Just Don't Get Sick: Access to Health Care in the Aftermath of Welfare Reform (Critical Issues in Health and Medicine)

226 Pages·2007·0.63 MB·English

by  Karen Seccombe

Just Don’t Get Sick
Critical Issues in Health and Medicine
Edited by Rima D. Apple, University of Wisconsin–Madison,
and Janet Golden, Rutgers University, Camden
Growing criticism of the U.S. health care system is coming from consumers,
politicians, the media, activists, and health care professionals. Critical Issues in
Health and Medicine is a collection of books that explores these contemporary
dilemmas from a variety of perspectives, among them political, legal, historical,
sociological, and comparative, and with attention to crucial dimensions such as
race, gender, ethnicity, sexuality, and culture.
Just Don’t Get Sick
Access to Health Care in the
Aftermath of Welfare Reform
Karen Seccombe and Kim A. Hoffman
Rutgers University Press
New Brunswick, New Jersey, and London
Library of Congress Cataloging-in-Publication Data
Seccombe, Karen, 1956–
Just don’t get sick : access to health care and the aftermath of welfare reform /
Karen Seccombe and Kim A. Hoffman.
p. ; cm. — (Critical issues in health and medicine)
Includes bibliographical references and index.
ISBN 978-0-8135-4090-0 (hardcover : alk. paper)
ISBN 978-0-8135-4091-7 (pbk. : alk. paper)
1. Health care reform—Oregon. 2. Insurance, Health—Oregon. 3. Health services
accessibility—Oregon. I. Hoffman, Kim A., 1970– II. Title. III. Series.
[DNLM: 1. Health Services Accessibility—Oregon. 2. Health Care Reform—Oregon.
3. Insurance, Health—Oregon. 4. Interviews—Oregon. 5. Social Welfare—Oregon.
6. Socioeconomic Factors—Oregon. W 76 S444j 2007]
RA395.A4J8744 2007
362.1'042509795—dc22 2006035925
A British Cataloging-in-Publication record for this book is available from the British Library
Copyright © 2007 by Karen Seccombe and Kim A. Hoffman
All rights reserved
No part of this book may be reproduced or utilized in any form or by any means, electronic
or mechanical, or by any information storage and retrieval system, without written
permission from the publisher. Please contact Rutgers University Press, 100 Joyce Kilmer
Avenue, Piscataway, NJ 08854–8099. The only exception to this prohibition is “fair use” as
defi ned by U.S. copyright law.
Manufactured in the United States of America
Contents
List of Figures and Tables vii
Acknowledgments ix
Chapter 1 Introduction: Access to Health Care and Welfare Reform 1
Chapter 2 Health Status and Health Changes 28
Chapter 3 Insurance Coverage 63
Chapter 4 Other Access and Barriers to Health Care 90
Chapter 5 Do Families Get the Health Care They Need? 114
Chapter 6 Worry, Planning, and Coping 136
Chapter 7 Facing Reality 163
Appendix 185
Bibliography 191
Index 205
v

Figures and Tables
Figures
2.1 Norm-based scoring of SF-12 Profi le, TANF leavers 34
3.1 Insurance trends over the year following Wave 1 interview 68
Appendix.1 Sampling 186
Tables
1.1 Characteristics of Study Sample 20
2.1 Physical and Mental Health Status 36
2.2 Health Condition Changes over Last Six Months, Wave 2 38
2.3 Weight, Obesity, and Food Security 46
2.4 Children’s Health 53
3.1 The Uninsured 71
3.2 Insurance Coverage and OHP 79
3.3 Insurance Coverage and Employer-Sponsored Insurance 85
4.1 Distances and Transportation Barriers to Seeking Health
Care, Wave 1 95
4.2 Personal Barriers: Bills and Debt, Telephone, Child Care 100
4.3 Providers and Services 104
4.4 Providers and Services by Race and Ethnicity 106
4.5 Employment Constraints 110
5.1 Respondent’s and Children’s Health Care Use 121
5.2 Delayed or Forgone Care 124
5.3 Dental Care 129
5.4 Use of Services and Delayed or Forgone Care, by Race
and Ethnicity, Wave 2 133
6.1 Worry 143
Appendix.1 Response, Cooperation, Refusal, and Contact Rates 187
vii

Acknowledgments
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.
We worked closely together for over three years so that we could better under-
stand what happens to the health of families and their access to health care
after they leave welfare for work. Their contributions are woven together here
in this book.
We also express our appreciation to the many students associated with
the School of Community Health and the Center for Public Health Studies
who contributed countless hours helping us conduct quantitative and quali-
tative interviews, transcribing and coding data, tracking respondents in the
far corners of Oregon, analyzing the mounds of data that we collected, and
assisting in drafting the fi nal report for our funding organization. These stu-
dents include Christina Albo, Gwen Marchand, Cathy Gordon, Tosha Zaback,
Richard Lockwood, Valerie Nias, and Terri Brockel. Karen McNeil, Donna
Harris, Beth Bull, and Wayne McFetridge provided important staff support at
our university, and Marcus Vincent generously donated many hours to help
us with programming and other technical tasks. As usual, Richard Meenan
provided the always appreciated editing assistance and help with organizing
the tables and references.
We also thank the Agency for Healthcare Research and Quality (AHRQ)
for its funding of this project, and Pamela Owens, our project offi cer at AHRQ.
Without their vote of confi dence a study of this magnitude would have been
impossible. We also want to acknowledge the key staff at Adult and Family
Services (AFS) and the Offi ce of Medical Assistance Programs (OMAP) for
providing us with access to their administrative data that allowed our ideas
to come to fruition.
Most of all, we extend our warmest appreciation and thanks to all the
women and men who generously gave of their time to participate in this
study. We are honored to represent your voices and hope that others will lis-
ten closely to them. You have much to add to discussions about meaningful
welfare reform.
ix