The Perils of Welfare to Work

Millions of Americans have enrolled in health insurance plans through Healthcare.gov and thousands more now qualify for state-sponsored Medicaid services in states that decided to expand the Medicaid option. In states that declined the Medicaid expansion, supporters of “small government” continue to tout the benefits of Welfare to Work and personal responsibility programs in lieu in Medicaid expansion. Several evaluations of state-based welfare-to-work programs have identified primary outcomes of increased income and improved health and health outcomes for program participants. An area not yet rigorously investigated, however, is the impact of such programs on participants’ mortality.

Source: Joris Louwes (Flickr / Creative Commons)

Source: Joris Louwes (Flickr / Creative Commons)

Connecticut’s Jobs First was a $5.3 million multi-center randomized welfare reform experiment that enrolled welfare recipients between January 1996 and February 1997. Researchers conducted a statistical analysis of this program, with the goal of answering the question: “Did the Jobs First experimental welfare reform program improve the mortality of the program participants as compared to the traditional welfare program, Aid to Families with Dependent Children (AFDC)?”

Though the researchers identified that the Jobs First program did facilitate improvement in employment, the uniquely identified outcome of this study was the increase in mortality across all demographics that participated in the Jobs First program when compared to AFDC controls. The overall mortality in the Jobs First group was 5.3 % as compared to 5.1% in the traditional welfare program; however, it should be noted that this outcome did not reach statistical significance in any group, even when controlling for factors such as race, number of children, and disadvantaged status. Additionally, the effects of the programs on morbidity and accessibility of health care were not examined in this study.

In conclusion, though this study is the first evaluation of a Welfare-to-Work program that identifies increased mortality as a possible outcome, more research needs to be done. It is doubtful that our political leaders will continue to rally support around programs that increase the mortality of its participants. The state of Connecticut needs to take a closer look at what happened with the Jobs First program to ensure that the necessary infrastructure to address health and employment needs are present instead of causing further detriment and harm to already vulnerable populations.

Abstract

This study enrolled 4,612 total participants, 2,362 of which were assigned to Jobs First and the remaining 2,250 to AFDC. The investigators specifically adjusted for age, marital status, gender, number of children, years of education, and welfare office, and clustered the standard errors at the town level.

At baseline, the study population had similar demographic characteristics to the control group. The subgroup analysis conducted by the researchers evaluated the effects of the Jobs First program on Blacks, Hispanics, families with greater than or less than two children, the fairly disadvantaged, and the most disadvantaged. PMID: 23678929 Wilde et al. AJPH. 2014; 104 (3): 534-8.

by

Loren Robinson, MD