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Personal Responsibility and Work Opportunity Reconciliation Act

  • Anthropologist
Personal Responsibility and Work Opportunity Reconciliation Act 1029
Along with all their tools to help others, health ser-
vices professionals also need tools to keep them-
selves both mentally and physically healthy. Self-
care includes a support system—at a minimum,
another professional with whom one may confide,
present dilemmas in a confidential setting, and
get feedback. is individual becomes basically a
therapist for the therapist, one who values the col-
league and meets his or her human services and
diversity needs. ere is a richness in diversity.
Valuing human diversity and possessing cultural
competence breaks down barriers and allows heal-
ing to begin.
Mary Burkhead Spencer
Walden University
See Also: Communication Styles, Ethnic and Cultural
Differences in; Health Care Delivery, Model of; Mental
Health Service Delivery, Cultural Characteristics of;
Mental Health Services, Adult; Peer Support and
Counseling Services; Social Work, Diversity Practice in.
Further Readings
Austin, M. J., M. Coombs, and B. Barr. “Community-
Centered Clinical Practice: Is the Integration of
Micro and Macro Social Work Practice Possible?”
Journal of Community Practice, v.13/4 (2005).
Diller, Jerry V. Cultural Diversity: A Primer for the
Human Services, 5th ed. Belmont, CA: Brooks/
Cole/Cengage Learning, 2014.
Netting, F. E., P. M. Kettner, S. L. McMurtry, and M. L.
omas. Social Work Macro Practice, 5th ed. Upper
Saddle River, NJ: Pearson Education, 2012.
Personal Responsibility
and Work Opportunity
Reconciliation Act
e Personal Responsibility and Work Opportu-
nity Reconciliation Act (PRWORA) was signed
on August 22, 1996. Also known as Public Law
104–193, it was reauthorized in 2002 with revisions
granting states greater flexibility to design their own
programs. Overall, the act reduced federal welfare
spending by eliminating and reorganizing cash and
food welfare programs. Most significantly, it termi-
nated entitlement to cash welfare under title IV–A
of the Social Security Act and replaced the Aid to
Families With Dependent Children (AFDC), which
was passed during the Depression era. In place of
the entitlement concept, the law created two block
grants that provided funds necessary to assist states
in supporting families by reducing out-of-marriage
pregnancy, encouraging two-parent families and
parental or adult employment, and subsidizing
child care and nutrition. Specifically, the act offered
annual grants to states for Temporary Assistance
for Needy Families (TANF).
e grant limited the receipt of cash benefits to
five years, though the law allowed states to exempt
up to 20 percent of their caseload from this provi-
sion. Furthermore, the law limited the provision of
welfare benefits to most noncitizens, families on wel-
fare for more than five years, children who are judged
to be disabled based on age-inappropriate behavior
standards, and drug addicts and alcoholics. In 1997,
Congress created Welfare-to-Work (WtW) grants to
help states move TANF recipients into jobs.
A fundamental stipulation of PRWORA law was
that all able-bodied adults on welfare for two years
would be required to participate in activities to help
them become self-supporting, requiring states to
have one-half of their recipients in work programs
for 30 hours per week. Medicaid could be provided
to eligible families. e purpose of the Social Services
Block Grant (SSBG) was to support social services
directed toward achieving economic self-sufficiency
and to prevent the neglect, abuse, or the exploitation
of children and adults.
Child care was provided for by a mandatory block
grant to low-income families, and states had flex-
ibility in designing child care policies. Mandatory
child care and abstinence education included provi-
sions designed to reduce nonmarital births in gen-
eral and teen nonmarital births in particular. Child
support enforcement required the federal and state
governments to establish automated registries as a
means for locating and tracking absent parents and
to operate automated, centralized units for collec-
tion, disbursement, and restriction purposes. e
PRWORA law required each state to have devel-
oped a unit for collecting and distributing child
support payments. According to the Office of Child
Support Enforcement, almost two out of every three
Copyright © 2014 SAGE Publications. Not for sale, reproduction, or distribution.
1030 Personal Responsibility and Work Opportunity Reconciliation Act
dollars collected by child support agencies came
from income withholding. is amounted to more
than $6 billion in 1995.
e PRWORA law significantly affected other
programs. For example, the Individual Functional
Assessment (IFA) for children was eliminated, and
children could only qualify through a more restric-
tive medical listing. Among the children most
likely to lose benefits were those suffering from
multiple impairments, none of which was severe
enough to meet the disability criteria established
by the law. Twenty to 30 percent of children with
mood disorders, pulmonary tuberculosis, mental
retardation, burns, intracranial injuries, schizo-
phrenia, and arthritis were at risk to be impacted
by the legislation. Additionally, alien eligibility
for welfare was not granted during the first five
years of residency unless there was a substantial
work history or military or veteran connection.
is changed in 1998, and food stamp eligibility
was restored for children, elderly persons, and dis-
ability benefit recipients who were in the United
States at enactment.
