Health & Poverty

IRP Discussion Papers, Reprints, and Special Reports

Health in the United States is very strongly correlated with income. Poor people are less healthy than those who are better off, whether the benchmark is mortality, the prevalence of acute or chronic diseases, or mental health. As a consequence, study of the physical and mental health of low-income populations has been a component of much IRP research. For example, IRP affiliates are currently undertaking a study of the effects of casino gambling income on health and health care among American Indian populations.

A sampling of the research currently being conducted by IRP affiliates addresses the following issues:

• Children with emotional and behavioral problems


• Health and health insurance status, particularly for low-income children and welfare leavers; and the role of expansions in public health insurance on health care coverage and labor force outcomes


• Socioeconomic status and health over the life course


• Aging and health, including the determinants of health status and mortality among the elderly, the economics of health and aging, inequality in health and well-being, and programs relating to long-term care for the elderly.

IRP Discussion Papers, Reprints, and Special Reports

Extending Health Care Coverage to the Low-Income Population: The Influence of the Wisconsin BadgerCare Program on Insurance Coverage
Barbara Wolfe, Thomas Kaplan, Robert Haveman, and Yoon Young Cho

This paper attempts to answer the following question: "To what extent does a public program with the characteristics of Wisconsin's BadgerCare program reduce the proportion of the low-income population without health care coverage?" Using a coordinated set of administrative databases, we track three cohorts of mother-only families who were receiving cash assistance under the Wisconsin AFDC and TANF programs in September 1995, 1997, and 1999, and who subsequently left welfare. We follow these "welfare leaver" families on a quarterly basis from two years before they left welfare through the end of 2001. All of our estimates indicate that BadgerCare substantially increased public health care coverage for mother-only families leaving welfare. (DP 1289-04)

An Empirical Investigation of the Relationship between Wealth and Health Using the Survey of Consumer Finances
Audra T. Wenzlow, John Mullahy, Stephanie A. Robert, and Barbara L. Wolfe

The paper addresses the role of financial wealth and its associations with the health status of individuals aged 25 to 54. The results from a battery of alternative estimated model specifications suggest that income and wealth are jointly significant correlates of health, and that wealth plays a stronger role for the oldest members of this age group. (DP 1287-04)

Understanding Racial Disparities in Health: The Income-Wealth Paradox
Audra T. Wenzlow, John Mullahy, and Barbara L. Wolfe

The paper examines the ways in which racial differences in health vary over the income-wealth distribution. Paradoxically, we find that although the largest unadjusted racial differences in health are between poor whites and poor nonwhites, after adjusting for income, wealth, and other demographic characteristics, health differences between nonwhites and whites are only significant among those in the upper half of the income-wealth distribution. The results suggest that unexplained racial differences in reported health status increase with socioeconomic status among individuals aged 25-54. (DP 1283-04)

Wisconsin's Family Care Long-Term Care Pilot Program: Care Managers' Perspectives on Progress and Challenges
Stephanie A. Robert

This report is part of an ongoing study of Wisconsin's Family Care pilot long-term care program, focusing on the perspective of care managers working in the Family Care program in four counties implementing Care Management Organizations. The goals were (1) to examine whether and how Family Care has changed the services provided to people with long-term support needs, (2) to describe some specific service issues that will need attention to improve Family Care, (3) to describe care managers' overall views of Family Care at the end of its early implementation phase, and (4) to describe care managers' suggestions for change to Family Care. (SR 87)

The Devil May Be in the Details: How the Characteristics of SCHIP Programs Affect Take-Up
B. Wolfe and S. Scrivner, with A. Snyder

In this paper we explore whether the specific design of a state's Children's Health Insurance Program has contributed to success in reducing the proportion of the targeted population that is uninsured, without a significant reduction in private coverage (that is, without crowd-out)? To answer these questions, we use three years of data (1998, 1999, 2000) from the Current Population Survey. Our research finds that the elimination of asset tests, phone information lines, and coverage for adults in low-income families all contribute to meeting these goals. (DP 1272-03)

