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Health Care and Family Stability: Policy Decisions and Costs (Pdf)

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Health Care and Family Stability: Policy Decisions and Costs (Pdf) Briefing REPORT 2009-1 Health Care and Family Stability: Policy Decisions and Costs by Mary G. Warren, PhD, Megan O’Donnell, Jennifer Harrison Family Impact Seminar held January 26, 2009 Health Care and Family Stability: Policy Decisions and Costs Overview The Executive Summary This is the first in a series of annual Family This report provides a written background for Impact Seminars (FIS) in Arizona. It follows the FIS speakers’ presentations. It includes a national model used in 25 other states. The a new way of examining public policy from Seminars connect research and state policy- the Family Impact Perspective. It contains making by providing state-of-the-art infor- demographic information on Arizona families, mation in an objective, non-partisan manner. including poverty, unemployment and employ- Each topical seminar includes forums, brief- ment rates, parent education and nativity. In ing reports, and follow-up activities designed addition, the report contains information on specifically for legislators, key agency di- health care access specific to Arizona families. rectors and staff. Rather than lobbying for particular policies, the Seminars provide an The presentation by Rae Jean Proeschold-Bell, array of policy options and opportunities for PhD, of Duke University, addresses (1) the participants to identify workable strategies and characteristics of strong, stable families and common ground. what supports them and (2) evidence-based research on the Healthy Families program as The Family Impact Seminars, a project of well as other effective family support pro- Arizona State University, School for Social grams. Laura Summer, from Georgetown Uni- and Family Dynamics, seek to promote: (1) versity, addresses various methods to increase a family perspective in policy development, insurance coverage, coverage stability issues, (2) collective discussion among policymakers costs to the system, and policies and proce- and researchers, (3) an analysis of the impact dures that can help Arizona families achieve public policies have on families, and (4) a more stable coverage. connection between family-relevant research and state policymaking. The Arizona Fam- For a full version of this report, please go to ily Impact Seminars website is www.asu.edu/ www.asu.edu/ssfd/fis/briefs.html. ssfd/fis. For more information about national Family Impact Seminars, go to http://family- impactseminars.org. Table of Contents 1.The Family Impact Perspective in 4. Promoting Family Stability in a Policymaking Down Economy 2. Arizona Families: The Statistics 5. The Impact of Policy Decisions on Access and Cost 3. Arizona Health Care Access and Insurance 1 THE FAMILY IMPACT PERSPECTIVE IN Assessing the Impact of Policies on Families: POLICYMAKING The Family Impact Checklist The family impact perspective in policymaking analyzes The first step in developing family-friendly policies is the consequences of any policy or program, regardless to ask the right questions: (1) What can government of whether it is explicitly aimed at families, to determine and community institutions do to enhance the family’s its impact on family well-being. The analyses include capacity to help themselves and others? (2) What effect a consideration of the ways families contribute to the does (or will) this policy or program have for families? problems, how families are affected by problems, and Will it help or hurt, strengthen or weaken family whether families need to be involved in solutions. Just functioning? as policy makers evaluate the economic or environmental impact of policies, there are methods for examining the The Consortium of Family Organizations developed family impact. a framework to assess the intended and unintended consequences of policies and programs on family A family impact perspective is different from family stability, family relationships, and family responsibilities. policy (policy that directly impacts family makeup Each of the six principles serves as a criterion for how and is designed to have specific effects on family). A sensitive to and supportive of families policies and family perspective examines implicit or unintended programs are. The principles are not rank ordered and consequences policies may have on families. Policies sometimes they conflict with one another, requiring developed at all levels can potentially affect families. trade-offs. Cost effectiveness must also be considered. Policies such as “No Child Left Behind” or “Welfare to Work” have an obvious relationship to families. Some questions are value-neutral and others incorporate specific values. People may not always agree on these Worksite policies have a clear relationship to an values, so sometimes questions will require rephrasing. employee’s ability to function as a member of the family This tool, however, reflects a broad non partisan and make sure that the needs of the family are taken care consensus, and it can be useful to people across the of. Others, such as transportation or feedlot zoning