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Just Don't Get Sick

Just Don't Get Sick: Access to Health Care in the Aftermath of Welfare Reform

Karen Seccombe
Kim A. Hoffman
Copyright Date: 2007
Published by: Rutgers University Press
Pages: 224
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  • Book Info
    Just Don't Get Sick
    Book Description:

    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.

    eISBN: 978-0-8135-4145-7
    Subjects: Health Sciences, Political Science

Table of Contents

  1. Front Matter
    (pp. i-iv)
  2. Table of Contents
    (pp. v-vi)
  3. List of Figures and Tables
    (pp. vii-viii)
  4. Acknowledgments
    (pp. ix-xii)
  5. Chapter 1 Introduction: Access to Health Care and Welfare Reform
    (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 the health care that she and her family need after leaving the security of welfare that had provided for her medical insurance?

    Molly touched us by the “ordinariness” of her struggle. Stories like hers are common. She is not a...

  6. Chapter 2 Health Status and Health Changes
    (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. We learned a great deal from the two telephone and two in-person interviews we had with Sarah, and her story illustrates the struggles that some women face getting health care for a sick child after leaving TANF.

    Sarah is a thirty-two-year-old woman living in the Portland, Oregon, metropolitan...

  7. Chapter 3 Insurance Coverage
    (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. Her small, ocean-colored ranch house was located in a Portland metropolitan neighborhood that, despite its pleasant appearance, had long been known for its share of crime and depressed property values.

    Vicky is a thirty-nine-year-old African American mother of three. When...

  8. Chapter 4 Other Access and Barriers to Health Care
    (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 her husband and eight children. Only three of her eight children were born in the United States, leaving the oldest five, along with Guadalupe and her husband, undocumented.

    Her community, which has a population of about 1,700 people, lies in a remote stretch of Oregon. The closest town...

  9. Chapter 5 Do Families Get the Health Care They Need?
    (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. Her background gives her a unique perspective in that her employer works in public policy, and she is his assistant. In addition to the story she shared about her own experiences, she was able to offer insights into what is...

  10. Chapter 6 Worry, Planning, and Coping
    (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; her sheer will to survive and overcome hardship was transforming. Kelly also provides an important perspective on how families plan for and cope with loss of their health insurance after leaving welfare for work.

    We arrived at Kelly’s home for her first interview and she shyly invited us into...

  11. Chapter 7 Facing Reality
    (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, affects health in varied ways. However, welfare reform policy does not exist in isolation. The political and fiscal attack on our welfare system has deep and historic roots that reflect American sentiment about poverty generally and poor women in particular. Americans tend to view public relief programs with suspicion, believing the programs...

  12. Appendix
    (pp. 185-190)
  13. Bibliography
    (pp. 191-204)
  14. Index
    (pp. 205-212)
  15. Back Matter
    (pp. 213-214)