GOVERNMENTWelfare rules, health needs often conflict, doctors sayFamilies dealing with chronic illnesses need more help than was provided under welfare reform, which Congress is due to reauthorize this year.By Amy Snow Landa, amednews staff. June 24, 2002. Washington -- When Congress debated welfare reform in 1996, there was little discussion of how the legislation might impact families affected by chronic illness. Instead, the goal was "to end welfare as we know it," which meant moving adults from welfare to work as quickly as possible. By that standard, the reform effort has largely succeeded. The U.S. Census Bureau reported this month that the number of mothers who receive welfare benefits has been cut in half over the past five years. But the push to get adults into the work force largely ignored the health concerns of poor families, particularly those affected by chronic illness, said Paul Wise, MD, MPH, director of social and health policy research at Boston Medical Center's Dept. of Pediatrics and a professor at Boston University School of Medicine. During the 1996 debate, lawmakers paid scant attention to how chronic illness might make it more difficult for parents to get and retain employment, which they are now required to do as a result of welfare reform. On the flip side, parents who must work have less time for doctor appointments, which has major implications for families with special health care needs. Some physicians, including Dr. Wise, are hoping to draw lawmakers' attention to these issues this year. The timing is critical because Congress is gearing up to reauthorize the welfare reform law, and many families are about to reach their five-year limit for welfare benefits.
25% of children on welfare have at least one chronic illness.
The physicians have launched "Doctors Speak Out on Welfare Reform," an initiative led by Dr. Wise and Wendy Chavkin, MD, MPH, a professor of obstetrics and gynecology, and population and family health at Columbia University, New York City. The project is intended to highlight concern in the medical community about welfare recipients' obstacles to balancing work and their families' special health care needs. More than a dozen physician organizations have endorsed the initiative, including the American Academy of Pediatrics, the American Medical Women's Assn., and the American College of Obstetricians and Gynecologists. The coalition sponsored a Capitol Hill briefing earlier this month to urge lawmakers to ease some of welfare reform's requirements for families affected by chronic illness. In particular, they hope that Congress will exempt these recipients from the law's time limits on cash assistance and its work requirements and provide them with additional child care support. The problem of juggling work and special health care needs appears to be widespread among families with chronically ill children, whether they receive welfare or not. In recent studies of over 900 such families in Boston and San Antonio, Texas, between a quarter and a third of parents reported having to miss a child's doctor appointment because they could not get the time off work. The problem is especially acute among the welfare population, which is disproportionately affected by chronic illness. At least 25% of children in families on welfare have at least one chronic illness, according to estimates that use a broad definition that includes behavioral and developmental disorders. But among children in general, the estimate is 15%, Dr. Wise said. Stark choicesTherefore, a large number of poor mothers with chronically ill children must choose between taking their children to doctor appointments or working enough hours each week. The choice is often stark for parents in low-wage jobs without paid sick leave: Take unpaid leave and risk their bosses' displeasure. "Parents are stuck in an untenable position," said Lauren Smith, MD, MPH, medical director of the pediatric inpatient unit at Boston Medical Center and a co-author of the Boston and San Antonio studies. If they know they are on the verge of losing a job, they might not bring their child in for a follow-up appointment after the child has been hospitalized. It is these types of choices that the physicians hope Congress will consider. But so far, lawmakers have been moving in the opposite direction. The Republican-controlled House passed its version of the welfare reauthorization bill in May. It did not include any additional help for these families. Instead, the measure would impose even stricter requirements, raising the percentage of welfare recipients who must work from 50% to 70% and lengthening their workweek from 30 hours to 40. The Democratic-controlled Senate is expected to debate its own measure later this year. ADDITIONAL INFORMATION:Speaking outThe Doctors Speak Out About Welfare Reform initiative recommends that Congress:
WeblinkFinding Common Ground, a sponsor of the Doctors Speak Out About Welfare Reform meeting (http://www.findingcommonground.hs.columbia.edu/) Theme issue, "Welfare and Women's Health," Journal of the American Medical Women's Assn., Winter issue (vol. 57, issue 1) (http://www.jamwa.org/vol57/toc57_1.htm) Copyright 2002 American Medical Association. All rights reserved.
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