in 1996. With the recent passage of legislation designed to reduce the number of uninsured children, the next focal point for health care reform could be early retirees and unemployed persons. President Clinton and some members of Congress have expressed an interest in improving access to and affordability of coverage for these groups. Currently, health care cost inflation is at its lowest point in years, but there are signals indicating that it is about to rise above current levels. The federal government's recent announcement that health insurance premiums will rise for federal employees an average of 8.5 percent in 1998 may portend higher future health care costs. Similarly, disappointing earnings announcements from several large insurers because of higher medical costs and lower-than-expected revenues may indicate that health insurance plans will increase premiums. Employment and income play a dominant role in determining an individual's likelihood of having health insurance. Age, gender, firm size, work hours, and industry are also important determinants; however, these variables are also closely linked to employment status and income. Some of the widest variations involve factors that are not always looked at in traditional demographic assessments, such as citizenship. However, variations by race, ethnicity, and citizenship are also closely linked to employment status and income.     

Employment and the Risk of Domestic Abuse Among Low‐Income Women

This paper uses data from 2 randomized evaluations of welfare‐to‐work programs—the Minnesota Family Investment Program and the National Evaluation of Welfare‐to‐Work Strategies—to estimate the effect of employment on domestic abuse among low‐income single mothers. Unique to our analysis is the application of a 2‐stage least squares method, in which random assignment enables us to control for omitted characteristics that might otherwise confound the association between employment and domestic abuse. We find that increased maternal employment decreases subsequent reports of domestic abuse in both studies. In the Minnesota Family Investment Program—a program with an enhanced income disregard that allowed welfare mothers to keep a portion of their welfare income as earnings rose—an increase in household incomes appears to have contributed to reductions in reports of domestic abuse.     

Girls’ Family Labor in Low‐Income Households: A Decade of Qualitative Research

This article analyzes a decade of qualitative research to identify and explore an overlooked survival strategy used in low‐income families: children's family labor. Defined as physical duties, caregiving, and household management responsibilities, children’s—most often girls’—family labor is posited as a critical source of support where low wages and absent adult caregivers leave children to take over essential, complex, and time‐consuming family demands. We argue that there are lost opportunities when children are detoured from childhood to do family labor and that an intergenerational transfer of poverty is associated with those losses.     

Americans’ Approval of the 2010 Affordable Care Act: Self‐interest and Symbolic Politics*

Public opinion data show substantial variation in attitudes toward the Affordable Care Act (ACA). Utilizing a 2013 Gallup survey of U.S. adults, we examine the effects of self‐interest and symbolic politics measures on several dimensions of ACA approval. Supporting symbolic politics, we find liberal political ideology, democratic party affiliation, and positive evaluations of President Obama are consistently associated with greater approval of the ACA generally, as well as the belief that the ACA will improve the healthcare situation of the United States and one's family specifically. In contrast, self‐interest variables produce less consistent results. Self‐reported familiarity with the law and being uninsured due to one's employer not offering health insurance are associated with greater belief the ACA will improve the healthcare situation of one's family specifically, but not the U.S. healthcare situation generally. Together these findings suggest that political values and symbols—in particular perceptions of President Obama—may be more important in shaping attitudes toward the ACA than self‐interest variables, especially in contexts assessing more generalized support for the legislation.     

Social profile,maternal depression and welfare concerns in clients of health visitors and social workers: a comparative study

Research into the practice of health visitors and child care social workers with depressed mothers is limited. This is surprising in view of the known relationship between motherhood and depression, and the association also between child care problems and maternal depression. The study described below is the first which seeks to compare health visitor and child care social work clients/service users in relation to the issue of maternal depression. In particular, it seeks to compare the extent to which maternal depression is a feature of the work of social workers and health visitors, the relationship between maternal depression and the social composition of different client groups, the relationship between maternal depression and welfare concerns—particularly child abuse—and the extent to which such concerns lead to referral from health visitors to social workers. The research shows: (1) interesting similarities between the depressed health visitor clients and social work clients as a whole; (2) the importance of low income and absence of support in the ‘progression’ from health visitor to social work clients status; and (3) an alarming emerging gap in services provided for severely disadvantaged families with child and family care problems.     

Economic Penalties and Rewards of Family Formation,Gender and Education in the Low‐income Sector in Germany1

This article examines the differential effects of changes in family formations on men's and women's economic vulnerability. The motivating question is whether investments in education provide sufficient resources to escape the risk of poverty in the low‐income sector or if changes in household characteristics are more important determinants of one's living standard. Changes in household characteristics are defined in terms of partners' entry into and exit from households and partners' different labour market profiles. The analysis focuses on households in the low‐income sector in Germany, a population that is at high risk of poverty in a social welfare state that is expected to mitigate the effects of changes in family formation independent of gender. Findings from panel regression analysis demonstrate that women, in contrast to men, benefit economically as much as or more from investing in traditional family formations than in their own labour market position. This is especially the case for women with lower levels of education.     

