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When the Personal Responsibility and Work Opportunity Reconciliation Act became law in 1996, the architects of welfare reform celebrated what they called the new \"consensus\" on welfare: that cash assistance should be temporary and contingent on recipients' seeking and finding employment. However, assessments about the assumptions and consequences of this radical change to the nation's social safety net were actually far more varied and disputed than the label \"consensus\" suggests. By examining the varied realities and accountings of welfare restructuring, Stretched Thin looks back at a critical moment of policy change and suggests how welfare policy in the United States can be changed to better address the needs of poor families and the nation. Using ethnographic observations, in-depth interviews with poor families and welfare workers, survey data tracking more than 750 families over two years, and documentary evidence, Sandra Morgen, Joan Acker, and Jill Weigt question the validity of claims that welfare reform has been a success. They show how poor families, welfare workers, and welfare administrators experienced and assessed welfare reform differently based on gender, race, class, and their varying positions of power and control within the welfare state. The authors document the ways that, despite the dramatic drop in welfare rolls, low-wage jobs and inadequate social supports left many families struggling in poverty. Revealing how the neoliberal principles of a drastically downsized welfare state and individual responsibility for economic survival were implemented through policies and practices of welfare provision and nonprovision, the authors conclude with new recommendations for reforming welfare policy to reduce poverty, promote economic security, and foster shared prosperity.

In 2008, a group of uninsured low-income adults in Oregon was selected by lottery to be given the chance to apply for Medicaid. This lottery provides an opportunity to gauge the effects of expanding access to public health insurance on the health care use, financial strain, and health of low-income adults using a randomized controlled design. In the year after random assignment, the treatment group selected by the lottery was about 25 percentage points more likely to have insurance than the control group that was not selected. We find that in this first year, the treatment group had substantively and statistically significantly higher health care utilization (including primary and preventive care as well as hospitalizations), lower out-of-pocket medical expenditures and medical debt (including fewer bills sent to collection), and better self-reported physical and mental health than the control group.

In 2008, a group of uninsured low-income adults in Oregon was selected by lottery for the chance to apply for Medicaid. Using this randomized design and 2009 administrative data, we find no significant effect of Medicaid on employment or earnings. Our 95 percent confidence intervals allow us to reject that Medicaid causes a decline in employment of more than 4.4 percentage points, or an increase of more than 1.2 percentage points. Medicaid increases food stamps receipt, but has little, if any, impact on receipt of other measured government benefits, including SSDI.

We study the welfare effects of offering choice over coverage levels—“vertical choice”—in regulated health insurance markets. We emphasize that heterogeneity in efficient coverage level is not sufficient to motivate choice. When premiums cannot reflect individuals’ costs, it may not be in consumers’ best interest to select their efficient coverage level. We show that vertical choice is efficient only if consumers with higher willingness to pay have a higher efficient level of coverage. We investigate this condition empirically and find that as long as a minimum coverage level can be enforced, the welfare gains from vertical choice are either zero or economically small.

We study the impact of expanded adult Medicaid eligibility on the enrollment of already-eligible children. We analyze the 2008 Oregon Medicaid lottery, in which some low-income uninsured adults were randomly selected to be allowed to apply for Medicaid. Children in these households were eligible for Medicaid irrespective of the lottery outcome. We estimate statistically significant but transitory impacts of adult lottery selection on child Medicaid enrollment: at three months after the lottery, for every nine adults who enrolled in Medicaid due to winning the lottery, one additional child also enrolled. Our results shed light on the existence, magnitude, and nature of so-called “woodwork effects.”

This study addresses whether providing housing vouchers through the Family Unification Program (FUP) to families involved in the child welfare system reduces child maltreatment and the need for child welfare services. The study uses child welfare administrative data on 326 children in Portland, Oregon, and 502 children in San Diego, California from the point at which their families were referred to the program through 18 months post-referral. Using a quasi-experimental waitlist comparison design, probit regressions show little impact of FUP on preventing child removal from home, but some positive impact on reunification among children already placed out of home. Hazard estimations show receipt of FUP speeds up child welfare case closure. Impacts on new reports of abuse and neglect are mixed, but point toward reduced reports. Low rates of removal among intact comparison families and high rates of reunification for children in out-of-home care suggest poor targeting of housing resources. Housing vouchers are being given to families not bearing the risks the program is intended to address. The presence of some positive findings suggests that housing vouchers might help reduce child welfare involvement if better targeting were practiced by child welfare agencies.

