Marianne P. Bitler

The Impact of Welfare Reform on Marriage and Divorce

The goal of the 1996 Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) was to end the dependency of needy parents on government benefits, in part by promoting marriage; the pre-reform welfare system was widely believed to discourage marriage because it primarily provided benefits to single mothers. However, welfare reform may have actually decreased the incentives to be married by giving women greater financial independence via the programs new emphasis on work. This paper uses Vital Statistics data on marriages and divorces during 1989-2000 to examine the role of welfare reform and other state-level variables on marriage and divorce rates. The results indicate that implementation of TANF is negatively associated with marriage and divorce rates, as are pre-TANF waivers from the AFDC program in some specifications.

WIC Eligibility and Participation

The authors examine WIC eligibility and participation using the Current Population Survey (CPS), the Survey of Income and Program Participation (SIPP), and state-level administrative data.

Welfare Reform and Children's Living Arrangements.

Little is known about welfare reforms effects on family structure and childrens living arrangements, an important focus for reformers. Using March CPS data, we find that state welfare waivers are associated with children being less likely to live with unmarried parents, more likely to live with married parents, and more likely to live with neither parent. Children living with neither parent are living with grandparents or other relatives, or rarely, in foster care. The estimates vary somewhat by childrens race and ethnicity. Due to the limited variation in TANFs implementation timing across states, we focus on the waiver results.

The State of the Safety Net in the Post-Welfare Reform Era

The 1996 welfare reform led to sweeping changes to the central cash safety net program for families with children. Along with other changes, the reform imposed lifetime time limits for receipt of cash welfare, effectively ending its entitlement nature for these families. Despite dire predictions, previous research has shown that program caseloads declined and employment increased, with no detectible increase in poverty or worsening of child well-being. We reevaluate these results in light of the severe 2007-09 recession. In particular, we examine how welfare reform has altered the cyclicality of the response of caseloads and family well-being. We find that use of food stamps and noncash safety net program participation have become significantly more responsive to the economic cycle after welfare reform, rising more when unemployment increases. By contrast, we find no evidence that cash welfare for families with children is more responsive, and some evidence that it might be less so. We find some evidence that poverty increases more with increases in the unemployment rate after reform, and none that it increases less. We find no significant effects of reform on the cyclical responsiveness of food consumption, food insecurity, health insurance, household crowding, or health.

The effect of abortion restrictions on the timing of abortions

This paper uses data on the distribution of abortions by weeks of gestation to examine the relationship between abortion restrictions and the timing of abortions. State-level data from 1974 to 1997 indicate that adoption of parental involvement laws for minors or enforcement of mandatory waiting periods is positively associated with the post-first trimester percentage of abortions. However, autocorrelation-corrected specifications indicate that enforced parental involvement laws increase the share of later-term abortions by lowering the first trimester abortion rate rather than by delaying abortions. Medicaid funding restrictions generally do not have a significant effect on the timing of abortions in our results.

Effects of venue‐specific state clean indoor air laws on smoking‐related outcomes

A large literature has documented relationships between state clean indoor air laws (SCIALs) and smoking-related outcomes in the United States. These laws vary within states over time and across venues such as schools, government buildings, and bars. Few studies, however, have evaluated whether the effects of SCIALs are plausibly concentrated among workers who should have been directly affected because they worked at locations covered by the venue-specific restrictions. We fill this gap in the literature using data on private sector workers, government employees, school workers, eating and drinking place workers, and bartenders from the 1992-2007 Tobacco Use Supplements to the Current Population Survey. Our quasi-experimental models indicate robust effects of SCIALs restricting smoking in bars: these laws significantly increased the presence of workplace smoking restrictions as reported by bartenders and reduced the fraction of bartenders who smoke. We do not, however, find that SCIALs in private workplaces, government workplaces, schools, or restaurants increased the presence of workplace smoking restrictions among groups of workers working in venues covered by these laws. This suggests that the smoking reductions associated with SCIALs in previous research are unlikely to have been directly caused by effects of workplace smoking restrictions on workers.

