摘要：Objectives . This study assessed chronic child illness among recipients of Temporary Assistance for Needy Families (TANF) benefits and poor families not receiving benefits. Methods . Data from the 1998 National Health Interview Survey were used to examine chronic child illness, enrollment in TANF, health insurance status, and selected access indicators. Results . One quarter of TANF-enrolled children had chronic illnesses. Unenrolled children were 3 times as likely as TANF-enrolled children to be uninsured. Among the chronically ill, 31.7% of unenrolled and 14.3% of enrolled children experienced gaps in insurance coverage that were associated with access barriers. Conclusions . Welfare policies should consider the effects of chronic illness and gaps in insurance coverage on the health of poor children. The expressed objective of the 1996 Personal Responsibility and Work Opportunity Reconciliation Act was to increase the economic independence of poor families through changes in US welfare policies. Among its many important provisions was the replacement of Aid to Families with Dependent Children with the Temporary Assistance for Needy Families (TANF) program, which imposes maternal work requirements, benefit reductions or terminations for noncompliance with program provisions, and time limits for enrollment. 1 Despite considerable public debate over the impact of the Personal Responsibility and Work Opportunity Reconciliation Act and its reauthorization, there remains a striking paucity of information on the health status of families affected by this legislation. 2, 3 Of particular concern is whether current or proposed welfare provisions adequately account for the special requirements of families affected by serious chronic illness. Such illness in women or their children has been shown to influence the prospects of maternal employment and intensify the need for adequate health insurance. 4– 6 In the present study, we sought to provide some empirical context for public deliberation of the act’s reauthorization by examining patterns of TANF participation among a national sample of poor chronically ill children. Specifically, the analyses outlined here describe the extent to which children on TANF experience chronic illness, gaps in insurance coverage, and selected barriers to health care services. In addition, comparative analyses were conducted among children living in poverty but not enrolled in TANF, a group that may increasingly reflect those never enrolled in TANF or those who have lost TANF benefits but whose family income did not rise above the federal poverty level.
