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Chapter Eleven
CONCLUSION
Beginning in the 1960s, concern about the unintended consequences of the AFDC program led to a sequence of reform efforts. The goals of these reforms were to promote work and reduce dependence while still alleviating need. These efforts culminated with PRWORA, which replaced the AFDC program with TANF. In addition to promoting work and reducing dependence, PRWORA also aimed to promote marriage and to reduce unwed childbearing. Welfare reform may also have implications for poverty and the well-being of low-income children.
The challenge for future reform efforts is not in achieving any one of these goals but in achieving them all simultaneously. As we will see below, most reform policies increase employment. Some raise both income and welfare use in the process, whereas others reduce welfare use but leave income unchanged. Likewise, some policies are more effective at improving children’s outcomes or at least at not leaving children worse off. As lawmakers seek to refine the new welfare system, it is important that they understand the trade-offs that different policies entail.
Our task has been to synthesize the evidence on how recent welfare reform policies affect these goals, as measured by a series of outcomes. Each of the preceding chapters has focused on a particular set of outcomes, such as welfare use, employment and earnings, or income and poverty. In this concluding chapter, we evaluate the trade-offs among the different reform goals that arise from different policies. The next section synthesizes the literature across all outcomes and all policies. After that, we assess the strengths and limitations of the existing research base. We close by discussing directions for future research.
11.1. SYNTHESIZING THE LITERATURE ACROSS ALL OUTCOMES AND ALL POLICIES
To compare and contrast the impacts of our list of policies on our list of outcomes, we return to the idea of a matrix, like the one discussed in Chapter 1. In Table 11.1, we list policies we examined along the rows and outcomes we examined along the columns. The outcome columns appear in the order of the chapters in which the outcomes were discussed.106 Many of the policy rows correspond to the entries in the tables in Chapters 4 to 10. In a few cases, we have disaggregated the policies further along dimensions where their effects may differ. For mandatory work-related activities combined with financial work incentives, we distinguish between programs with strong incentives (e.g., MFIP and FIP) and those with weaker incentives (e.g., WRP and TSMF). The latter programs involve implicit tax rates that may be higher than those under AFDC. For time limits, we distinguish pre—time limit effects from post—time limit effects. The effects of reform as a bundle, in row (11), pertain only to the pre—time limit period. The assignment of particular studies to the rows of Table 11.1 is detailed in Appendix B.
The entries in the cells of Table 11.1 are qualitative summaries of the effect of each policy on each outcome. The words in the cells indicate the direction of the effect, whereas the shading of the cells indicates the depth of the knowledge base, that is, how much is known about the effect of that policy reform on that outcome.107 The entry "increase" indicates that a majority of the studies that analyze the policy-outcome pair in question show that the policy increases the outcome. The entry "decrease" indicates the opposite. The entry "mixed" indicates that there are roughly as many results showing a decrease as an increase. The entry "no change" indicates that the estimated impacts are mixed in sign and that nearly all are small and insignificant.
Cells with a deep knowledge base are indicated by the dark gray shading. These cells are populated by several high-quality studies, most of which yield similar and significant estimates. At the other end of the spectrum, cells with a shallow knowledge base are indicated by no shading. These cells are populated by a single high-quality study that yielded a significant estimate, two moderate-quality studies that yield similar and significant estimates, or similar constellations of evidence. Cells whose knowledge base falls between these two categories are indicated by intermediate gray shading. Cells populated by a single moderate-quality study, or one or more high-quality studies whose results were insignificant, are indicated by an asterisk, denoting a nearly empty knowledge base. Cells for which there are no studies are left blank.
The entries in column (B) indicate that most reforms or combinations of reforms considered in Table 11.1 increase employment, although we assign varying degrees of confidence to this qualitative assessment. Column (C) shows that many of these policies also increase earnings. Beyond employment and earnings, however, the impacts of specific policies vary to a greater extent, illustrating the trade-offs facing policymakers. Thus, we organize the remainder of our discussion of Table 11.1 by the table rows.
11.1.1. Financial Work Incentives
Although all the recent reform policies are capable of increasing employment (column (B)), they involve different trade-offs between reducing welfare use (column (A)) and increasing income (column (H)). Programs with generous financial work incentives generally increase welfare use, as seen in cell A1. This is also true for financial work incentives tied to hours of work through an earnings supplement outside the welfare system (cell A2), where transfer payments (welfare payments or the earnings supplement) increase. Welfare use also increases when generous financial incentives are combined with mandatory work-related activities (cell A5), but the opposite is true for programs with weaker incentives (cell A6).