Notably, the PRWORA was implemented dur-
ing the longest boom in postwar history and culmi-
nated out of bipartisan debate. Both political par-
ties relied on research to argue their points. Some
researchers argued that 40 to 80 percent of the
reduction of caseloads was attributable to the eco-
nomic boom rather than the policy reforms. Strong
labor demand played an important role in creat-
ing jobs for welfare recipients to move into, while
weakened labor demand in the future would make
it more difficult for former welfare recipients to find
or maintain employment.
While the overall health of the U.S. economy in
the 1990s was a positive background factor contrib-
uting to a reduction in welfare dependence, other
researchers argued that the economy was neither
a sufficient nor a primary factor in that reduction.
e huge state variations in the rates of caseload
decline were not attributed to differences in state
economic factors but were explained by differences
in the rigor of work-related welfare reforms. Policy
reform, not economics, was considered the princi-
pal engine driving the decline in dependence. It was,
however, not that the effects of inflation, increases
in populations, and economic recessions may lead
to fewer opportunities for work and welfare inde-
pendence, but that allocated governmental funds
may be insufficient to meet the needs of adults,
children, and families living below the poverty line.
In 2002, the Bush Administration amended the
law by passing a bill increasing the number of work-
ing hours per week required for welfare recipients
under TANF from 30 to 40 (citing issues of responsi-
bility), and PRWORA was reauthorized in the Defi-
cit Reduction Act of 2005. In response to the Great
Recession of 2007 to 2009, the Obama Administra-
tion passed the American Recovery and Reinvest-
ment Act of 2009 (ARRA) to stimulate the economy
and provide temporary relief to those in need. A $5
million emergency fund was created to help with
increasing caseloads, but this funding expired in
2010. Because of persisting low employment rates
and joblessness, in 2012, the Department of Health
and Human Services (HHS) released a memo allow-
ing states greater flexibility in how they operate their
welfare programs, stating that they could apply for a
waiver for the work requirements of the TANF pro-
gram. Other changes stipulated that welfare recipi-
ents could qualify by participating in work prepara-
tion activities, such as vocational training. Because
of such changes, Republicans have accused the
Obama Administration of gutting welfare reform.
However, according to the Center on Budget and
Policy Priorities, because of rising inflation and per-
sisting economic difficulties, in 2013, TANF benefit
levels were insufficient to provide family income
above half of the poverty line in any state.
el-Sayed el-Aswad
United Arab Emirates University
See Also: Aid to Families With Dependent Children,
Historical Role of; Temporary Aid to Needy Families;
Welfare Reform, Role of.
Further Readings
Beland, Daniel, and Alex Wadden. e Politics of Policy
Change:Welfare, Medicare, and Social Security
Reform in the United States. Washington, DC:
Georgetown University Press, 2012.
Boushey, Heather. “e Effects of the Personal
Responsibility and Work Opportunity Reconciliation
Act on Working Families.Viewpoints. http://www
testimony/ (Accessed September 2001).
Burke, Vee. “e 1996 Welfare Reform Law.
Congressional Research Service: Welfare Briefing
Copyright © 2014 SAGE Publications. Not for sale, reproduction, or distribution.
Pharmaceuticals, Access to 1031
1996%20welfare%20reform%20law.pdf (Accessed
July 2003).
Floyd, Ife, and Liz Schott. “TANF Cash Benefits
Continued to Lose Value in 2013.” Center on Budget
and Policy Priorities.
index.cfm?fa=view&id=4034 (Accessed October
Midgley, James. “e United States: Welfare, Work,
and Development.International Journal of Social
Welfare, v.10/4 (2001).
Nathan, Richard P., and omas L. Gais. Implementing
the Personal Responsibilities Act of 1996: A First
Look. Albany, NY: Nelson A. Rockefeller Institute of
Government, State University of New York, 1999.
Rector, Robert. “e Effects of Welfare Reform.” e
Heritage Foundation.
(Accessed March 2001).
Access to
Limited access to pharmaceuticals, or prescrip-
tion drugs, is a problem that can have dire health
consequences. e poor, minorities, and rural
populations already suffering health disparities
are more likely to face limited access. Using lower-
cost generic medicines, when available, helps off-
set costs for under- and uninsured. Government
programs like Medicare and Medicaid, as well as
prescription assistance programs (PAPs), improve
access for many.
