The impact of welfare reform on health insurance coverage in rural areas.

The Personal Responsibility and Work Opportunity Act of 1996 (PRWOA, often simply called “welfare reform”) led to profound changes in the Aid to Families with Dependent Children (AFDC) program, which was renamed the Temporary Assistance to Needy Families (TANF) program in the process. Those changes included removing millions of persons from eligibility for direct public assistance, which in previous years would have meant loss of eligibility for Medicaid as well. However, the PRWOA eliminated the link between welfare (now TANF) and Medicaid. Despite the clear intent to minimize the impact on Medicaid and therefore on financial access to health care services, did PRWOA contribute to increases in the number of uninsured Americans? Have there been particular consequences for rural residents?