Generational differences in U.S. public spending, 1980-2000

Health Affairs

Volumn 23, Issue 5, 2004, Pages 131-141

  Pati, Susmita ^a,b,c   Keren, Ron ^a,b,c   Alessandrini, Evaline A ^a,b,d   Schwarz, Donald F ^a,b,e  

^a CHILDREN S HOSPITAL OF PHILADELPHIA   (United States)

^b UNIVERSITY OF PENNSYLVANIA   (United States)

^c Department of Pediatrics   (United States)

^d C

^e UNIVERSITY OF PENNSYLVANIA   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; CHILD CARE; ECONOMIC ASPECT; ELDERLY CARE; FINANCIAL MANAGEMENT; HEALTH PROGRAM; HUMAN; SOCIAL WELFARE; UNITED STATES;

AGE FACTORS; AGED; CHILD; CHILD HEALTH SERVICES; CHILD, PRESCHOOL; HEALTH EXPENDITURES; HUMANS; POLICY MAKING; SOCIAL WELFARE; UNITED STATES;

EID: 4644234982     PISSN: 02782715     EISSN: None     Source Type: Journal    
DOI: 10.1377/hlthaff.23.5.131     Document Type: Article

References (46)

1. Personal Responsibility and Work Opportunity Reconciliation Act of 1996, 104-193, 110 Stat. 2105 (22 August 1996).
2. C. Mann, "The Bush Administration's Medicaid and State Children's Health Insurance Program Proposal" (Washington: Georgetown University Institute for Health Care Research and Policy, 2003).
3. G.A. Anderson et al., "It's the Prices, Stupid: Why the United States Is So Different from Other Countries," Health Affairs 22, no. 3 (2003): 89-105; Organization for Economic Cooperation and Development, Society at a Glance: OECD Social Indicators, Edition 2002 (Paris: OECD, 2003); I. Kawachi and B.P. Kennedy, "Income Inequality and Health: Pathways and Mechanisms," Health Services Research 34, no. 1, Part 2 (1999): 215-227; B.P. Kennedy, I. Kawachi, and D. Prothrow-Stith, "Income Distribution and Mortality: Cross Sectional Ecological Study of the Robin Hood Index in the United States," British Medical Journal 312, no. 7037 (1996): 1004-1007 (see erratum in British Medical Journal 312, no. 7040 [1996]: 1194); and J.P. Martin, "Transforming Social Protection for the Twenty-first Century" (Paper presented at PrimeFinland 2020, 29 March 2004).
4. G.A. Anderson et al., "It's the Prices, Stupid: Why the United States Is So Different from Other Countries," Health Affairs 22, no. 3 (2003): 89-105; Organization for Economic Cooperation and Development, Society at a Glance: OECD Social Indicators, Edition 2002 (Paris: OECD, 2003); I. Kawachi and B.P. Kennedy, "Income Inequality and Health: Pathways and Mechanisms," Health Services Research 34, no. 1, Part 2 (1999): 215-227; B.P. Kennedy, I. Kawachi, and D. Prothrow-Stith, "Income Distribution and Mortality: Cross Sectional Ecological Study of the Robin Hood Index in the United States," British Medical Journal 312, no. 7037 (1996): 1004-1007 (see erratum in British Medical Journal 312, no. 7040 [1996]: 1194); and J.P. Martin, "Transforming Social Protection for the Twenty-first Century" (Paper presented at PrimeFinland 2020, 29 March 2004).
5. G.A. Anderson et al., "It's the Prices, Stupid: Why the United States Is So Different from Other Countries," Health Affairs 22, no. 3 (2003): 89-105; Organization for Economic Cooperation and Development, Society at a Glance: OECD Social Indicators, Edition 2002 (Paris: OECD, 2003); I. Kawachi and B.P. Kennedy, "Income Inequality and Health: Pathways and Mechanisms," Health Services Research 34, no. 1, Part 2 (1999): 215-227; B.P. Kennedy, I. Kawachi, and D. Prothrow-Stith, "Income Distribution and Mortality: Cross Sectional Ecological Study of the Robin Hood Index in the United States," British Medical Journal 312, no. 7037 (1996): 1004-1007 (see erratum in British Medical Journal 312, no. 7040 [1996]: 1194); and J.P. Martin, "Transforming Social Protection for the Twenty-first Century" (Paper presented at PrimeFinland 2020, 29 March 2004).
6. G.A. Anderson et al., "It's the Prices, Stupid: Why the United States Is So Different from Other Countries," Health Affairs 22, no. 3 (2003): 89-105; Organization for Economic Cooperation and Development, Society at a Glance: OECD Social Indicators, Edition 2002 (Paris: OECD, 2003); I. Kawachi and B.P. Kennedy, "Income Inequality and Health: Pathways and Mechanisms," Health Services Research 34, no. 1, Part 2 (1999): 215-227; B.P. Kennedy, I. Kawachi, and D. Prothrow-Stith, "Income Distribution and Mortality: Cross Sectional Ecological Study of the Robin Hood Index in the United States," British Medical Journal 312, no. 7037 (1996): 1004-1007 (see erratum in British Medical Journal 312, no. 7040 [1996]: 1194); and J.P. Martin, "Transforming Social Protection for the Twenty-first Century" (Paper presented at PrimeFinland 2020, 29 March 2004).