Some Evidence on Race, Welfare Reform, and Household Income

In 1996, federal welfare-reform legislation eliminated Aid to Families with Dependent Children (AFDC) and replaced it with Temporary Assistance for Needy Families (TANF). Numerous studies have estimated impacts of reform on welfare caseloads, employment, earnings, family structure, income, and poverty. Two principal challenges to identifying TANF’s impact have been discussed in the literature. First, factors other than welfare reform should have increased household income. It is well known that reform occurred during a period of strong economic performance. While the unemployment rate for blacks fell to the lowest level ever recorded, wages for low-skill groups rose for the first time since the 1970’s. Further, other policy changes in the second half of the 1990’s focused on improving the economic status of the disadvantaged. Examples include expansions in the Earned Income Tax Credit (EITC), minimum wages, and public health insurance (Medicaid and the Children’s Health Insurance Program). Second, TANF was implemented in all states over just 16 months (between September 1996 and January 1998), leaving only limited scope for identifying impacts of TANF through timing across states. While these challenges are well known, their implications for interpreting estimated TANF impacts in nonexperimental studies are not. In this paper, we do four things. First, we discuss the identification of TANF effects in a prototypical nonexperimental model. We show that if TANF effects are the same in every year, then the lack of time variation in TANF implementation is not problematic. However, if TANF and trend effects are allowed to vary over time in an unrestricted fashion, then TANF effects for later years are unidentified. Second, we propose a method for bounding impacts in light of this identification problem. Third, we apply this method to analyze the impact of TANF on household income for a sample of children in the Current Population Survey (CPS) covering calendar years 1988–1999. Fourth, we document significant heterogeneity in the association between household income and both TANF and residual factors across white, Hispanic, and black children.

Effects of Increased Access to Infertility Treatment on Infant and Child Health Outcomes: Evidence from Health Insurance Mandates

This paper examines the association between use of infertility treatment and infant and child health outcomes. Infertility treatment makes conception possible for many couples who otherwise would have been unable to reproduce. Many treatments also increase the chance of having a multiple birth, typically a more risky pregnancy. State insurance mandates compelling insurers to cover or offer to cover infertility treatment induce variation across states over time in access to subsidized infertility treatment. Using birth certificate data, this paper finds the infertility mandates are associated with a statistically significant 10 percent increase in twin births among older mothers. Twin pregnancies are typically more dangerous (and costly) than singleton pregnancies. Thus, even if the only effect of the mandates is to increase twin births, they have likely had a negative effect on infant health. For twins born to older mothers, the mandates are also associated with small but statistically significant negative effects on birth weight, gestation, and the 5-minute Apgar score. Effects for singletons born to older mothers are smaller in magnitude but still negative. Using Census data, the paper finds more mixed evidence about longer term effects of the mandates on child health. The findings for twin birth outcomes suggest that positive effects of investment by older mothers in their pregnancies are outweighed by negative impacts of either the infertility treatments themselves or by the selection into pregnancy of women with reduced fecundity.

Effects of State Cervical Cancer Insurance Mandates on Pap Test Rates

Objective. To evaluate the effects of state insurance mandates requiring insurance plans to cover Pap tests, the standard screening for cervical cancer that is recommended for nearly all adult women. Data Sources. Individual‐level data on 600,000 women age 19–64 from the CDCs Behavioral Risk Factor Surveillance System. Study Design. Twenty‐four states adopted state mandates requiring private insurers in the state to cover Pap tests from 1988 to 2000. We performed a difference‐in‐differences analysis comparing within‐state changes in Pap test rates before and after adoption of a mandate, controlling for the associated changes in other states that did not adopt a mandate. Principal Findings. Difference‐in‐differences estimates indicated that the Pap test mandates significantly increased past 2‐year cervical cancer screenings by 1.3 percentage points, with larger effects for Hispanic and non‐Hispanic white women. These effects are plausibly concentrated among insured women. Conclusions. Mandating more generous insurance coverage for even inexpensive, routine services with already high utilization rates such as Pap tests can significantly further increase utilization.

Health Insurance Mandates, Mammography, and Breast Cancer Diagnoses

We examine the effects of state health insurance mandates requiring coverage of screening mammograms. We find evidence that mammography mandates significantly increased mammography screenings by 4.5-25 percent. Effects are larger for women with less than a high school degree in states that ban deductibles, a policy similar to a provision of federal health reform that eliminates cost-sharing for preventive care. We also find that mandates increased detection of early stage in-situ pre-cancers. Finally, we find a substantial proportion of the increased screenings were attributable to mandates that are not consistent with current recommendations of the American Cancer Society.