We are unable to assign a direction for financial work incentives alone on the use of food stamps or Medicaid (cells D1 and E1). A shallow evidence base suggests financial work incentives tied to hours of work may increase food stamp use (cell D2). When combined with work requirements, it appears that both strong and weak financial work incentives may decrease food stamp use (cells D5 and D6). Such programs decrease (weak incentives) or have an uncertain impact (strong incentives) on Medicaid use (cells E5 and E6). A very shallow knowledge base suggests that financial work incentives alone may increase marriage (cell F1), but we do not have enough evidence to say how marriage is affected when financial work incentives are tied to hours worked or combined with work requirements. There is some suggestive evidence from MFIP that programs that provide generous financial work incentives combined with work requirements may increase marriage or keep existing marriages intact. However, the mixed results for the Canadian SSP suggest caution in interpreting the MFIP results. There is no evidence base from which to assess the relationship between financial work incentives and fertility.
Since financial work incentives allow families to keep more of their welfare benefits as their earnings rise, they also increase income and decrease poverty, as shown in columns (H) and (I). However, these programs increase income by modest amounts. The most effective program was MFIP, which combined a strong financial incentive–stronger than most state TANF plans–with mandatory work-related activities for long-term recipients. MFIP increased the income of long-term recipients by 12—15 percent throughout the three-year follow-up period. However, even in MFIP, participants’ incomes remained low, averaging $12,000 per year, even after accounting for the EITC. More than one-half of the participants had income from work and transfer programs that still fell below the official poverty line. At best, these programs abate poverty somewhat; none can be said to alleviate it altogether.
With one exception (cell K6), financial work incentives (alone, or tied to hours of work, or combined with work requirements) are also associated with improvements in other measures of well-being such as food security, children’s health insurance coverage, and savings (the intersection of rows (1), (2), (5), and (6) with columns (J) to (K)). However, several of the relevant cells are empty, and those that indicate a favorable impact are derived from a shallow knowledge base.
The impact on child well-being is more uncertain, and, when we are able to assign a direction, it is almost always based on a shallow evidence base. For children who are school-aged at the time of follow-up, strong financial work incentives (alone, or tied to hours of work, or combined with work mandates) appear to decrease behavior problems and possibly also school achievement problems as well (the intersection of rows (1), (2), (5), and (6) with columns (Q) to (S)). The increase in health problems for this age group associated with strong financial work incentives comes from statistically significant unfavorable impacts of MFIP-IO and MFIP on emergency room visits, which may result from less parental supervision or better access to health care. Thus, it appears that for this age group, the increased income associated with reforms that incorporate strong financial work incentives may lead to some improvements in children’s outcomes in certain domains.
In contrast, for adolescents at follow-up, the various policies that include financial work incentives consistently appear to increase behavior problems and school achievement problems (the intersection of rows (1), (2), (5), and (6) with columns (T) and (U)). (There is insufficient evidence regarding health problems for adolescents as seen in column (V).) The evidence base available to assess the impact of financial work incentives on outcomes for pre-school-aged children at the time of follow-up is almost nonexistent although some of the impacts recorded in Table 11.1 for grade-school-aged children pertain to children who were preschoolers at the time of random assignment.
11.1.2. Mandated Work-Related Activities
Mandated work-related activities have been studied more than any other reform. Consequently, most of the cells with the darkest shading are in row (3). A substantial body of evidence shows that they generally reduce welfare use (cell A3). However, they have little effect on income, with 11 of 13 studies in the cell finding no significant impact and only one study each finding a positive or negative impact (cell H3). This is because, in the absence a financial work incentive, the increase in earnings generated by work mandates (cell C3) is offset nearly dollar-for-dollar by a decrease in benefit payments. The evidence base is also deep in indicating that mandated work-related activities reduce food stamp use (cell D3). These programs also appear to decrease Medicaid use, although the knowledge base for that conclusion is much shallower (cell E3).
However, viewed from a different perspective, row (5) of the table shows that it is possible to require work and raise income at the same time. The key is to combine the work requirement with a strong financial incentive, so that earnings rise more rapidly than benefits fall. The price for raising incomes is higher welfare use, which again illustrates the central trade-off facing efforts to reform welfare.