7. G.A. Anderson et al., "It's the Prices, Stupid: Why the United States Is So Different from Other Countries," Health Affairs 22, no. 3 (2003): 89-105; Organization for Economic Cooperation and Development, Society at a Glance: OECD Social Indicators, Edition 2002 (Paris: OECD, 2003); I. Kawachi and B.P. Kennedy, "Income Inequality and Health: Pathways and Mechanisms," Health Services Research 34, no. 1, Part 2 (1999): 215-227; B.P. Kennedy, I. Kawachi, and D. Prothrow-Stith, "Income Distribution and Mortality: Cross Sectional Ecological Study of the Robin Hood Index in the United States," British Medical Journal 312, no. 7037 (1996): 1004-1007 (see erratum in British Medical Journal 312, no. 7040 [1996]: 1194); and J.P. Martin, "Transforming Social Protection for the Twenty-first Century" (Paper presented at PrimeFinland 2020, 29 March 2004).
8. OECD, Society at a Glance.
9. U.S. Bureau of the Census, Current Population Survey, Annual Social and Economic Supplements, Poverty and Health Statistics Branch/HHES Division, "Table 3, Poverty Status of People by Age, Race, and Hispanic Origin: 1959 to 2002," Historical Poverty Tables, 2 October 2003, www.census.gov/hhes/ poverty/histpov/hstpov3.html (21 June 2004).
10. Ibid. According to U.S. Census Bureau estimates, the number of Americans age sixty-five and older will grow from 41.4 million in 2001 (14 percent of the population) to 101.4 million in 2050 (25 percent of the population).
11. Boards of Trustees, Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds, 2004 Annual Report of the Boards of the Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds (Washington: Boards of Trustees, 2004).
12. OECD, Society at a Glance.
13. A.E. Benjamin, P.W. Newacheck, and H. Wolfe, "Intergenerational Equity and Public Spending," Pediatrics 88, no. 1 (1991): 75-83.
14. I b i d.
15. For food stamps, elderly are considered to be those over age sixty, and children are considered to be those under age eighteen.
16. M.R. Gold, ed., Cost-Effectiveness in Health and Medicine (New York: Oxford University Press, 1996).
17. The study sample is the entire U.S. population, so statistical inferences and testing are not necessary to evaluate the significance of observed differences and trends.
18. Full bibliographic information is available in an online appendix, content.healthaffairs.org/cgi/content/full/23/5/131/DC1.
19. Elderly people's portion of Social Security includes payments to retired workers, their wives and husbands, surviving widowed mothers and fathers, widows and widowers, parents, and special beneficiaries. The children's portion includes payments to retired workers' children and surviving children.
20. Appropriations under the Older Americans Act were tracked by the House Committee on Aging in the mid- to late 1980s in a series of volumes entitled Developments in Aging.
21. Child nutrition programs include National School Lunch, School Breakfast, and Special Milk Programs.
22. Because of space limitations, spending data are presented for selected years 1980-2000. An expanded Exhibit 3 is available at content.healthaffairs. org/cgi/content/full/23/5/131/DC1.
23. Benjamin et al., "Intergenerational Equity and Public Spending."
24. C.E. Steuerle, The Incredible Shrinking Budget for Working Families and Children (Washington: Urban Institute, 2003).
25. U.S. House Committee on Ways and Means, Green Book, 1994: Background Material and Data on Programs within the Jurisdiction of the Committee on Ways and Means, 14th ed. (Washington: U.S. Government Printing Office, March, 1994).
26. Family Support Act of 1988, 100-485 (13 October 1988).
