Poverty And Limited Access To Health Care A Problem For Some Former Welfare

June 23, 2000

GAINESVILLE, Fla.–Reform efforts and a booming economy have carved 100,000 people off Florida’s welfare rolls in recent years, but a new University of Florida study shows that many of the most vulnerable former aid recipients continue to be plagued by poverty, joblessness and inadequate health care.

Designed to measure the effects of welfare reform on those who had been among the most impoverished of aid recipients, the research shows that less than half of the 140-person study group became employed in the months after their last benefit check. While some said their income had increased, 25 percent described themselves as worse off economically. Many had fallen behind on housing payments or gone without needed medical care.

“One man said he borrows pills for high blood pressure from a friend because he can’t afford to buy them for himself. A woman was living without bottom teeth because she couldn’t afford dentures,” said Leslie L. Clarke, who conducted the study under a contract with the state’s welfare reform program, known as WAGES (for Work and Gain Economic Self-sufficiency).

Clarke, an associate professor in the UF College of Medicine’s department of health policy and epidemiology, submitted her final report to the WAGES board of directors earlier this month. Her work was part of a larger effort by the Florida Inter-University Welfare Reform Collaborative, composed of researchers from five universities in the state.

Responding to changes in the national entitlement-based Aid to Families with Dependent Children program, Florida in 1996 established the WAGES program, which imposes work requirements on aid recipients and a 48-month lifetime limit on receiving cash benefits. Since WAGES began, Florida’s welfare rolls have dropped from more than 152,000 recipients to fewer than 40,000, a decline attributed to economic expansion, tightening of program eligibility requirements and the efforts to assist people with finding jobs.

Policy researchers have tried to analyze how former aid recipients are adjusting. Did the end of welfare give them new motivation to find work and move up the economic ladder, as reform proponents hoped? Or did they sink deeper into poverty, as reform opponents feared?

An earlier study explored the lives of former welfare recipients in Florida, but Clarke noted that the researchers had surveyed people by telephone. Thus, they likely did not reach the poorest of former aid recipients, she said.

For the latest study, Clarke and her colleagues, Brenda Jarmon, of the Florida State University School of Social Work, and Merlin Langley, of the Florida A&M University School of Social Work, selected residents from rural Panhandle counties who had no telephone service when they were last on the welfare rolls-a condition shared by an estimated 15 percent of the state’s former welfare participants.

Trained interviewers met with 140 people who had left welfare between October 1996 and December 1998. By the time of the interviews, 17 had rejoined the WAGES program.

Compared with those who had been interviewed by telephone, those in Clarke’s study were less likely to be working (42 percent vs. 57 percent); tended to earn less per hour; and were more likely to have held a series of jobs rather than just one. Of the 63 employed, about half were making less than $6 an hour.

“The key finding was that by and large, they aren’t doing any better economically, and their life circumstances typically are worse,” Clarke said. Intriguingly, most said they are doing better-even if economically they were doing worse.

“They explain that’s because they’re glad to have the welfare system out of their lives,” Clarke said. “They said things like, ‘I don’t have people being rude to me or asking if I’ve got someone living with me.’”

Few in the group had been cut off from welfare checks because of time limits, which permit no more than 24 months of aid in any 60-month period, as well as a lifetime limit of 48 months of assistance. But researchers speculate some may have left the program as a way to “bank” their eligibility for a needier future.

“A large proportion have medical problems or disabilities that would prevent them from working,” Clarke said. “We found that people had very little education and family support and often no reliable transportation, which does not bode well for them getting a job and certainly not getting a job with benefits.”

National studies have shown that 12 percent of non-elderly adults are in fair or poor health; in contrast, almost 50 percent of the UF study group described their health that way. Nearly 30 percent said they were unemployed because of health problems or a disability, 13 percent could not work because they were caring for a sick family member and 38 percent said they had been unable to afford medical care in recent months.

Mary Hoppe, communications director for the state WAGES board, said the program has been modified to try to better serve some of the people facing the most difficult challenges. For example, this past spring, the state Legislature voted to recognize educational activities, such as pursuing a high school equivalency diploma, as fulfilling the requirement to work in order to receive benefits. Additionally, in select cases, the WAGES program now has the flexibility to grant extensions of the time limit on benefits, such as for a person who has applied for, but not yet received, disability benefits.

“Since the process of applying for disability benefits can be a long and cumbersome one, extending welfare time limits in such cases should be helpful,” Hoppe said.