Book completed after $900,000 study

An urban studies professor and a one-time Ph.D. student await the publication of their new book after completing a $900,000 study about the effects of a temporary assistance program on adults and children.

Just Don’t Get Sick: Access to Health Care in the Aftermath of Welfare Reform, a book by Karen Seccombe and Kim Hoffman, both from the School of Urban Studies, was funded by the Agency for Healthcare Research and Quality and will be published by Rutgers University Press this summer.

Drawing upon statistical data and in-depth interviews with over 600 families in Oregon, Seccombe and Hoffman offer an assessment of the ways in which Temporary Assistance for Needy Families (TANF) affects the well-being of adults and children who leave the program for work. TANF, commonly known as welfare, is a monthly cash assistance program for poor families with children under age 18.

The study examines the effects of welfare reform on the access to health insurance and the use of health services among former welfare recipients in the state of Oregon, according to Seccombe.

“Specifically, we explored the ways in which TANF affects families and their children and the ways in which families leaving welfare for employment plan and cope with the expiration of their one-year transitional Medicaid/OHP coverage,” Seccombe said.

President Bill Clinton instituted TANF through the Personal Responsibility and Work Opportunity Act in 1996 and put a time limit on welfare eligibility. There is now a maximum of 60 months of benefits within one’s lifetime (some states instituted shorter periods) and there is a component requiring clients to attempt to find employment.

Representative of poor communities nationwide, the case studies used in the book represent the critical relationship between health insurance coverage and the ability to transition off welfare and into the job market.

“The low-wage jobs that individuals in transition are typically able to secure provide few benefits and often disqualify employees from receiving federal aid,” Seccombe said. “The likelihood that a parent is able to provide their family health insurance is slim.”

The study found that families coming off TANF are vulnerable because many of them experience poor health. With many children also in poor health, the study found that an alarming percentage of the respondents were uninsured.

Families leaving TANF experience a multitude of other barriers in securing health care, such as traveling more than 10 miles to find health care because of a lack of health providers, according to the study. Related to access difficulties, many of the respondents reported that they delayed or did without needed care, and the likelihood of doing so increased over time. Many respondents’ primary concern was their access to health care.

“It was hard to see so many people struggling with these issues,” Hoffman said, having met day after and day with many families.

Seccombe and Hoffman also make plenty of recommendations in their book. Among them, the two say welfare workers should be required to assist TANF recipients in not only job seeking, but also health insurance planning.

The professors recommend that federal or state governments provide greater incentives for businesses to provide insurance to their workers if the United States plans to continue to rely on employer-sponsored insurance as the foundation for coverage. Ultimately, these personal barriers must be acknowledged and policies must be developed to handle them, the book says.

Seccombe is professor of community health at PSU and was the primary investigator for the project. She received her Ph.D. in sociology from Washington State University and has since published countless journal articles and a book, “So you think I drive a Cadillac?”: Welfare Recipients’ Perspectives on the System and its Reform. She has also served as director to the Center for Public Health Studies.

“I’m a sociologist by training and have always been interested in understanding social inequality, the distribution of inequality, and believe that it must be documented in order to remedy it,” Seccombe said.

“I too have always been interested in poverty and health research, and this study is a perfect confluence of the two,” Hoffman said. Hoffman was a School of Urban Studies Ph.D. candidate throughout the study and has since received her Ph.D. She is now a research associate for the department for preventative medicine at OHSU.