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The December issue of Health Affairs contains several studies focusing on research addressing disparities in the use of government programs providing financial safety nets. Other issue studies address access to contraception, medical device shortages, and building community power to achieve equity.
The equitable social support articles were supported by the Robert Wood Johnson Foundation.
Featured articles highlighted and described below:
Income supports: how low-income parents navigate eligibility “cliffs.”
Policy makers worry that benefit “cliffs,” where a small increase in income can reduce or eliminate eligibility for public benefits, serve as disincentives to work. Little is known about how low-paid workers navigate this complex financial terrain. To better understand the navigation process, Kess Ballentine of Wayne State University and coauthors interviewed twenty-five low-income parents in Pittsburgh, Pennsylvania, on multiple occasions between June and December 2020. The researchers found that the primary driver of parents’ decision making was their ability to care for and ensure the survival of their families. Parents made employment decisions based on nuanced assessments of their currently available resources—financial, material, and emotional—of which public benefits are just one element. As a result, the authors recommend that policy makers avoid trying to incentivize work by tying public benefits to employment. Rather, they suggest that programs focus on alleviating labor precarity and financial insecurity, which will lead to better outcomes for families.
Cash assistance: racial patterns of child support compliance sanctions.
Enrollees in Temporary Assistance for Needy Families (TANF), a federal cash welfare program, face sanctions if they do not comply with various program requirements. Past research has shown that although sanctions are intended to serve as an accountability measure, sanctioning has not been shown to be effective in improving customer outcomes. In addition, to date, little research has examined how implementation of TANF may have differential impacts depending on race, geography, age, and other demographic traits. To better understand these differences, Kathryn Kaplan of the Heartland Alliance and coauthors reviewed data about families with young children in Illinois for 2017–20, combining data analysis with semistructured interviews of TANF clients. They found that during 2018–19, Black families enrolled in TANF were 111 percent more likely than White families to receive at least one sanction. According to the authors, child support compliance is a major barrier for many TANF families and can contract the program’s goal of supporting two-parent households. The researchers conclude that policy recommendations should include shifting to alternative cash assistance models so that families receive the full child support benefit.
Contraception access in Colorado increases college competition.
The Colorado Family Planning Initiative expanded access to contraceptives in 2009 by allowing all clients of Title X clinics in the state to choose any contraceptive method approved by the Food and Drug Administration, including long-acting reversible methods, at low or no cost. Past research has linked the introduction of the oral contraceptive pill in the 1960s to women’s college completion, but it is unclear whether improvements in access to contraception in the contemporary US will yield similar gains. To better understand this connection, Sara Yeatman of the University of Colorado Denver and coauthors analyzed linked data from the 2000 and 2010 censuses and the American Community Survey. They found that exposure to the initiative at high school age was associated with an increase in women’s on-time bachelor’s degree attainment of 1.8–3.5 percentage points, which represents a 6–12 percent increase in women’s level of college completion. According to the authors, the initiative resulted in an additional 2,300 college graduates in the state over the course of the three years studied. They conclude that at a time when some US states are seeking to restrict public subsidies for contraception, this finding provides important contemporary evidence that access to contraception improves women’s lives.
Also of interest in the December issue:
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