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You are here: Home / Anderson On Health Insurance / Administrative burden is everywhere

Administrative burden is everywhere

by David Anderson|  August 31, 20218:38 am| 17 Comments

This post is in: Anderson On Health Insurance

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In the recent issue of JAMA, a team of researchers led by Aditi Vasan looked at how Women-Infant-Children take-up varied during the pandemic by an administrative decision — did the WIC card get loaded with new benefits  automatically or was there an administrative step involved:

As of July 2021, 9 states (Arkansas, Louisiana, Missouri, New Mexico, Ohio, Pennsylvania, Texas, Utah, and Wyoming) require WIC beneficiaries to either mail or present these cards in person at their local WIC office every 3 to 4 months to reload their benefits

They found, using a difference in difference estimate that the extra step mattered a lot.

Difference in Difference trends before and after COVID on WIC take-up by Online and Off-line states

 

States that were always off-line had lower rates of participation than states that did not have this step.  However after COVID started as a public policy issue in the United States in March 2020, the offline states participation rate continued to decline while the other states saw gains in their participation rate.

The number of steps that need to be taken to access a benefit that someone is eligible for  has incredible influence on the number of people who will actually sign up.  Sometimes there can be an argument that the presentation of an “ordeal” will allow for effective targeting of a benefit to only those who have a high need/willingness to pay for the benefit but given that WIC is targeted at low income kids and their others, we have a strong prior that well fed, healthy kids should be a good thing with long lasting net advantages to both individuals and society compared to kids being raised in nutritional and economic stress.

 

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Reader Interactions

17Comments

  1. 1.

    Betty

    August 31, 2021 at 8:55 am

    Please share this with members of Congress. They love adding these burdens to benefits – just to keep those in need honest, you know.?

  2. 2.

    satby

    August 31, 2021 at 8:55 am

    Living in a red state has really opened my eyes to the casual cruelty that’s encouraged by the voters against themselves. Government has never worked properly for them by design because they continually vote in anti-government politicians, and most people don’t even grasp that a different way is possible.

  3. 3.

    RepubAnon

    August 31, 2021 at 8:59 am

    For a party that talks about the harm caused by “burdensome government regulations” and “red tape”, Republicans sure do like imposing burdensome government regulations and mounds of useless red tape on the poor.  It’s almost as though they think that regulations are not so much needed to rein in the potential for abuse by the rich and powerful as they are for punishing one’s political scapegoats.

  4. 4.

    terraformer

    August 31, 2021 at 9:14 am

    Republicans get off on punishing and humiliating people who are not them. GOP:

    Gaslight (you didn’t see/hear what you saw/heard)

    Obstruct (block anything that doesn’t benefit the rich)

    Punish (punish those who are not rich)

  5. 5.

    lowtechcyclist

    August 31, 2021 at 9:28 am

    @RepubAnon:

    For a party that talks about the harm caused by “burdensome government regulations” and “red tape”, Republicans sure do like imposing burdensome government regulations and mounds of useless red tape on the poor.

    Of course, in the minds of GQP politicians, ‘poor’ is essentially synonymous with ‘black or maybe Hispanic,’ IOW a caste of lesser beings as far as they’re concerned, so the less money thrown at them, the better.  They’d zero out all assistance to poor people if they could get away with it.

  6. 6.

    narya

    August 31, 2021 at 9:36 am

    And never, at any time, does anyone consider that the extra steps and burdens may be more than some folks who are already at the margins can possibly shoulder. I really have this burning desire for the most fervent of the obstructionists to have to live for two years in the shoes of the people they’re harming. No resources, poor health insurance and difficult access to it, trying to figure out how to feed the kids and get them to school and fix the old car so you don’t lose your job, and more than I can even imagine. Live like that for two years and then tell me whether you think those extra steps are a good thing.

  7. 7.

    raven

    August 31, 2021 at 9:39 am

    MY bride worked with/for the WIC Program for many years before she retired. While they have the electronic component in Georgia they find other ways to burden the recipients.

  8. 8.

    Butter Emails!

    August 31, 2021 at 9:45 am

    Burdensome requirements seems more like it would select for the scammers not the needy.

  9. 9.

    catclub

    August 31, 2021 at 9:50 am

    @RepubAnon: 

    Republicans sure do like imposing burdensome government regulations and mounds of useless red tape on the poor.

    also taxes on the poor. not a problem.

  10. 10.

    Redshift

    August 31, 2021 at 10:04 am

    You can either make the priority ensuring everyone gets what they need, or you can make the priority ensuring that no one gets something they don’t deserve. You cannot do both.