Urban and Rural Differences in the Provision of Health Insurance Coverage for Children of Divorce

Abstract

Using data from divorce case records in New Hampshire this study examined urban and rural differences in the provision of health insurance coverage for children of divorce. In the overall sample of cases (N= 474) results from a chi-square test found rural children (N= 123) to be nearly twice as likely to be uninsured than urban children (N= 351). Results from the logistic regression in the urban county found fathers' and mothers' incomes to increase the log odds of children having access to health insurance. Mothers' employment also increased the log odds of children being insured. In the rural county fathers' earnings and mothers' employment increased the log odds of children having access to health insurance. Pre-school age (0-5) decreased the log odds of children being insured. Implications for family practitioners in rural areas are discussed.     

When to Work for Pay,When Not to: A Comparative Study of Australian and Danish Volunteer Care Workers

This paper explores the links between volunteers care workers’ current unpaid work and their own present or former paid work with the objective of analysing the ways welfare states influence volunteer care work. Data were collected between August 2012 and May 2013 through 41 face-to-face interviews with Danish and Australian volunteers working with the frail elderly, very sick and terminally ill. Three related arguments are made. One, paid and unpaid care work are so intertwined that it is not possible to understand volunteers’ unpaid working lives without simultaneously understanding their paid work lives. Two, many volunteer care workers are attracted to care work, not volunteering per se. Three, volunteering must be understood in relation to men’s and women’s ‘access to work’ in the welfare state, access that ultimately depends on the design and developments of these two contrasting welfare states.     

Instability in patchworks of child care when moving from welfare to work

We use longitudinal, qualitative interview data collected from 38 initially welfare‐reliant women in Cleveland, Ohio to examine the factors driving instability in child‐care arrangements when women transitioned from welfare to work. Grounded theory analysis revealed that decisions about care were circumscribed by scarce social and economic resources, women went to extraordinary lengths to patch together arrangements that typically involved multiple providers, relative care was central to patchworks of care, and patchworks of child care were often highly unstable. These complex arrangements and their instability were influenced by mothers’ desires to find the most suitable arrangements for their children within resource and job constraints, dissatisfaction with providers, difficulties accessing subsidies, and changes in provider availability. Findings suggest that policymakers must consider instability in patchworks of multiple child‐care providers as they consider alternatives for meeting low‐wage working women's and children's needs for safe, affordable, accessible, and enriching nonmaternal child care.     

Maternal Functioning, Time, and Money: The World of Work and Welfare

Numerous studies have assessed families' employment and financial stability following welfare reform. Yet little research has addressed whether welfare and work transitions are linked with other changes in family functioning. Using a representative sample of approximately 2,000 low-income urban families from the Three-City Study, analyses assessed whether mothers' welfare and employment experiences over a two-year period following welfare reform were related to changes in family well-being. Lagged regression models controlling for family characteristics and earlier levels of functioning found that moving into employment and stable employment (of 30 hours or more per week) were linked to substantial increases in income and improvements in mothers' psychological well-being. Movements into employment also were associated with declines in financial strain and food insecurity. Sustained or initiated welfare receipt was related to relative declines in income, physical health, and psychological well-being, but also to improved access to medical care. In contrast, mothers' welfare and work experiences showed very limited relations to changes in the quality of parenting or of children's home environments. These patterns were similar for families with young children and those with adolescent children. Results suggest that parenting behaviors are more resistant to change than are maternal emotional and economic functioning.     

A Model for Change: Legislative Advocacy to Improving Access for the Uninsured and Underinsured in New York State 1

Advocates can successfully improve access to health care for people without health insurance. This article demonstrates the success of what began as a local advocacy effort to improve access to health care on Long Island, which later grew to become a major statewide advocacy movement. It explores the process taken by local coalition members to successfully fight for monumental public health legislation—first locally then statewide—to improve access to hospital care for the medically indigent. Using New York State as a model, it includes several approaches that could facilitate the enactment of legislation in other states. The experiences of New York advocates suggest that with focused collaborative efforts it is feasible to promote significant changes to public health laws to benefit the uninsured and underinsured.     