27. U.S. Department of Health and Human Services, Change in TANF Caseloads since Enactment of New Welfare Laws (Washington: HHS, Administration for Children and Families, 2000); U.S. Department of Agriculture, The Decline in Food Stamp Participation: A Report to Congress (Washington: USDA, 2001); U.S. Government Accountability Office, Medicaid Enrollment: Amid Declines, State Efforts to Ensure Coverage after Welfare Reform Vary (Washington: GAO, 1999); K. Kronebusch, "Children's Medicaid Enrollment: The Impacts of Mandates, Welfare Reform, and Policy Delinking," Journal of Health Politics, Policy and Law 26, no. 6 (2001): 1223-1260; S. Pati, D. Romero, and W. Chavkin, "Changes in Use of Health Insurance and Food Assistance Programs in Medically Underserved Communities in the Era of Welfare Reform: An Urban Study," American Journal of Public Health 92, no. 9 (2002): 1441-1445; and S.R. Zedlewski, "Leaving Welfare Often Severs Families' Connections to the Food Stamp Program," Journal of the American Medical Women's Association 57, no. 1 (2002): 23-26.
28. U.S. Department of Health and Human Services, Change in TANF Caseloads since Enactment of New Welfare Laws (Washington: HHS, Administration for Children and Families, 2000); U.S. Department of Agriculture, The Decline in Food Stamp Participation: A Report to Congress (Washington: USDA, 2001); U.S. Government Accountability Office, Medicaid Enrollment: Amid Declines, State Efforts to Ensure Coverage after Welfare Reform Vary (Washington: GAO, 1999); K. Kronebusch, "Children's Medicaid Enrollment: The Impacts of Mandates, Welfare Reform, and Policy Delinking," Journal of Health Politics, Policy and Law 26, no. 6 (2001): 1223-1260; S. Pati, D. Romero, and W. Chavkin, "Changes in Use of Health Insurance and Food Assistance Programs in Medically Underserved Communities in the Era of Welfare Reform: An Urban Study," American Journal of Public Health 92, no. 9 (2002): 1441-1445; and S.R. Zedlewski, "Leaving Welfare Often Severs Families' Connections to the Food Stamp Program," Journal of the American Medical Women's Association 57, no. 1 (2002): 23-26.
29. U.S. Department of Health and Human Services, Change in TANF Caseloads since Enactment of New Welfare Laws (Washington: HHS, Administration for Children and Families, 2000); U.S. Department of Agriculture, The Decline in Food Stamp Participation: A Report to Congress (Washington: USDA, 2001); U.S. Government Accountability Office, Medicaid Enrollment: Amid Declines, State Efforts to Ensure Coverage after Welfare Reform Vary (Washington: GAO, 1999); K. Kronebusch, "Children's Medicaid Enrollment: The Impacts of Mandates, Welfare Reform, and Policy Delinking," Journal of Health Politics, Policy and Law 26, no. 6 (2001): 1223-1260; S. Pati, D. Romero, and W. Chavkin, "Changes in Use of Health Insurance and Food Assistance Programs in Medically Underserved Communities in the Era of Welfare Reform: An Urban Study," American Journal of Public Health 92, no. 9 (2002): 1441-1445; and S.R. Zedlewski, "Leaving Welfare Often Severs Families' Connections to the Food Stamp Program," Journal of the American Medical Women's Association 57, no. 1 (2002): 23-26.
30. U.S. Department of Health and Human Services, Change in TANF Caseloads since Enactment of New Welfare Laws (Washington: HHS, Administration for Children and Families, 2000); U.S. Department of Agriculture, The Decline in Food Stamp Participation: A Report to Congress (Washington: USDA, 2001); U.S. Government Accountability Office, Medicaid Enrollment: Amid Declines, State Efforts to Ensure Coverage after Welfare Reform Vary (Washington: GAO, 1999); K. Kronebusch, "Children's Medicaid Enrollment: The Impacts of Mandates, Welfare Reform, and Policy Delinking," Journal of Health Politics, Policy and Law 26, no. 6 (2001): 1223-1260; S. Pati, D. Romero, and W. Chavkin, "Changes in Use of Health Insurance and Food Assistance Programs in Medically Underserved Communities in the Era of Welfare Reform: An Urban Study," American Journal of Public Health 92, no. 9 (2002): 1441-1445; and S.R. Zedlewski, "Leaving Welfare Often Severs Families' Connections to the Food Stamp Program," Journal of the American Medical Women's Association 57, no. 1 (2002): 23-26.