More than 2 billion people lack access to medi-
cines worldwide, and millions die every year from
diseases that are treatable. While manufactur-
ing, infrastructure, and distribution inadequacies
limit access in developing nations, the high cost of
prescription medicines is an obstacle for patients
everywhere. Prescription drug prices have more
than doubled over the last decade. In the United
States, where drug prices are the highest in the
world, costs approach $280 billion a year.
Even for those with prescription drug cover-
age, access can be difficult given high copayments
coupled with prior authorization and restrictive
refill policies. Studies show that about one-quar-
ter of Americans routinely skip doses or split pills
because of high costs. More than one-third of all
prescriptions written are never filled. Not taking
medicines as prescribed is associated with adverse
health outcomes: Studies link poor management
of high blood pressure, diabetes, and cholesterol
with medication noncompliance. Inadequate
access is also associated with more emergency
room visits and longer hospital stays, diminishing
quality of life and increasing overall health care
costs in the process.
e availability and utilization of generic medi-
cines merits discussion. ere are generic medi-
cines to treat diseases with high morbidity, like
heart disease, human immunodeficiency virus/
acquired immune deficiency syndrome (HIV/
AIDS), and diabetes, but generics are underuti-
lized. Several studies show that generic medi-
cines are just as effective as their more-expensive
counterparts; nonetheless, patients often request
brand-name drugs instead. Critics claim pharma-
ceutical advertising clouds consumer judgment by
promoting brand loyalty, but physicians also play
a role. A 2004 study found inappropriate prescrib-
ing of brand-name medicines to treat high blood
pressure, while clinical guidelines recommended
a cheaper generic alternative. e practice added
$1 billion to Medicare costs that year alone. Many
physicians may not know generic alternatives exist.
ey may not know how much their patients spend
on medicines either and so fail to suggest cheaper
alternatives. Pharmaceutical companies also
impede widespread access and use; pay-for-delay
deals or reverse payments to generic drug manu-
facturers push back production and delay access to
cheaper medicines for years.
People with the most difficulty accessing medi-
cines are often those with the greatest need. e
National Institutes of Health (NIH) Health Dis-
parities Strategic Plan identifies racial and ethnic
minorities, as well as those living in rural com-
munities, at increased risk for early death due to
health disparities. ese groups suffer a dispro-
portionate number of health-related problems
made worse by inadequate access to prescription
medicines. Studies show that Hispanics, blacks,
and the poor are less likely to take medicines to
treat high blood pressure and cholesterol than
whites; in addition to an increased risk for heart
Copyright © 2014 SAGE Publications. Not for sale, reproduction, or distribution.
ResearchGate has not been able to resolve any citations for this publication.
It has long been claimed that social welfare programmes harm economic development. These programmes, it is alleged, depress work incentives, divert scarce investment resources to ‘unproductive’ social services and create a large underclass of dependent individuals. Welfare reform in the United States intends to reverse these allegedly negative economic effects by requiring welfare clients to work. It also hopes to reduce poverty. This article examines these claims. It discusses the welfare reform programme and concludes that its impact on both economic development and poverty has been minimal. Policies that transcend the current obsession with work, promote sustained economic development and invest in human capabilities are more likely to succeed.
TANF Cash Benefits Continued to Lose Value in 2013 Center on Budget and Policy Priorities
  • Ife Floyd
  • Liz Schott
Floyd, Ife, and Liz Schott. " TANF Cash Benefits Continued to Lose Value in 2013. " Center on Budget and Policy Priorities. index.cfm?fa=view&id=4034 (Accessed October 2013).
Implementing the Personal Responsibilities Act of 1996: A First Look. Albany, NY: Nelson A. Rockefeller Institute of Government The Effects of Welfare Reform The Heritage Foundation
  • Richard P Nathan
  • Thomas L Gais
Nathan, Richard P., and Thomas L. Gais. Implementing the Personal Responsibilities Act of 1996: A First Look. Albany, NY: Nelson A. Rockefeller Institute of Government, State University of New York, 1999. Rector, Robert. " The Effects of Welfare Reform. " The Heritage Foundation. research/testimony/the-effects-of-welfare-reform (Accessed March 2001).
The Effects of Welfare Reform The Heritage Foundation. research/testimony/the-effects-of-welfare-reform
  • Robert Rector
Rector, Robert. " The Effects of Welfare Reform. " The Heritage Foundation. research/testimony/the-effects-of-welfare-reform (Accessed March 2001).