Magazine article Policy & Practice

A Lesson from Welfare Reform

Magazine article Policy & Practice

A Lesson from Welfare Reform

Article excerpt

Editor's Note: "Jerry's Blog " is now a feature on APHSA's website, Please go there to share your thoughts with Jerry.

There is an adage that people who fail to learn from history are destined to repeat it. I think that the reverse is also true. If we fail to take advantage of positive lessons learned, we will not maximize our potential. This is an exciting time to be in Washington, D.C., with the reauthorization of TANF and health care reform on the congressional agenda.


Welfare reform represented the most significant change in social policy in my lifetime. I also believe that lessons learned from that experience can help with the implementation of health care reform.

Let's take a look at the effects of welfare reform. In exchange for the end of entitlements and adoption of time limits, states were given block grants with greater flexibility to design programs that made sense to them. Over the course of a decade, we witnessed:

* A 60 percent decline in caseloads

* Double the number of child support collections

* Well over a million people becoming gainfully employed who were not previously attached to the workforce

* Creation of hundreds of thousands of safe child care slots

* Implementation of a national EBT system

By all accounts, especially with static funding, this would be considered a success. Unless, of course, you were the 109th Congress and decided to attach it to a Deficit Reduction Act and imposed AFDC-type process requirements, restrictions and penalties. That, however, is a topic for another column.

Let's look at lessons learned from welfare reform that may also be applicable to health care reform. Perhaps we have a model.

First, it's a misnomer to assume that welfare reform actually started with a new law. Prior to enactment, more than 40 states obtained waivers to test new self-sufficiency models, similar to the experimentation occurring in Medicaid programs today. PRWORA was an accumulation of the common threads that wove through those "laboratories of democracy."

We learned that welfare dependency was a bad investment strategy, creating a compelling case for change. Similarly, much of our current health care system profits from limiting services and under-emphasizes prevention and wellness.

We learned that personal responsibility was a critical component of effective human service policy. Likewise, people are ultimately responsible for their own health care behaviors and choices.

We learned that people, when given viable options, will make responsible choices and respond appropriately to incentives--both positive and negative.

We learned that the best service delivery is designed from the bottom up--leveraging local community assets.

We learned that to be truly successful, we had to rely on partnerships, especially with business, private providers and other public sectors. Government alone can't fix health care any more than it could solve welfare reform in a vacuum.

We learned that coordinated and integrated service delivery strategies were vital to successful outcomes for clients with multiple problems. A similar need exists to incorporate integrated public health, medicine, education and social services into our health care thinking. …

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