Health Inequality between Black and White Women
Y.-W. Hu and B. Wolfe

Our objective is to explore the extent to which the inequality in health status between black and white women are associated with observed dissimilarities in characteristics. We use data from the 1996 Medical Expenditure Panel Survey, and predict that black women's likelihood of having excellent health would increase by 3-4 percentage points if they had the same characteristics, such as number of physician visits, educational level, marital status, weight status, and income level, as their white counterparts. (DP1251-02)

Medical Spending, Health Insurance, and Measurement of American Poverty
G. Burtless and S. Siegel

The paper examines the effects of three methods of including household spending on health care in the measurement of poverty. Whatever the method, the inclusion of medical spending in the poverty definition has a large effect on the level and composition of poverty, providing a very different picture than the official poverty lines. Levels and composition of poverty are, however, comparatively unaffected by the decision to add "reasonable" medical spending to poverty thresholds rather than subtract actual medical spending from family resources. The choice between these two methods depends on the user's theoretical preferences, since both approaches can produce virtually identical pictures of the nation's poor. (DP 1238-01)

Child Well-Being and the Intergenerational Effects of Undocumented Immigrant Status
S. M. Kanaiaupuni

Findings of this study support the author's argument that children with undocumented immigrant parents suffer higher risks of poverty and poor health than children in legal households, and that children in mixed-status households are equally disadvantaged. (DP 1210-00)

The Economics of Disability and Disability Policy
R. Haveman and B. Wolfe

RPT 816 (Handbook of Health Economics, Volume 1A, ed. A. Culyer and J. Newhouse [Amsterdam: North-Holland, 2000], pp. 995-1051).

The chapter assesses the prevalence, trend, and composition of the population of disabled working-aged people in the United States and other Western societies, and documents the extent of market work among this population. It discusses income support policy and public policy toward disabled people that is associated with antidiscrimination legislation, rehabilitation and training programs, income support for poor disabled children, and public regulations and financial support for special education in schools.

The Changing Economic Status of Disabled Women, 1982-1991: Trends and Their Determinants
R. Haveman, K. Holden, B. Wolfe, P. Smith, and K. Wilson

RPT 805 (The Economics of Disability, ed. D. Salkever and A. Sorkin [Stamford, CT: JAI Press, Inc.], pp. 51-80).

This paper provides an assessment of the intertemporal economic well-being of a representative sample of women who became new Social Security Disability Insurance (SSDI) beneficiaries in 1982. It compares their economic circumstances from 1982 to 1991 with those of both disabled men who became new SSDI beneficiaries in 1982, and a matched sample of nondisabled women.

Inequality in Health Care Access and Utilization and the Potential Role for the Public Sector
B. Wolfe and D. Vanness

RPT 803 (Fighting Poverty: Caring for Children, Parents, the Elderly and Health, ed. S. Ringen and P. De Jong [Foundation for International Studies on Social Security], pp. 251-285).

A fundamental issue in this paper is what we mean by equity in the health sector, and what is required to achieve it. The implications for equalization of health under alternative definitions are discussed, and international evidence on the link between public insurance and use of medical care in a number of developed countries and in the United States is reviewed.

The Changing Economic Status of U.S. Disabled Men: Trends and Their Determinants, 1982-1991
R. Haveman, K. Holden, B. Wolfe, P. Smith, and K. Wilson

RPT 800 (Empirical Economics, Vol. 24, Issue 4 [1999], pp. 571-598).

We track the level of economic well-being of the population of men who began receiving Social Security Disability Insurance benefits in 1980-81 from the time just after they became beneficiaries (in 1982) to 1991.

Early Evidence from Wisconsin's Family Care Long-Term Care Pilot Program: Continuity and Change in the Provision of Formal Services
S. A. Robert

The report examines early evidence regarding service changes brought about during the first year of implementation of Family Care, obtained through surveys of care managers working in Family Care in four counties and other managers working in the statewide long-term care system. (SR 80)