Turning to the poverty results in column (I), the more limited evidence available suggests that mandatory work-related activities decrease poverty somewhat (cell I3). Although these programs have no effect on mean income, they may be able to raise incomes for families just below the poverty line. This is consistent with the evidence presented in Appendix A that such programs have greater effects on income among relatively advantaged recipients than among disadvantaged recipients.
This policy has no effect on marriage or fertility (cells F3 and G3), a conclusion that is based on five years of follow-up data for seven programs and two years of follow-up data for five other programs (hence the dark shading). Regarding other measures of well-being, the available evidence suggests that mandated work-related activities reduce food security and children’s health insurance coverage (cells J3 and K3). A somewhat more substantial evidence base provides a very mixed picture of the impact of these programs on child well-being for all three of the age groups shown in Table 11.1 (the intersection of row (3) with columns (N) to (V)). The only favorable assessment is for health problems of grade schoolers (cell S3), while the one clear unfavorable impact is for school achievement problems of adolescents (U3).
11.1.3. Sanctions
While financial work incentives and work mandates have been relatively well-studied, other policy reforms have been analyzed less thoroughly. As a result, their effects are less well understood. Sanctions are an important case in point (see row (4)). Many states have enacted sanctions that are substantially more stringent than those under JOBS. Moreover, many families have lost their aid, or at least part of their aid, because of sanctions. However, no experiments were conducted to isolate the effects of sanctions. Indeed, none of the experiments we consider involve any experimental variation in sanction policy, except in conjunction with other policy reforms. Some econometric studies of the caseload indicate that stricter sanctions have greater effects on welfare use, but evidence showing that substantial declines in welfare use preceded the imposition of such sanctions by several years clouds the interpretation of those findings (cell A4). With the exception of a single econometric study of child maltreatment (represented by the asterisk in cell M4), there are no studies of the effects of sanctions on any other outcome.
11.1.4. Time Limits
Time limits have been better studied than sanctions, but much less well-studied than mandatory work-related activities. Because the random assignment studies that involved time limits all involved other reforms as well, the experimental results from those studies do not isolate the effects of time limits. Several econometric studies have analyzed the behavioral effects of time limits, that is, how time limits affect behavior before recipients exhaust their benefits. These studies form the basis for the cell entries in row (7) (see Table B.1 in Appendix B). The cell entries in row (8) are based on nonexperimental estimates from two random assignment studies, along with one econometric study of employment, that provide some insights into how behavior changes once recipients begin reaching the time limit.
Most of the econometric studies suggest that time limits reduce welfare use during the pre—time limit period (cell A7). One set of studies reports results that are consistent with the notion that some families bank their months of eligibility for future use. Only two studies suggest that time limits also increase employment during the pre—time limit period (cell B7), so we place less confidence on this cell entry. There is insufficient evidence or no evidence available for assigning the direction of impact of time limits before recipients reach the limit for any of the other outcomes shown in Table 11.1, including child well-being.
The knowledge base regarding the post—time limit effects of time limits is even shallower. Two studies show that welfare use falls sharply once recipients begin to exhaust their benefits. Effects on employment are mixed, but none of the evidence suggests that it changes much, either up or down, once recipients start reaching the limit. Clearly, the post—time limit consequences of time limits could increase substantially once a higher proportion of the caseload reaches the limit.
11.1.5. Family Caps and Parental Responsibility
Table 11.1 also documents that we know relatively little about how family caps and parental responsibility requirements affect key outcomes. The limited available evidence points to a mixed impact of family caps on fertility (cell G9). An equally shallow evidence base also produces mixed evidence with respect to the impact of family caps on welfare use (cell A9). Parental responsibility requirements, specifically those related to well-baby and well-child services (e.g., vaccinations), have been assessed in terms of their direct impact on the behaviors they seek to change, with some limited evidence of favorable effects in terms of child health for young children (cell S10). How this policy affects other outcomes is unknown.
11.1.6. Welfare Reform as a Bundle
Looking beyond specific policy reforms, a number of econometric studies and the six random assignment studies that involved TANF-like bundles of reforms provide insights into the effects of reform as a bundle. For many outcomes, welfare reform as a bundle produces impacts similar to those seen for mandatory work-related activities with weak financial work incentives (compare rows (6) and (11)): a decline in welfare use and food stamp use, and an increase in employment, earnings, and income. This is plausible given that most states implemented weaker financial work incentives combined with mandatory work-related activities, and given that what is known about the behavioral impacts of time limits suggests that they operate in the same direction as weak financial work incentives and work mandates (compare cell A6 with A7, and B6 with B7).
