The Cost of Instability: The Effects of Family, Work, and Welfare Change on Low-Income Women's Health Insurance Status

The number of uninsured Americans has risen substantially over the last decade. Despite the availability of Medicaid, low-income women are at particularly elevated risk of having no or inadequate health insurance. How does continuity of work, family, and welfare affect low-income women's health insurance status? A multinomial logistic regression analysis of 1,662 low-income women from the Welfare, Children, and Families: A Three-City Study provides evidence of the consequences of life changes on access to health insurance from 1999—2005. The results show that compared to those with stable welfare, work, and family attachments, new full-time employment actually increases low-income women's risk of being uninsured as does being underemployed, on welfare, or single for extended periods of time. These findings illustrate how health-care reform must adequately address the complexity of low-income women's lives—including the ways labor market, state, and family factors interact to create barriers to health insurance—in order to improve access to care under the current U.S. health insurance model.