issues political spectrum. may not seem to have an obvious impact on families, but if one looks beneath the surface to the intended and Policies are most beneficial to families when they: unintended consequences for families of all kinds, the • Foster and support rather than hinder or replace relationships become obvious. the major functions of families – family creation, Although our primary goal is to make sure that families economic support, childrearing, and caring for their in Arizona are well served by governmental agencies members and institutions, we do not engage in direct advocacy • Encourage and reinforce family membership and in behalf of families. Most family advocates campaign stability for an under-represented group or a particular policy alternative that they believe may potentially enhance • Recognize the interdependence and strength of family family well-being. In doing this, advocates examine relationships, even when those relationships may be options in light of their own value system, using a conflicted personal interpretation of the scientific evidence, with the aim of promoting a single policy option that they deem • Encourage families to be involved in addressing issues most desirable for families. that affect them In contrast and complement to this approach of • Recognize that there are many forms and influencing policies, policy educators do not lobby configurations of families, and the effects of policies for a single policy, but rather attempt to inform policy on diverse families may be very different discourse by clarifying potential consequences of several policy alternatives. They make an effort to educate • Recognize and act on the need to support families who by presenting research findings objectively without are vulnerable economically and/or socially imposing personal biases. The intent of the framework is to provide individuals or groups with a tool to help think critically about a policy or a program in relation to the family. It provides the user an opportunity to formally or informally assess the possible benefits, as well as the possible negative impact, of a policy or program on families. Sometimes, it might be used to compare and contrast two or more different policy or program options. In other cases, it may be used only to identify the reasons for and reasons against one specific policy or program. The framework can also be used to help in the initial stages of policy or program development as a way to encourage critical thinking about the potential policy or program and the possible impact it may have on families. The framework is not designed to be an evaluation tool in the sense of determining if the goals of a policy or program have been met. A scope of the framework, titled “Family Impact Checklist” can be found at http://www.familyimpactseminars.org. 2 ARIZONA FAMILIES ARIZONA HEALTH CARE ACCESS AND INSURANCE Basic Overview How are Arizona residents insured? The Arizona Health In order to set the stage regarding families in Arizona, Survey (AHS), conducted May 2008, specifically we reviewed several reports and sources. According researched Arizona residents as opposed to national to the U.S. Census (2005-2007 ACS data), there are an surveys. Roughly 4,000 residents were surveyed, estimated 6.15 million people living in Arizona. There including children; however, the data on children has not are 897,582 families with roughly 1.6 million children. been analyzed to date. Findings on the health insurance The average family size is 3.33 persons, slightly larger of Arizona adults are currently available, and key points than the U.S. average of 3.19 persons. have been included here. The full report is available at www.arizonahealthsurvey.org. The median family income is $57,004, less than the U.S. average of $60, 374. There are slightly more families About one in five adults (17%) lacked health insurance with children living in households below the federal coverage in Arizona for at least some part of 2008, and poverty level in Arizona as compared to the national roughly the same number (16%) use AHCCCS, the average, 10.3% and 9.8% respectively. state’s Medicaid program (Rissi et al., 2008). Nearly one-third (29%) of residents are Latino, compared Arizona residents who identify as Latino or Hispanic to an overall U.S. average of 14.7%. There are 15% are more likely than non-Hispanics to report lack of foreign-born Arizona residents as opposed to the national insurance, which is primarily due to access to employer- average of 12.5%. based coverage (Rissi et al., 2008:11). Forty-two percent (42%) of Hispanics report employer-based coverage Unemployment Rates compared to 66% of non-Hispanic residents. Since access to health care is primarily employer-based, Adults who are currently looking for employment have unemployment rates are key statistics. According the lowest rate of coverage at 68%. Nearly half of to the U.S. Bureau of Labor Statistics October 2008 this group, 45%, is covered by AHCCCS, which may preliminary data reports, Arizona is 3rd among states in possibly be due to changes in social welfare benefits the percentage of residents losing employment over the (Rissi et al., 2008:12).
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