For other outcomes, the knowledge base is very shallow. The impact on Medicaid use, marriage, and fertility is mixed (cells E11, F11, and G11), while poverty appears to decrease (cell I11). There is too little evidence to assess the impact of reform as a bundle on other measures of well-being in columns (J) to (L). In the case of the child well-being outcomes in columns (N) to (V), the limited available evidence appears to show a mixed impact on behavior problems of young children and adolescents, and an increase in school achievement problems for adolescents. There is some indication of reduced health problems for grade schoolers. However, the cells that are signed in these columns are based exclusively on results from two random assignment studies, FTP and Jobs First. The bundle of reforms implemented in these two states is not very representative of the reforms implemented in other states in terms of the length of the time limit (two years or less in both cases) or the generosity of the financial work incentives (notably in Connecticut). Thus, the impacts in row (11) for these columns should be interpreted cautiously.
It is also important to note that, regardless of the depth of the knowledge base, the entries in row (11) represent the effects of reform as a bundle during the pre—time limit period. Post—time limit evidence is very limited, and most studies summarized in this row cover time periods prior to when recipients could have exhausted their benefits. Once recipients reach the limit in substantial numbers, these effects could change.
11.1.7. Welfare Reform Effects on Subgroups
As detailed in Appendix A, for the most part, the effects of reform do not generally appear to be concentrated among any particular group of recipients. Many observers would view this as good news, since there was widespread concern when PRWORA was enacted that only relatively advantaged recipients would respond, leaving the most disadvantaged behind. The subgroup-specific analyses provide no consistent evidence about this effect. In some cases, subgroup-specific impacts are similar for persons of different levels of disadvantage. In other cases, different measures of disadvantage generate different patterns, some appearing to favor the relatively advantaged and some appearing to favor the relatively disadvantaged. In many cases, subgroup-specific estimates are insignificant, in part because subgroup-specific sample sizes are too small to generate precise results even when the program has a substantial effect.
11.2. STRENGTHS AND LIMITATIONS OF THE EXISTING KNOWLEDGE BASE
Another way to use Table 11.1 is to look across the whole table and assess the general state of the knowledge base (the types of shading or lack of shading in the various cells). Table 11.1 reveals that the knowledge base is strongest for understanding the impact of various welfare reform policies on welfare use, employment, earnings, and income. The base is weakest for assessing the impact of policies on broader measures of well-being, especially child outcomes, most notably those for pre-school-age children. Among the policies, a solid base of research exists to evaluate the impacts of mandatory work-related activities on most outcomes, and it is nearly as strong for financial work incentives, either alone or when tied to hours worked or in combination with mandatory work-related activities. As we have already discussed, several reform policy components have received less attention, most notably time limits, sanctions, family caps, and parental responsibility requirements. Overall, just under half the cells in our matrix (120 out of 242 cells) are empty, indicating no research base exists to assess the policy-outcome pair. Another 36 cells (those with an asterisk) are nearly empty.
Some of the gaps in the knowledge base are particularly relevant for policy. For example, there have been relatively few causal studies of how welfare reform has affected Medicaid participation, as shown in column (E), or the health care coverage of children more generally, as shown in column (K). This omission is particularly important in light of the initial decreases in Medicaid enrollment that occurred following the implementation of TANF–despite 15 years of policy initiatives designed to increase the coverage of poor children. As seen in columns (F) and (G), less is known about the impact of individual welfare reform policies and reform as a whole on marriage and fertility despite continued interest among many policymakers in policies to promote the formation and maintenance of two-parent families and to reduce out-of-wedlock childbearing. Columns (N)—(P) show that little is known about welfare reform and child development prior to school entry, which is troublesome given the increased emphasis on work for mothers of children as young as age one or younger. This is an issue that is particularly relevant for policies aimed at improving early care and education.
For the policy-outcome combinations where we have a more substantial knowledge base, a nearly universal limitation of our conclusions is that they apply mostly to the short run. Most of the studies present evidence from follow-up periods of roughly two years, although the 11 NEWWS programs and several others provide results based on four or five years of follow-up data. The limited available evidence suggests that some of the effects change over time for reasons that are not well understood.