31. U.S. Department of Health and Human Services, Change in TANF Caseloads since Enactment of New Welfare Laws (Washington: HHS, Administration for Children and Families, 2000); U.S. Department of Agriculture, The Decline in Food Stamp Participation: A Report to Congress (Washington: USDA, 2001); U.S. Government Accountability Office, Medicaid Enrollment: Amid Declines, State Efforts to Ensure Coverage after Welfare Reform Vary (Washington: GAO, 1999); K. Kronebusch, "Children's Medicaid Enrollment: The Impacts of Mandates, Welfare Reform, and Policy Delinking," Journal of Health Politics, Policy and Law 26, no. 6 (2001): 1223-1260; S. Pati, D. Romero, and W. Chavkin, "Changes in Use of Health Insurance and Food Assistance Programs in Medically Underserved Communities in the Era of Welfare Reform: An Urban Study," American Journal of Public Health 92, no. 9 (2002): 1441-1445; and S.R. Zedlewski, "Leaving Welfare Often Severs Families' Connections to the Food Stamp Program," Journal of the American Medical Women's Association 57, no. 1 (2002): 23-26.
32. U.S. Department of Health and Human Services, Change in TANF Caseloads since Enactment of New Welfare Laws (Washington: HHS, Administration for Children and Families, 2000); U.S. Department of Agriculture, The Decline in Food Stamp Participation: A Report to Congress (Washington: USDA, 2001); U.S. Government Accountability Office, Medicaid Enrollment: Amid Declines, State Efforts to Ensure Coverage after Welfare Reform Vary (Washington: GAO, 1999); K. Kronebusch, "Children's Medicaid Enrollment: The Impacts of Mandates, Welfare Reform, and Policy Delinking," Journal of Health Politics, Policy and Law 26, no. 6 (2001): 1223-1260; S. Pati, D. Romero, and W. Chavkin, "Changes in Use of Health Insurance and Food Assistance Programs in Medically Underserved Communities in the Era of Welfare Reform: An Urban Study," American Journal of Public Health 92, no. 9 (2002): 1441-1445; and S.R. Zedlewski, "Leaving Welfare Often Severs Families' Connections to the Food Stamp Program," Journal of the American Medical Women's Association 57, no. 1 (2002): 23-26.
33. P.J. Cunningham, J.D. Reschovsky, and J. Hadley, "SCHIP, Medicaid Expansions Lead to Shifts in Children's Coverage," Issue Brief no. 59 (Washington: Center for Studying Health System Change, 2002), 1-6; and A.D. Racine et al., "Differential Impact of Recent Medicaid Expansions by Race and Ethnicity," Pediatrics 108, no. 5 (2001): 1135-1142.
34. P.J. Cunningham, J.D. Reschovsky, and J. Hadley, "SCHIP, Medicaid Expansions Lead to Shifts in Children's Coverage," Issue Brief no. 59 (Washington: Center for Studying Health System Change, 2002), 1-6; and A.D. Racine et al., "Differential Impact of Recent Medicaid Expansions by Race and Ethnicity," Pediatrics 108, no. 5 (2001): 1135-1142.
35. Balanced Budget Act of 1997, 105-33 (5 August 1997).
36. U.S. Census Bureau, "Table 1 - People without Health Insurance for the Entire Year by Selected Characteristics: 2001 and 2002," 30 September 2003, www.census.gov/hhes/hlthins/hlthin02/hi02tl.pdf (21 June 2004).
37. L.A. Aday et al., "Health Insurance and Utilization of Medical Care for Children with Special Health Care Needs," Medical Care 31, no. 11 (1993): 1013-26; G.R. Byck, "A Comparison of the Socioeconomic and Health Status Characteristics of Uninsured, State Children's Health Insurance Program-Eligible Children in the United States with Those of Other Groups of Insured Children: Implications for Policy," Pediatrics 106, no. 1, Part 1 (2000): 14-21; K. Fiscella and P. Franks, "Poverty or Income Inequality as Predictor of Mortality: Longitudinal Cohort Study," British Medical Journal 314, no. 7096 (1997): 1724-1727; M. Marmot, "The Influence of Income on Health: Views of an Epidemiologist," Health Affairs 21, no. 2 (2002): 31-46; and P.W. Newacheck, "Poverty and Childhood Chronic Illness," Archives of Pediatric and Adolescent Medicine 148, no. 11 (1994): 1143-1149.
