Citation URL: http://www.urban.org/AlyssaWigton

Alabama made several changes to improve health care access for its low-income population. Effective outreach for SCHIP and streamlined enrollment for Medicaid and other insurance programs for the uninsured poor have increased coverage for children. The state has also increased Medicaid payment rates for physicians and dentists to improve access for enrollees. Budget pressures may threaten progress in these areas. Medicaid funding comes chiefly from intergovernmental transfers from hospitals in conjunction with use of the upper payment limit and disproportionate share hospital programs. Both of these programs are being cut back at the federal level. Since the structure of its tax system limits Alabama's ability to raise revenues, these changes in federal sources of financing represent the greatest current threat to health care programs for low income Alabamians.

California recently applied for a waiver of federal State Children's Health Insurance Program (SCHIP) requirements that would allow it to expand Healthy Families, its insurance program for low-income children, to parents. This paper explores the implications of expanding Healthy Families for marginal tax rates and marriage penalties and bonuses. The authors use a model of California tax and transfer programs to analyze the impact of the proposed expansion on the work and marriage incentives of several prototypical families. They also discuss tradeoffs associated with program expansion and examined a few alternative designs based on higher income limits and different premium structures. (Published by the Medi-Cal Policy Institute; 2001 September.)

California recently applied for a waiver of federal State Children’s Health Insurance Program (SCHIP) requirements that would allow it to expand Healthy Families, its insurance program for low-income children, to parents. This brief summarizes the findings from a larger paper written by the authors that explored the implications of expanding Healthy Families for marginal tax rates and marriage penalties and bonuses, as well as alternative design options that might increase work and marriage incentives. (Published by the Medi-Cal Policy Institute; 2001 September.)

Snapshots of America's Families II is the Urban Institute's first look at the well-being of children and adults through the lens of the 1999 National Survey of America's Families (NSAF). Snapshots II presents a picture of how the experiences of American families have changed in the first few years following federal welfare reform and other major policy changes. This new information will broaden the nation's understanding of the experience of low-income families and the challenges they face. Snapshots II offers national and state-specific portraits of family well-being that can inform future debates on welfare, health care, and the social safety net in America.

Using data collected by the National Survey of America's Families (NSAF), this Snapshot compares changes in seven indicators of family well-being--employment, family income, food hardship, housing hardship, family structure, health insurance, and health status--between 1997 and 1999 by race and ethnicity. Data are grouped into three racial and ethnic categories: white non-Hispanics, black non-Hispanics, and Hispanics of all races (referred to as white, black, and Hispanic, respectively).

This brief uses data from the 1997 National Survey of America's Families (NSAF) to show that black, Hispanic, and Native American families face hardship that is not tied to income alone. This brief looks at poverty, family structure, child support, food and housing hardship, and health status and insurance coverage. Among the findings: over one-half of low-income blacks, Hispanics, and Native Americans experienced hardship. Even at higher incomes, blacks, Hispanics, and Native Americans are nearly twice as likely to experience food hardships as whites. Regardless of income, Hispanic adults are more likely to report being in fair or poor health.

Recent public policy initiatives are aimed at promoting work so that families can pay for their basic needs. However, even people who work may have problems paying their housing expenses. The Department of Housing and Urban Development reported recently that many people working full-time at the minimum wage have difficulty affording decent-quality housing in the private rental market.

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