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May 19, 1993

Uninsured Children and National Health Care Reform

JAMA. 1993;269(19):2506. doi:10.1001/jama.1993.03500190048026

To the Editor.  —In discussing policy options for providing health care access to uninsured children, Marquis and Long1 ignore one of the most perverse features of the current Medicaid system. A family with children and no working adults could almost always qualify for both Aid to Families With Dependent Children and Medicaid. However, if one parent got a minimum-wage job, family income could exceed the Medicaid eligibility cutoff, and the family would lose its health insurance. In many cases, the value of the health insurance lost could exceed the after-tax income from that minimum-wage job. In such circumstances the decision to go on welfare, rather than work, would be perfectly logical.In order to avoid creating incentives that perpetuate the cycle of poverty and welfare dependence it is necessary to ensure that the advantages offered by welfare dependence never exceed those offered by gainful employment. In the case of