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The Changing Safety Net for Low-Income Parents and Their Children: Structural or Cyclical Changes in Income Support Policy?

ABSTRACT: Refundable tax credits and food assistance are the largest transfer programs available to able-bodied working poor and near-poor families in the United States, and simultaneous participation in these programs has more than doubled since the early 2000s. To understand this growth, we construct a series of two-year panels from the 1981-2013 waves of the Current Population Survey Annual Social and Economic Supplement to estimate the effect of state labor-market conditions, federal and state transfer program policy choices, and household demographics governing joint participation in food and refundable tax credit programs. Overall, changing policy drives much of the increase in the simultaneous, biennial use of food assistance and refundable tax credits. This stands in stark contrast from the factors accounting for the growth in food assistance alone, where cyclical and structural labor market factors account for at least one-half of the growth, and demographics play a more prominent role. Moreover, since 2000, the business cycle factors as the leading determinant in biennial participation decisions in food programs and refundable tax credits, suggesting a recent strengthening in the relationship between economic conditions and transfer programs.

SUBMITTER: Hardy B

PROVIDER: S-EPMC5991492 | biostudies-literature | 2018 Feb

REPOSITORIES: biostudies-literature

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The Changing Safety Net for Low-Income Parents and Their Children: Structural or Cyclical Changes in Income Support Policy?

Hardy Bradley B Smeeding Timothy T Ziliak James P JP

Demography 20180201 1

Refundable tax credits and food assistance are the largest transfer programs available to able-bodied working poor and near-poor families in the United States, and simultaneous participation in these programs has more than doubled since the early 2000s. To understand this growth, we construct a series of two-year panels from the 1981-2013 waves of the Current Population Survey Annual Social and Economic Supplement to estimate the effect of state labor-market conditions, federal and state transfe ...[more]

PMID: 29380273

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Project description:ImportanceAlthough readmission rates are declining under Medicare's Hospital Readmissions Reduction Program (HRRP), concerns remain that the HRRP will harm quality at safety-net hospitals because they are penalized more often. Disparities between white and black patients might widen because more black patients receive care at safety-net hospitals. Disparities may be particularly worse for clinical conditions not targeted by the HRRP because hospitals might reallocate resources toward targeted conditions (acute myocardial infarction, pneumonia, and heart failure) at the expense of nontargeted conditions.ObjectiveTo examine disparities in readmission rates between white and black patients discharged from safety-net or non-safety-net hospitals after the HRRP began, evaluating discharges for any clinical condition and the subsets of targeted and nontargeted conditions.Design, setting, and participantsCohort study conducting quasi-experimental analyses of patient hospital discharges for any clinical condition among fee-for-service Medicare beneficiaries from 2007 to 2015 after controlling for patient and hospital characteristics. Changes in disparities were measured within safety-net and non-safety-net hospitals after the HRRP penalties were enforced and compared with prior trends. These analyses were then stratified by targeted and nontargeted conditions. Analyses were conducted from October 1, 2017, through August 31, 2018.Main outcomes and measuresTrends in 30-day readmission rates among white and black patients by quarter and differences in trends across periods.ResultsThe study sample included 58 237 056 patient discharges (black patients, 9.8%; female, 57.7%; mean age [SD] age, 78.8 [7.9] years; nontargeted conditions, 50 372 806 [86.5%]). Within safety-net hospitals, disparities in readmission rates for all clinical conditions widened between black and white patients by 0.04 percentage point per quarter in the HRRP penalty period (95% CI, 0.01 to 0.07; P = .01). This widening was driven by nontargeted conditions (0.05 percentage point per quarter [95% CI, 0.01 to 0.08]; P = .006), whereas disparities for the HRRP-targeted conditions did not change (with an increase of 0.01 percentage point per quarter [95% CI, -0.07 to 0.10]; P = .74). Within non-safety-net hospitals, racial disparities remained stable in the HRRP penalty period across all conditions, whether the conditions were HRRP-targeted or nontargeted.Conclusions and relevanceFindings from this study suggest that disparities are widening within safety-net hospitals, specifically for non-HRRP-targeted conditions. Although increases in racial disparities for nontargeted conditions were modest, they represent 6 times more discharges in our cohort than targeted conditions.

Project description:INTRODUCTION:Parks are an important component of the neighborhood environment, and their presence is believed to support higher levels of physical activity among residents. The present study examined park use frequency among a sample of 534 low-income parents of preschool aged children. Associations with child and parent physical activity, neighborhood characteristics and physical characteristics of the block immediately surrounding the home were examined. METHODS:Data are from baseline measurements completed in 2012-2014 as part of larger study (NET-Works: Now Everybody Together for Amazing and Healthy Kids) targeting low-income preschool children and their parents (N = 534 parent-child dyads). Physical activity was measured in parent and child using accelerometry. Parents reported their frequency of use with their child of parks within a half kilometer from their residence. Block audits were performed by trained research staff to describe the quality and walkability of the streets around the home. STATISTICAL ANALYSIS:Bivariate associations between demographic variables, perceptions of the neighborhood environment, parent support for child physical activity, and physical activity were examined using regression or Chi square analysis. RESULTS:Park use frequency was not significantly associated with child accelerometry light, moderate or vigorous physical activity. However, it was marginally significantly inversely associated with child accelerometry sedentary time (p < 0.06). Television viewing hours on weekend days (but not on weekdays) were significantly fewer among children in the high park use group compared with children who visited the park less frequently (p < 0.01). Park use frequency was significantly positively associated with parent accelerometry moderate physical activity (p < 0.004), and was significantly inversely associated with parent accelerometry sedentary time (p < 0.002). Frequent park use was significantly positively associated with parent report of the child frequency of being taken to a park or playground outside the home (p < 0.0001), past week visit to park and recreation center (p < 0.0001) and parent-reported supportive behaviors for child physical activity (p < 0.0001). Parents who reported having to cross busy streets to reach play areas reported less frequent park use (p < 0. 02). Walkable neighborhoods (p < 0.003) and more incivilities (p < 0.02) in the immediate block surrounding the home were significantly associated with more frequent park use. CONCLUSIONS:Frequent park use with their preschool child may support higher levels of physical activity among low-income parents and reduce sedentary time for both child and parent.

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The Changing Safety Net for Low-Income Parents and Their Children: Structural or Cyclical Changes in Income Support Policy?

Publications

The Changing Safety Net for Low-Income Parents and Their Children: Structural or Cyclical Changes in Income Support Policy?

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