The health of farm owners and farmworkers has significant impacts on farm businesses, farming families, and local rural communities where agriculture is an important driver of social and economic activity. Rural residents and farmworkers have higher rates of food insecurity, but little is known about food insecurity among farm owners and the collective experiences of farm owners and farmworkers. Researchers and public health practitioners have stressed the need for policies that target the health and well-being of farm owners and farmworkers while remaining sensitive to the nature of life on the farm, yet farm owner and farmworker lived experiences have been understudied, especially in relation to one another. In-depth qualitative interviews were conducted with 13 farm owners and 18 farmworkers in Oregon. Modified grounded theory was used to analyze interview data. Data were coded using a three-stage process to identify salient core characteristics of food insecurity. Farm owner and farmworker meanings and interpretations of their food insecurity were often contradicted by evaluated food security scores using validated quantitative measures. According to such measures, 17 experienced high food security, 3 had marginal food security, and 11 had low food security, but narrative experiences suggested higher rates. Narrative experiences were categorized by core characteristics of food insecurity, including seasonal food shortages, resource stretching, working extended hours most days of the week, limited use of food assistance, and the tendency to downplay hardship. These unique factors have important implications for developing responsive policies and programs to support the health and well-being of farm livelihoods whose work enables health and well-being among consumers. Future studies to test the relationships between the core characteristics of food insecurity identified in this study and farm owner and farmworker meanings and interpretations of food insecurity, hunger, and nourishment are warranted.

The number of small-scale and backyard livestock and poultry owners in urban and peri-urban areas has increased greatly over the last 10 years in the U.S. However, these animal owners may live in areas without access to livestock and/or poultry veterinary care. The purpose of this study was to identify potential veterinary service needs of these animal owners in the western US, assess their use of management and husbandry practices with regards to disease prevention, and assess their attitudes about animal health and food safety. A semi-structured survey was made available to small-scale and backyard livestock and poultry owners in Washington State, California, Colorado and Oregon. The survey instrument included questions about types of animals reared, uses of the animals, veterinary services and information-seeking behaviors of owners, attitudes on animal health and food safety, and management practices. Four hundred thirty-five individuals completed at least some portion of the survey. Most described themselves as living in rural areas (76%). Most (86%) owned chickens, 53% owned small ruminants, and 31% owned cattle. Many individuals owned more than one species and most had fewer than 20 animals of a given species. About 74% of respondents utilized their animals' products for their own consumption but 48% sold animal products (primarily through internet sales (35%) or farmers' markets (25%)). Overwhelmingly, respondents gained information about animal health (82%) and animal treatment procedures (71%) from the internet. Respondents reported their veterinarian's practice type as companion animal (26%) or a mixed animal or food animal predominant (66%). Overall, respondents were very satisfied with the level of care (82%), but 43% had not sought animal health care in last 12 months. However, the veterinarian's primary practice type and owner's satisfaction with veterinary care were associated with their location (state), species owned, and urban or peri-urban setting. Livestock species type (cattle, small ruminants and swine), and use (personal or commercial) were associated with implementation of different biosecurity practices. The results of this survey highlight some of the needs of these animal owners for veterinary care and information which are location- and species-specific. Veterinary care for these small-scale and backyard animals is vital to the health and welfare of the animals as well as for identification of zoonoses and assurance of the food safety of animal products.

Exposure to biodiverse environments such as forests can benefit human well-being, and evidence suggests exposure to high microbial diversity may improve mental and immune health. However, the factors that drive microbial community assembly are poorly understood, as is the relationship between exposure to these communities and human health. We characterized airborne bacterial communities in two disparate types of urban greenspace (forest and grass) in late-spring 2017 at sites previously sampled in late-summer 2015 in Eugene-Springfield, Oregon, using high-throughput metabarcode sequencing. While all sites shared a core aerobiome in late-spring consisting of plant- and soil-associated genera, forests had significantly higher diversity than grass sites (F = 12, P = 0.004). Vegetation type explained 14% of the difference between forest and grass aerobiomes, yet individual site location explained 41% of the variation. These results were similar to but amplified over those from late summer, suggesting that both aerobiome diversity and vegetation-driven effects are higher when deciduous foliage is fresher and more active, temperatures cooler, and humidity higher. Continued exploration and hypothesis-driven research will enable development of mechanistic theory describing key drivers of urban aerobiome assembly and its relationship to human health, which, in turn, will help urban designers and planners create evidence-based salutogenic cities for future generations.