  11. 11.

    laura

    August 31, 2021 at 10:04 am

    I worked at a grocery store for 20 years and changed careers just as the electronic benefits cards were adopted. WIC was the tightest, no margin for error, no substitutes, targeted high nutritive value foods program aimed at ensure infants and children got enough of the type of food that would allow normal growth and development. And you’d think who could possibly be against allowing children to  not starve and post pregnancy women to get enough to eat. Lots and lots of people, that’s who. The public shaming was cruel and I tried my best to be helpful and minimize the ordeal in any way possible; mostly by recognizing the specific items, grouping them together because each group had to be wrung up as separate orders, and speeding up the cashiering and check franking. I worked a night crew shift for about five years and would occasionally have a male customer try and return a case of baby formula for cash… because the baby didn’t need it anymore and you knew that they were either scamming or desperate for cash for any of the myriad of reasons that poor households suddenly need cash. Those were always very tense encounters.

    The WIC program is the barest minimum of decency we as a society has offered the youngest of our fellow citizens and it works as intended and anyone who has familiarity with it could see that the participants were subject to public shaming of women in the presence of their small children every single time the benefits were accessed. The cruelty was very much the point. Electronic benefits had to be a huge improvement in both efficiencies and human dignity.

  12. 12.

    gvg

    August 31, 2021 at 10:12 am

    Privatization is also an administrative burden that drives people away. among those it drives away are the actual workers and volunteers. Those extra steps all require a lot more work by the workers in the agencies.
    I was a foster parent. Florida “privatized” a whole bunch of the child protection services functions before I was a part of it. It wasn’t great before, and the republicans gave a bunch of it away as contracts to charity organizations. What that did was break it up into different geographical units and also divided it’s functions and they couldn’t talk to each other to well because of confidentiality. The administrative burden I saw was having to go around to different organizations to get the day care paid for, another one for getting vouchers for clothes and WIC to get formula and baby food credits. We didn’t get paid enough to cover costs but I accepted that. I knew they used it to get rid of people who were trying to profit off the children. The administrative burden was really tiresome because after all we were doing them favors, they shouldn’t have been making it so hard for us. The churches higher ups got nice salaries, the case workers and supervisors not so much, plus they no longer got state health care (mostly same people rehired by churches). We had problems with records being garbled by passing through to many agencies. If you didn’t get the daycare reimbursement set up and paying before the child was removed because they found a responsible family member, we could not get reimbursed. It took weeks so that was generally hundreds of dollars each time.
    There was a priggish state congressman who wanted to require all foster parents to buy at thrift stores. Luckily that got no support. Thrift stores that survive have limited hours and prefer to sell high end used clothes, fashionable brands. I shop there when I want to find something nice that is too pricy used. Got the kids plenty of special clothes and toys as a matter of fact. But you get most kids in the middle of the night. They need diapers and formula or maybe clothes for school NOW. That means walmart, cheap and open 24 hours. Its been years and I am still pissed at him. The other administrative burdens are well remembered too. Every one they impose of poor citizens is also a burden on the clerks too.

  13. 13.

    gvg

    August 31, 2021 at 10:16 am

    @laura: ​
      Yes. All foster kids get it automatically here. The foster parents income is not considered and most of them have decent incomes because otherwise they can’t afford to be foster parents. This means my sister who was a doctor with a nice car, didn’t dare use the card, I did all the shopping. People think they know, but they really have no idea of all the valid variety of circumstances. It’s none of their business that those kids are in foster care, some of them in recent traumatic circumstances.

  14. 14.

    Fake Irishman

    August 31, 2021 at 10:19 am

    Relatedly, one of the biggest changes contained in the Affordable Care Act was that it quietly wiped out whole reams of required paperwork and administrative hassle for Medicaid recipients. Trump-era waivers put a sole back in some states, but the change was profound.

  15. 15.

    MontyTheClipArtMongoose

    August 31, 2021 at 10:38 am

    @Betty: so do the staff of the social service agencies, (un)surprisingly, i say, having worked thru scott walker’s transition of the milwaukee county department of health & human services into a quasi-private office called milwaukee enrollment services that was & is peopled by quisling nepotists from the prior dhhs & nOObz from hp enterprise services

  16. 16.

    MontyTheClipArtMongoose

    August 31, 2021 at 10:40 am

    @RepubAnon: but the gqp is burdening unreal americans while the libz are punishing true redblooded people unnecessarily

  17. 17.

    Lobo

    August 31, 2021 at 1:11 pm

    Administrative burden is a huge issue.   It is one reason for exchanging benefits for a “guaranteed income.”  Administrative burden is expensive because you need staff, space and infrastructure to oversee requirements apart from the benefits themselves.   It would be interesting to understand how benefits fall off as admin burdens increase.   I am sure it is a cliff at some point, which is the point.

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