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COULD WELFARE REFORM BE `SICKENING’?

SHARE COULD WELFARE REFORM BE `SICKENING’?

The welfare reform signed by President Clinton Thursday might achieve its objective of prodding millions of Americans to get productive jobs, but some public health officials are expressing the fear that it could cause many to simply get sick.

And the poor, they said, might not get sick alone.As legal immigrants lose access to Medicaid and families run up against a new five-year limit on cash benefits, these health experts anticipate a resurgence of tuberculosis and sexually transmitted diseases not likely to confine themselves to low-income neighborhoods. Over time, they foresee a rising infant mortality rate and a gradual lowering of life expectancy for many Americans, not just those on welfare.

"Sooner or later, we will find ourselves with housekeepers who are tubercular, workers dying of infectious illnesses. No matter how much we create isolated enclaves, we depend on people who live in poor communities to make our clothes, package our food, work at our McDonald's," said David Rosner, professor of history and public health at City University of New York. "We have developed a sense of invulnerability to these things, and it will come back to haunt us."

Such problems, if they occur, could be particularly acute in Los Angeles and New York, homes to teeming populations of legal immigrants who receive subsidized health services under Medicaid, or its California equivalent, Medi-Cal. Under the sweeping welfare reform legislation, states are authorized to deny Medicaid coverage to legal immigrants.

Welfare reform advocates dismissed such scenarios as scare talk, in large part because they dispute the underlying premise that poor people cut off from public assistance will fail to fend for themselves.

"The basic assumption of liberals is that some people have virtually no capacity to care for them-selves, that if you are not stuffing free services at them they will go blind and starve to death. That's simply not true," said Robert Rector, senior policy analyst for welfare at the Heritage Foundation, a conservative Washington think tank.

The fastest growing group of welfare dependents are elderly immigrants who come to the United States to retire. If left unchecked, their needs would cost the American taxpayer $312 billion during the next 10 years, said Rector, who helped craft the congressional welfare measure.

The welfare measure rolls up the federal safety net which has guaranteed for 61 years that America's poor would receive assistance underwritten by Washington. It replaces that open-ended assurance with finite block grants and leaves it to the 50 states to decide what benefits to provide.

Under the new law, states would not be required to offer Medicaid to legal immigrants and they could impose new restrictions on aid to needy families with children. In addition, the new law would limit cash assistance to two years, unless recipients find work or enter a job program, and it would impose a lifetime cap of five years on cash benefits.

At the same time, the legislation contains exceptions designed to cushion the blow on vulnerable populations. States could choose to continue providing Medicaid benefits to legal immigrants and they would be permitted to exempt as many as 20 percent of their cash welfare caseloads from the work requirements and benefit caps.

But some health officials said that they fear those safety valves are not sufficient to prevent a gradual deterioration of medical services for the poor and that the consequences could spread far beyond the people most directly affected.

"The sooner you get a communicable disease isolated and treated, the sooner you have a noncontagious person," said Dr. Shirley Fannin, director of disease control programs for the Los Angeles County Department of Health Services. "Going into the 21st century with this kind of backward-thinking legislation - I think we will rue the day."

With prenatal and well-baby care no longer guaranteed for legal immigrants, infant mortality and developmental impairment is likely to increase, these officials said. Children in families denied cash assistance or basic medical services could report to school sick, hungry or not at all.

Still, states are only beginning to analyze the details of the welfare reform legislation and it is difficult to predict with certainty how each will choose to spend the federal block grants it receives for assistance to the poor.

If the reformed system works as its crafters hope, the result could be better health for the nation's needy, advocates said. States eager to move people off welfare might be more likely to expand health-care coverage to help them do it. Already, some 20 states have pending waivers asking permission to give welfare recipients who find work transitional health benefits for one year rather than the customary six months.