Looking at the health effects of economic security policies
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Dear John,
The December 2022 issue of Health Affairs includes research funded
through the Robert Wood Johnson Foundation's Equity-Focused Policy
Research program. In an introductory analysis, Daniel Finkelstein and
colleagues describe the relationship between income and health.
Although various government programs provide a financial safety net, the
authors point out that "there is inequitable access to these programs,
which can exacerbate health disparities."
Read The Issue
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Equitable Social Supports
The Earned Income Tax Credit (EITC) is associated with improved health
outcomes, but about one in five eligible families do not receive the
benefit.
In interviews with EITC-eligible Californians, Rita Hamad and coauthors
find gaps in awareness of the program
<[link removed]>,
confusion about complex eligibility requirements, and language barriers
to obtaining needed information.
Dana Thomson and coauthors examine EITC receipt among eligible Hispanic
families
<[link removed]>.
They find "lower odds of EITC receipt among income-eligible families
with a self-employed parent, families with a parent who had lower
English language proficiency, and families living with relatives."
Enrollees in Temporary Assistance for Needy Families (TANF) face
sanctions if they do not comply with various program requirements.
Quantitative analysis of Illinois data
<[link removed]>
conducted by Kathryn Kaplan and coauthors shows that "Black and
multiracial families enrolled in TANF were more likely to be sanctioned
compared with families of other races."
Qualitative interviews highlight the role of child support cooperation
requirements, which the authors refer to as "an outdated and
institutionally racist operating model that takes away money from
families that are already struggling to achieve economic stability."
Donna Ginther and Michelle Johnson-Motoyama examine the association
between state TANF policies and child welfare
<[link removed]>.
As economic resources are correlated with child maltreatment, the
authors find that state TANF policies that restrict access to benefits
yield "statistically significant increases in neglect victims, total
foster care placements, and foster care placements for reasons of
neglect."
Policy makers worry that benefits "cliffs," where a small increase in
income can reduce or eliminate eligibility, serve as disincentives to
work or advancement.
In interviews with low-income parents in Pittsburgh
<[link removed]>,
Pennsylvania, Kess Ballentine and coauthors find little evidence of this
response.
Rather, they report, "In the context of a limited social welfare system
and a labor market rife with jobs with low pay, meager fringe benefits,
and little flexibility, parents focused on securing the right balance of
resources, including money, time, energy, and in-kind resources, to
promote family well-being."
Read More
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Community Health
In a Policy Insight
<[link removed]>,
Anthony Iton and coauthors argue that population health interventions
intended to promote equity and reduce disparities must shift from a
"technocratic" approach with a "focus on individuals' behaviors,
genes, or access to health care" to one based on communities exercising
power.
The work of health equity, the authors state, "requires enhancing the
quality of democracy to change the status quo power balance in
communities throughout the US."
Stephen Trinidad and coauthors analyze fifteen indices of area-based
socioeconomic deprivation
<[link removed]>,
identified through a systematic scoping review, and find variation in
the data used to define
**deprivation**, the geographic boundaries used to define each area, and
whether or not the indices rank areas.
Read More
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Access To Care
The Colorado Family Planning Initiative expanded access to
contraceptives in 2009 by allowing all clients of Title X clinics to
choose any contraceptive method approved by the Food and Drug
Administration at low or no cost to the client.
Sara Yeatman and coauthors find that the initiative led to a 6-12
percent increase in on-time college completion among women
<[link removed]>.
Drawing upon Germany's reference pricing for anti-inflammatory
biosimilars
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James Robinson explains that it is "administratively feasible,
clinically acceptable to patients, and financially beneficial to
purchasers" to group biologics and biosimilars into a single category
for payment, as advocated by the Medicare Payment Advisory Commission.
Using national data from the period 2011-15
<[link removed]>,
Paula Chatterjee and coauthors find that up to 31.6 percent of Medicaid
disproportionate share hospital payments, which subsidize hospitals
serving low-income patients and providing uncompensated care, have gone
to hospitals that "demonstrated low orientation toward caring for
low-income populations."
Read More
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Acknowledgments
Health Affairs thanks the Robert Wood Johnson Foundation for its
financial support of the equitable social supports articles. As the year
comes to a close, I express my deep gratitude to Sarah Kolk and Ndidi
Anekwe for preparing excellent drafts of the article summaries that
appear in each month's From The Editor-In-Chief.
Read More
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Order The Issue
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Join Health Affairs Unlimited to access our current and past issues
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Attend These Events
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Join us on December 8, 2022 for the free briefing, "EITC, TANF and More:
The Health and Policy Implications of Building Income Supports for
Low-Income Families with Young Children
<[link removed]>."
Selected authors and experts will present their work and discuss how
policy makers can better understand the drivers of disparities in access
to income support programs.
Additional events this month include:
* Policy Spotlight: One-On-One with Ashish Jha, White House Coordinator
of the COVID-19 Response
<[link removed]>
(12/12)
* Insider Journal Club: Understanding Take-Up Of The Earned Income Tax
Credit Among Californians With Low Income
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(12/15)
View Full Event Schedule <[link removed]>
Â
Health Affairs Branded Post:
2022 Health Equity in Medicaid Report: Challenges and Opportunities
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Sponsored by United Healthcare
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Listen To These Podcasts
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This month, we'll feature authors from the December issue discussing
topics like expanded contraceptive access and the use of area-based
socioeconomic deprivation indices.
Recently, Health Affairs Editor-in-Chief Alan Weil interviewed Abdinasir
Ali from the University of Iowa College of Public Health to discuss the
effects of state eviction moratoriums on mental health
<[link removed]>.
Check out our podcasts, and subscribe on Spotify
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or wherever you prefer to listen.
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About Health Affairs
Health Affairs is the leading peer-reviewed journal
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health care, and policy. Published monthly by Project HOPE, the journal
is available in print and online. Late-breaking content is also found
through healthaffairs.org <healthaffairs.org>, Health Affairs Today
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Project HOPE <[link removed]> is a global health and
humanitarian relief organization that places power in the hands of local
health care workers to save lives across the globe. Project HOPE has
published Health Affairs since 1981.
Copyright © Project HOPE: The People-to-People Health Foundation, Inc.
Health Affairs, 1220 19th Street, NW, Suite 800, Washington, DC 20036, United States
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