The Role of Family Income in the Intergenerational Association of AFDC Receipt

Daughters from low‐income families who did not receive Aid to Families with Dependent Children (AFDC) are compared to daughters from low‐income families who did receive assistance to better account for family income in the intergenerational association of AFDC. The research models the timing of a daughter's first birth and, for those who become mothers, the number of years a daughter receives any AFDC. Women whose families received AFDC during their childhood are more likely to receive AFDC as adults relative to those women whose families did not receive AFDC. Controlling for family income in a more careful and comprehensive way than past research explains part but not all of the effects of childhood AFDC receipt. Among daughters from chronically poor families, however, parental AFDC use is not associated with additional years of AFDC participation. Although the present research cannot confirm or deny a causal role for parental welfare use, the intergenerational transmission of financial resources does explain part of the intergenerational association of welfare use.     

Economic hardship in the family of origin and children's psychological well‐Being in adulthood

Past research consistently indicates that poverty and economic hardship have negative consequences for children. Few studies, however, have examined whether these consequences persist into adulthood. This study addresses this gap by assessing whether economic resources in the family of origin have long‐term effects on psychological well‐being in adulthood. Specifically, we test two processes—one involving interpersonal processes in the family of origin, and the other involving children's socioeconomic attainment—that may help to explain the link between early economic factors and later well‐being. Using 17‐year longitudinal data from two generations (N= 589), we find evidence that economic hardship in the family of origin predicts later adult well‐being through the parents’ marital relationship, the parent‐teen relationship, children's educational attainment, and children's earned income. Supplementary analyses suggest that economic hardship is particularly problematic when it is of long duration or when it occurs during adolescence.     

Consequences of Male Partner Violence for Low‐Income Minority Women

The current study used a random sample of 563 low‐income women to test Johnson's (1995) theory that there are two major forms of male‐partner violence, situational couple violence and intimate terrorism, which are distinguished in terms of their embeddedness in a general pattern of control. The study examined the associations between type of violence experienced and respondents’ physical health, psychological distress, and economic well‐being. Analyses revealed three distinct patterns of partner violence: intimate terrorism, control/no threat, and situational couple violence. Compared to victims of control/no threat and situational couple violence, victims of intimate terrorism reported more injuries from physical violence and more work/activity time lost because of injuries. Compared to women who experienced no violence in the previous year, victims of intimate terrorism reported a greater likelihood of visiting a doctor, poorer health, more psychological distress, and a greater likelihood of receiving government assistance.     

Changes in Wives' Income: Effects on Marital Happiness,Psychological Well‐Being,and the Risk of Divorce

We investigate the effects of increases in married women's actual income and in their proportion of total family income on marital happiness, psychological well‐being, and the likelihood of divorce. We use data from a sample of 1,047 married individuals (not couples) in medium‐duration marriages, drawn from a five‐wave panel survey begun in 1980 and continuing to 1997. Structural equation modeling is used to assess the impact of increases in married women's absolute and relative income from 1980 to 1988 on the marital happiness and well‐being of married men and women in 1988. Event history analysis is used to determine how these changes affect the risk of divorce between 1988 and 1997. We find that increases in married women's absolute and relative income significantly increase their marital happiness and well‐being. Increases in married women's absolute income generally have nonsignificant effects for married men. However, married men's well‐being is significantly lower when married women's proportional contributions to the total family income are increased. The likelihood of divorce is not significantly affected by increases in married women's income. Nevertheless, increases in married women's income may indirectly lower the risk of divorce by increasing women's marital happiness.     

Adaptive Strategies,Gender Ideology,and Work‐Family Balance Among Dutch Dual Earners

Using questionnaire data on 149 Dutch dual‐earner couples with young children participating in the European Famwork study, we examine how adaptive strategies and gender ideology relate to parents’ perceived success in balancing work and family. Path analysis indicates that some adaptive strategies may harm individuals’ work‐family balance, particularly when they are made in the domain where the time budget is limited. In the need to succeed in multiple roles, however, endorsement of traits traditionally linked with the opposite gender, that is masculine traits for women and feminine traits for men, seems beneficial. We speculate that two underlying mechanisms — social pressure and time constraints — jointly operate in determining perceived success in balancing work and family.     

Paternal Work Characteristics and Father‐Infant Interactions in Low‐Income,Rural Families

To examine the implications of paternal occupational conditions for the quality of father‐infant interactions, home visits, including interviews and videotaped observations of father‐infant interactions, were conducted with 446 fathers living in six low‐income, nonmetropolitan counties in North Carolina and Pennsylvania. When a variety of individual and demographic characteristics were controlled for, a less supportive work environment was associated with lower levels of fathers’ engaged and sensitive parenting. Significant interactions pointed to the importance of understanding combinations of risk factors. Experiencing high levels of workplace stressors, including low levels of self‐direction and high levels of care work, in the presence of other individual or demographic risk factors was associated with lower levels of father parenting quality.