38. L.A. Aday et al., "Health Insurance and Utilization of Medical Care for Children with Special Health Care Needs," Medical Care 31, no. 11 (1993): 1013-26; G.R. Byck, "A Comparison of the Socioeconomic and Health Status Characteristics of Uninsured, State Children's Health Insurance Program-Eligible Children in the United States with Those of Other Groups of Insured Children: Implications for Policy," Pediatrics 106, no. 1, Part 1 (2000): 14-21; K. Fiscella and P. Franks, "Poverty or Income Inequality as Predictor of Mortality: Longitudinal Cohort Study," British Medical Journal 314, no. 7096 (1997): 1724-1727; M. Marmot, "The Influence of Income on Health: Views of an Epidemiologist," Health Affairs 21, no. 2 (2002): 31-46; and P.W. Newacheck, "Poverty and Childhood Chronic Illness," Archives of Pediatric and Adolescent Medicine 148, no. 11 (1994): 1143-1149.
39. L.A. Aday et al., "Health Insurance and Utilization of Medical Care for Children with Special Health Care Needs," Medical Care 31, no. 11 (1993): 1013-26; G.R. Byck, "A Comparison of the Socioeconomic and Health Status Characteristics of Uninsured, State Children's Health Insurance Program-Eligible Children in the United States with Those of Other Groups of Insured Children: Implications for Policy," Pediatrics 106, no. 1, Part 1 (2000): 14-21; K. Fiscella and P. Franks, "Poverty or Income Inequality as Predictor of Mortality: Longitudinal Cohort Study," British Medical Journal 314, no. 7096 (1997): 1724-1727; M. Marmot, "The Influence of Income on Health: Views of an Epidemiologist," Health Affairs 21, no. 2 (2002): 31-46; and P.W. Newacheck, "Poverty and Childhood Chronic Illness," Archives of Pediatric and Adolescent Medicine 148, no. 11 (1994): 1143-1149.
40. L.A. Aday et al., "Health Insurance and Utilization of Medical Care for Children with Special Health Care Needs," Medical Care 31, no. 11 (1993): 1013-26; G.R. Byck, "A Comparison of the Socioeconomic and Health Status Characteristics of Uninsured, State Children's Health Insurance Program-Eligible Children in the United States with Those of Other Groups of Insured Children: Implications for Policy," Pediatrics 106, no. 1, Part 1 (2000): 14-21; K. Fiscella and P. Franks, "Poverty or Income Inequality as Predictor of Mortality: Longitudinal Cohort Study," British Medical Journal 314, no. 7096 (1997): 1724-1727; M. Marmot, "The Influence of Income on Health: Views of an Epidemiologist," Health Affairs 21, no. 2 (2002): 31-46; and P.W. Newacheck, "Poverty and Childhood Chronic Illness," Archives of Pediatric and Adolescent Medicine 148, no. 11 (1994): 1143-1149.
41. L.A. Aday et al., "Health Insurance and Utilization of Medical Care for Children with Special Health Care Needs," Medical Care 31, no. 11 (1993): 1013-26; G.R. Byck, "A Comparison of the Socioeconomic and Health Status Characteristics of Uninsured, State Children's Health Insurance Program-Eligible Children in the United States with Those of Other Groups of Insured Children: Implications for Policy," Pediatrics 106, no. 1, Part 1 (2000): 14-21; K. Fiscella and P. Franks, "Poverty or Income Inequality as Predictor of Mortality: Longitudinal Cohort Study," British Medical Journal 314, no. 7096 (1997): 1724-1727; M. Marmot, "The Influence of Income on Health: Views of an Epidemiologist," Health Affairs 21, no. 2 (2002): 31-46; and P.W. Newacheck, "Poverty and Childhood Chronic Illness," Archives of Pediatric and Adolescent Medicine 148, no. 11 (1994): 1143-1149.
42. HHS, Healthy People 2010: Understanding and Improving Health, 2d ed. (Washington: U.S. GPO, November 2000).
43. See Note 18. According to the Internal Revenue Service, more than 98 percent of EITC refunds in 1999 went to families. IRS, Compliance Estimates for Earned Income Tax Credit Claimed on 1999 Returns (Washington: Department of the Treasury, IRS, 28 February 2002). Detailed legislative history is available from House Committee on Ways and Means, Green Book, 2004, 18th ed. (Washington: GPO, March 2004).
44. See Note 18. According to the Internal Revenue Service, more than 98 percent of EITC refunds in 1999 went to families. IRS, Compliance Estimates for Earned Income Tax Credit Claimed on 1999 Returns (Washington: Department of the Treasury, IRS, 28 February 2002). Detailed legislative history is available from House Committee on Ways and Means, Green Book, 2004, 18th ed. (Washington: GPO, March 2004).
45. House Committee on Ways and Means, Green Book, 2004.
46. I b i d.