Hierarchies of risk: The longitudinal dynamics of family, work, welfare, and health insurance in low-income women's lives

Low-income women are at particularly high risk of having no or inadequate insurance. Welfare reform has pushed more low-income women into the labor market but women's access to insurance has continued to erode. In addition, low-income women often experience work and family changes which affect their ability to access both private/employer-based and public insurance programs. We know continuity of coverage matters for women's health, but few have examined the role of individual-level health insurance instability in perpetuating low-income women's poverty. Cross-sectional analyses do not adequately reflect the dynamic nature of low-income women's lives and their lack of continuity in health insurance access.;The goal of this dissertation is to assess the role of individual-level welfare, work, and family changes in predicting low-income women's access to insurance and poverty over time in order to inform effective social policy. Specifically, I seek to answer the following research questions: (1) What is the relative importance of various welfare, work, and family changes in predicting low-income women's insurance coverage over time? (2) Given the diversity of low-income women's experiences, are there significant differences between categories of low-income women (such as the poor and near-poor) in the significance of these changes and women's access to insurance? And (3) given the effects of welfare, work, and family changes on low-income women's health insurance access, what role does health insurance stability play in determining changes in women's poverty status over time?;Results of the various statistical analyses provide consistent evidence of a hierarchy of risk among low-income women. For example, I find that low-income women who experience welfare, work, and family changes may have access to public and private forms of insurance, but compared to women with stable welfare, work, and family attachments low-income women who iv experience many changes over time simply do not fare as well and are at greater risk of being uninsured or having unmet health needs. I also find evidence that the significance of various welfare, work, and family factors varies by type of insurance examined. For instance, while stable marriage and work patterns may increase women's access to private forms of insurance while reducing their access to public forms of insurance, the same factors do not significantly predict women's risk of being uninsured. Nevertheless, this should not suggest that marriage and work patterns are unrelated to women's risk of being uninsured. Instead, I argue that such findings illustrate the complex effects of welfare, work, and family factors on women's access to various forms of health insurance; while some low-income women may benefit from access to marriage and work opportunities, others may find themselves at greater risk of lacking access to sufficient insurance. The complex and contradictory nature of these effects may make them difficult to model statistically but illustrate the importance of examining the nuances of low-income women's lives.;I also find evidence that certain factors may be more (or less) consequential for poor women than their near-poor peers. Such findings provide evidence of the differential strategies low-income women utilize in order to meet their health insurance needs -- poor women's reliance on public forms of health insurance creates different risks for them than their near-poor peers who are forced to rely on private forms of insurance to meet their health needs. Finally, I find some limited evidence that certain welfare, work, and family factors are indeed related to low-income women's movement into and out of poverty over time. I conclude by arguing that recent health care reforms have the potential to significantly improve low-income women's access to insurance, thereby altering the hierarchy of risks many low-income women face under the status quo.