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Just Don't Get Sick

Access to Health Care in the Aftermath of Welfare Reform

Karen Seccombe and Kim A Hoffman

Publication Year: 2007

The ability to obtain health care is fundamental to the security, stability, and well-being of poor families. Government-sponsored programs provide temporary support, but as families leave welfare for work, they find themselves without access to coverage or care. The low-wage jobs that individuals in transition are typically able to secure provide few benefits yet often disqualify employees from receiving federal aid.

Drawing upon statistical data and in-depth interviews with over five hundred families in Oregon, Karen Seccombe and Kim Hoffman assess the ways in which welfare reform affects the well-being of adults and children who leave the program for work. We hear of asthmatic children whose uninsured but working mothers cannot obtain the preventive medicines to keep them well, and stories of pregnant women receiving little or no prenatal care who end up in emergency rooms with life-threatening conditions.

Representative of poor communities nationwide, the vivid stories recounted here illuminate the critical relationship between health insurance coverage and the ability to transition from welfare to work.

Published by: Rutgers University Press

Title Page, Copyright

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List of Figures and Tables

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pp. vii

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pp. ix

A project of this magnitude involves the assistance of many people, and we are appreciative of all our colleagues who gave considerable time and effort to this project. Co-investigators included Heather Hartley, Jason Newsom, and Clyde Pope, who were integral to all aspects of data collection and analysis...

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1. Introduction: Access to Health Care and Welfare Reform

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pp. 1-27

Let us introduce “Molly,” a young woman who recently left welfare for work. We interviewed her in her home in a small community at the end of 2002 and then again at the end of 2003 to see how she had been faring since leaving welfare. The focus of our conversation was on health—has Molly been able to get...

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2. Health Status and Health Changes

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pp. 28-62

When conducting a research study, it is common for some participants to stand out as particularly dedicated to the project—faithfully returning phone calls and letters, informing the project staff when they move, and willing to be open about subjects that may be sensitive or painful. Sarah is one of those people...

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3. Insurance Coverage

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pp. 63-89

Vicky had been difficult to reach for her interview. It was clear she was a very busy woman and that time given to us for an interview meant time away from more important and pressing aspects of her life. Despite this, we made arrangements to meet on one of her days off from work on a blistering hot July afternoon...

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4. Other Access and Barriers to Health Care

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pp. 90-113

Guadalupe is a hearty Mexican woman with round features. She is very soft spoken and shy; her smile is warm and welcoming. Originally from Durango, Mexico, where her other siblings still live, she has been residing for the past ten years in the sparsely populated, rural, dry climate of eastern Oregon with...

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5. Do Families Get the Health Care They Need?

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pp. 114-135

One advantage of a study that takes place over time is the kind of trust and rapport that can be built between a respondent and an interviewer. Maya is an example of someone who initially seemed a bit reserved toward us, but over the course of a year of contact, made a distinct effort to allow us into her life...

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6. Worry, Planning, and Coping

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pp. 136-162

When the stories we have gathered from respondents find their readers, they are simply words on the page, unable to convey the rich context and sometimes difficult surroundings in which those words were collected. Kelly is an example of a woman who is difficult to fully describe with the printed word...

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7. Facing Reality

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pp. 163-184

Social policies can have profound consequences for the health of the population. The passage of the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) in 1996 is often viewed as a defining moment in the history of social welfare in the United States and, as we have shown...


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pp. 185-189


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pp. 191-203


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pp. 205-211

About the Author

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pp. 213

E-ISBN-13: 9780813541457
E-ISBN-10: 081354145X
Print-ISBN-13: 9780813540900

Page Count: 224
Publication Year: 2007