摘要：Objectives . The purpose of this study was to assess changes in health insurance and food assistance enrollment following passage of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996. Methods . Extant data sources were used to calculate changes in Temporary Assistance for Needy Families (TANF), Medicaid, and Food Stamp program enrollment in medically underserved Manhattan communities after 1996. Results . Dramatic declines in TANF enrollment were accompanied by declines in Food Stamp program enrollment and a deceleration in Medicaid enrollment among several communities. Conclusions . As the Personal Responsibility and Work Opportunity Reconciliation Act comes up for reauthorization later in 2002, policymakers should revise legislation so that needy families do not lose health insurance or food assistance support. Passage of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 ended standard entitlement and most regulatory oversight of traditional welfare mechanisms in the United States and separated cash assistance from food assistance and health insurance. 1 As part of the federal Balanced Budget Act of 1997, the State Child Health Insurance Plan was established to allow many low-income children to be eligible for health insurance even if their parents were not. 2 Although many people no longer eligible for cash assistance could have continued to receive food assistance and health insurance, various reports have documented declines in enrollment in all 3 programs. 3– 11 Nationally, there have been reduced Food Stamp 5 and Medicaid 6 program enrollments, a rise in the uninsured population, 12 and inadequate enrollment in the State Child Health Insurance Plan. 13 The devolution of welfare responsibility to the states under the Personal Responsibility and Work Opportunity Reconciliation Act has resulted in more than 50 versions of welfare reform. Previous studies have documented declines in Medicaid and Food Stamp program enrollment at the state level. 6, 14– 16 However, it is important to learn how these policy changes have affected underserved populations at the local level. In New York City, the welfare caseload declined from 1.16 million in 1995 to less than half a million in 2001. 17 In 1998, a lawsuit filed by 7 poor New York City residents ( Reynolds v Giuliani, 35 F Supp 2d 331 [SDNY 1999]) alleged that the city did not always provide Food Stamps and Medicaid benefits to eligible people who filed applications for cash assistance. 18 Our hypothesis was that welfare reform would be adversely associated with use of health insurance and food assistance programs among underserved populations. To test this hypothesis, we examined welfare, Medicaid, and Food Stamp program enrollment data from the 12 community districts in the New York City borough of Manhattan.