The short-run nature of the evidence limits our understanding of whether reform has accomplished its goals of reducing unwed childbearing, encouraging marriage, and maintaining two-parent families. Marriage and fertility involve substantially more inertia than other aspects of behavior. As a result, we would expect the effects of welfare reform on such outcomes to become apparent only over a longer horizon. With mostly a short-run follow-up period to draw on, it should come as little surprise that most of the evidence from high-quality studies is mixed and statistically insignificant. One exception is MFIP-IO, which appears to have decreased marital disruption among married couples and perhaps increased marriage among previously unmarried recipients. However, the results from SSP suggest caution in interpreting the MFIP-IO results. In SSP, a similar program of financial work incentives provided through an earnings supplement, marriage increased in one site but decreased in the other. The different outcomes may be the result of the different treatment of recipients who marry, but more research is needed. The other exception is the NEWWS evaluation, which provides consistent evidence that mandatory work-related activities have no impact on marriage or fertility up to five years after random assignment.
The short-run nature of the data also poses a problem for assessing how welfare reform affects the well-being of children. Although some aspects of a child’s well-being, such as behavior problems, may respond quickly in reaction to changes in his or her parent’s behavior, other aspects, such as cognitive skills, are likely to take much longer to change. Furthermore, even effects apparent in the short-term may change as children are exposed to cumulatively lower levels of welfare use and higher levels of employment on the part of their parents. In the short run, there is some evidence of favorable impacts on grade-school-aged children in the behavior and school achievement domains associated with programs that include more generous financial work incentives, either alone or tied to hours worked or to mandatory work-related activities. But the available evidence shows both favorable and unfavorable impacts associated with work requirements and reform as a bundle in these same domains. In the case of adolescents, there is more consistent evidence of unfavorable behavioral and school achievement impacts associated with these same policies up to five years after reform. Whether these same patterns will continue in the longer run–or whether they will be attenuated or exacerbated–remains to be determined.
A more general omission is any understanding of how reform has affected families’ decisions to go on welfare to begin with. Random assignment experiments are a powerful research design for revealing how policy reforms affect families’ decisions to leave the welfare rolls, but they provide no information at all on how families decide to join the rolls. Econometric studies of welfare use reflect the effects of entry decisions, but they do not distinguish them specifically. To date, there have been few econometric studies that focus specifically on welfare entry.
This omission is significant because entry appears to be important. Theoretical considerations lead us to expect that most policy reforms affect both entry and exit. Recent empirical work indicates that as much as one-half of the recent decline in the caseload is attributable to declining rates of entry. To the extent that welfare entry is the point at which many families learn they are eligible for Medicaid, the effects of welfare reform on welfare entry may work against the policy goal of expanding health coverage among the poor. Finally, as we argued in Chapter 7, understanding the full effects of reform on marriage and fertility will require that we understand how reform affects the types of behavior that historically have triggered recipients’ initial entry onto welfare.
This discussion highlights a number of gaps in our knowledge base and indicates that we do not know everything that ideally should be known as policymakers begin to debate the reauthorization of PRWORA. To some extent this is inevitable. Policy evaluations take time to conduct, and the policies being evaluated have been in place for at most the last decade.
Another conclusion that we draw from the same evidence is more constructive. It shows that, with sufficient time and sufficient resources, we can greatly expand our knowledge about the workings of new policies. NEWWS provides the leading case in point. Because of the NEWWS evaluation, the effects of mandatory work-related activities are among the best-understood of all social policies.
11.3. AN AGENDA FOR FURTHER RESEARCH
From this example we draw a broader lesson: Our knowledge base in 2002 is stronger because of research programs put in place in the late 1980s and early 1990s under the strong guidance of USDHHS, and that increase in knowledge occurred only as a result of major expenditures on program development and evaluation. Likewise, the inclusion of research funding in the PRWORA legislation supported a continuation of the research and evaluation studies that were initiated prior to federal reform. Consequently, the available knowledge base associated with the welfare reforms implemented in the last decade is superior in many respects to that available for many other areas of social policy.
To add to that knowledge base, it is desirable to learn about current policies that are poorly understood and about reforms that may be proposed in the future. To do so requires that we act now, putting in place a research agenda capable of bearing fruit in time for the next reauthorization. Since the research cycle is at least as long as the policy cycle, we need to continue to put research efforts in place now for what we will need to know when the nation next considers major welfare reform.
Several specific agenda items deserve priority. To begin, more long-run information on the effects of current policies is crucial. Current long-run studies should be continued and, where possible, extended. Long-term evaluations should include such outcomes as child well-being, where the impacts may take time to materialize or where they may vary with the stage of child development. Further research is also needed to understand the effectiveness of alternative strategies for promoting the transition from welfare to work for subgroups of the welfare population, such as for recipients with substance abuse problems and those who experience domestic violence.
Other policies that are less well understood need further evaluation. Time limits represent an important example. Although the time has probably passed for conducting experiments to understand their behavioral effects, their mechanical effects will soon become increasingly important: As of April 2001, roughly 120,000 families had hit their time limits, most of whom live in states with time limits that are shorter than the federal five-year maximum (Center on Budget and Policy Priorities, 2001). The number of families exhausting their benefits may grow sharply in the near future as recipients in other states reach the federal five-year time limit. Studies to assess how families respond are critical.
Sanctions are among the most poorly understood of all of the policy reforms. This is an area where both econometric and experimental work would be useful. Econometric analyses that incorporate information on the likelihood of sanctioning and the monetary value of sanctions would provide a more complete understanding of this policy than the studies that are currently available. Experimentation could also help reveal how different levels of sanctions affect a broad range of outcomes. In either case, future research should continue on the path of expanding the range of outcomes examined, in addition to welfare use, employment, and earnings, which have been the focus of most studies to date.
Entry effects need to be better understood, both to fully grasp how reform has affected welfare use and labor market behavior and to understand how it affects fertility and the utilization of important in-kind services. This is an area where experimentation has less to offer. What is needed are high-quality econometric studies that focus directly on entry decisions.
Evidence from future econometric studies would be more useful if researchers characterized the variation in specific policy reforms across the states. Sanctions can be characterized by their monetary penalties, as suggested above; financial work incentives can be characterized by the benefit payment available to working recipients, as some researchers have done. More fully characterizing the policy environment is essential if econometric studies are to move beyond estimating the effects of reform as a bundle. Although existing national databases pose limitations for such efforts, approaches that utilize richer representations of states’ policies are more likely to yield success in estimating the effects of specific reforms than approaches that rely on policy-specific dummy variables (Moffitt and Ver Ploeg, 2001; Adams and Hotz, 2001).
Initiatives sponsored by USDHHS and other agencies in several of these areas will add to the current knowledge base. For example, follow-up studies continue for a number of the experimental evaluations we examined in Chapters 4 to 10, and evaluations are under way in a number of other states that implemented other bundles of reforms. Reports are expected soon with longer-term results for Indiana’s IMPACT program, Iowa’s FIP, and Vermont’s WRP, including impacts on child well-being up to five years after randomization (like those already available for the NEWWS programs). Other studies are under way to understand issues regarding accessing Medicaid and the Food Stamp Program, to evaluate the effectiveness of programs serving particularly disadvantaged segments of the welfare population, and to evaluate alternative approaches to promoting job retention and advancement among TANF recipients.
As in the past, advancing such an ambitious research agenda will require substantial federal participation. Many of the experiments reviewed here were conducted to satisfy the requirement that waiver-era reforms be evaluated and because the federal government paid for a portion of the costs. TANF’s devolution of discretion to the states removed the requirement for rigorous evaluation. If we are to increase our knowledge base between now and the next time the nation considers major welfare reform, federal funds need to be invested to continue the evaluation of state investments under TANF. Even given TANF’s devolution of welfare policy to the states, a strong federal role in research and evaluation remains necessary. As this study demonstrates, knowledge gained in one state may be broadly applicable in others. Because of these knowledge spillovers, the states cannot be expected to finance and carry out the needed amount of evaluation research without federal assistance.
Although the current research base provides answers to many of the important questions about welfare reform, many others remain unanswered. With planning, resources, and action, many of the outstanding questions can be addressed in time for the next reauthorization debate. With further research, we can better understand the trade-offs that reform entails and determine whether it has met its goals.
106Table 11.1 lists only three of the outcomes considered in Chapter 9. The results for adult health insurance coverage are similar to what is shown for children’s coverage. Many of the cells for the other outcomes considered in the chapter would be blank or have an asterisk.(back)
107Appendix B provides the details on how we determined the indicators for the direction and depth of the knowledge base assigned to each cell in the table.(back)
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