Health Insurance is a Family Matter is the third of a series of six reports on the problems of uninsurance in the United Sates and addresses the impact on the family of not having health insurance. The book demonstrates that having one or more uninsured members in a family can have adverse consequences for everyone in the household and that the financial, physical, and emotional well-being of all members of a family may be adversely affected if any family member lacks coverage. It concludes with the finding that uninsured children have worse access to and use fewer health care services than children with insurance, including important preventive services that can have beneficial long-term effects.

The balance between state and federal health care financing for low-income people has been a matter of considerable debate for the last 40 years. Some argue for a greater federal role, others for more devolution of responsibility to the states. Medicaid, the backbone of the system, has been plagued by an array of problems that have made it unpopular and difficult to use to extend health care coverage. In recent years, waivers have given the states the flexibility to change many features of their Medicaid programs; moreover, the states have considerable flexibility to in establishing State Children's Health Insurance Programs. This book examines the record on the changing health safety net. How well have states done in providing acute and long-term care services to low-income populations? How have they responded to financial incentives and federal regulatory requirements? How innovative have they been? Contributing authors include Donald J. Boyd, Randall R. Bovbjerg, Teresa A. Coughlin, Ian Hill, Michael Housman, Robert E. Hurley, Marilyn Moon, Mary Beth Pohl, Jane Tilly, and Stephen Zuckerman.

"The Nation has lost sight of its public health goals and has allowed the system of public health to fall into 'disarray'," from The Future of Public Health. This startling book contains proposals for ensuring that public health service programs are efficient and effective enough to deal not only with the topics of today, but also with those of tomorrow. In addition, the authors make recommendations for core functions in public health assessment, policy development, and service assurances, and identify the level of government--federal, state, and local--at which these functions would best be handled.

Child welfare services are intended to prevent the abuse or neglect of children; ensure that children have safe, permanent homes; and promote the well-being of children and their families. As the U.S. Constitution has been interpreted, states bear the primary responsibility for ensuring the welfare of children and their families. In recent years, Congress has annually appropriated between $7.6 billion and $8.7 billion in federal support dedicated to child welfare purposes. Nearly all of those dollars (97%) were provided to state, tribal, or territorial child welfare agencies (via formula grants or as federal reimbursement for a part of all eligible program costs). Federal involvement in state administration of child welfare activities is primarily tied to this financial assistance. The remaining federal child welfare dollars (3%) are provided to a variety of eligible public or private entities, primarily on a competitive basis, and support research, evaluation, technical assistance, and demonstration projects to expand knowledge of, and improve, child welfare practice and policy. At the federal level, child welfare programs are primarily administered by the Children's Bureau, which is an agency within the Administration for Children and Families (ACF) at the U.S. Department of Health and Human Services (HHS). However, three competitive grant programs (authorized by the Victims of Child Abuse Act) are administered by the Office of Justice Programs (OJP) within the Department of Justice (DOJ). Federal child welfare support is provided via multiple programs, the largest of which are included in the Social Security Act. Title IV-B of the Social Security Act primarily authorizes funding to states, territories, and tribes to support their provision of a broad range of child welfare-related services to children and their families. Title IV-E of the Social Security Act entitles states to federal reimbursement for a part of the cost of providing foster care, adoption assistance, and (in states electing to provide this kind of support) kinship guardianship assistance on behalf of each child who meets federal eligibility criteria. Title IV-E also authorizes funding to support services to youth who "age out" of foster care, or are expected to age out without placement in a permanent family. Legislation concerning programs authorized in Title IV-B and Title IV-E, which represents the very large majority of federal child welfare dollars, is handled in Congress by the House Committee on Ways and Means and the Senate Finance Committee. Additional federal support for child welfare purposes, including research and demonstration funding, is authorized or otherwise supported in the Child Abuse Prevention and Treatment Act (CAPTA) and the Adoption Opportunities program. Further, the Victims of Child Abuse Act authorizes competitive grant funding to support Children's Advocacy Centers, Court Appointed Special Advocates, and Child Abuse Training for Judicial Personnel and Practitioners. Authorizing legislation for these programs originated with the House and Senate Judiciary committees. Each child welfare program that receives discretionary funding is funded through April 28, 2017 at about 99.8% of the funding provided for each of the programs in FY2016. For child welfare programs receiving mandatory funding, the continuing resolution makes funding available at the rate needed to maintain the current law program, under the authority and conditions provided in the FY2016 appropriations act. While the continuing resolution allows federal funds to be awarded, until a final appropriations bill is enacted, the total amount of FY2017 funding that will be made available for a given program remains unknown and may be less (or more) than the annualized amount provided in the continuing resolution.

The Temporary Assistance for Needy Families (TANF) block grant provides federal grants to states for a wide range of benefits, services, and activities. It is best known for helping states pay for cash welfare for needy families with children, but it funds a wide array of additional activities. TANF was created in the 1996 welfare reform law (P.L. 104-193). TANF funding and program authority were extended through FY2010 by the Deficit Reduction Act of 2005 (DRA, P.L. 109-171). TANF provides a basic block grant of $16.5 billion to the 50 states and District of Columbia, and $0.1 billion to U.S. territories. Additionally, 17 states qualify for supplemental grants that total $319 million. TANF also requires states to contribute from their own funds at least $10.4 billion for benefits and services to needy families with children -- this is known as the maintenance-of-effort (MOE) requirement. States may use TANF and MOE funds in any manner "reasonably calculated" to achieve TANF's statutory purpose. This purpose is to increase state flexibility to achieve four goals: (1) provide assistance to needy families with children so that they can live in their own homes or the homes of relatives; (2) end dependence of needy parents on government benefits through work, job preparation, and marriage; (3) reduce out-of-wedlock pregnancies; and (4) promote the formation and maintenance of two-parent families. Though TANF is a block grant, there are some strings attached to states' use of funds, particularly for families receiving "assistance" (essentially cash welfare). States must meet TANF work participation standards or be penalised by a reduction in their block grant. The law sets standards stipulating that at least 50% of all families and 90% of two-parent families must be participating, but these statutory standards are reduced for declines in the cash welfare caseload. (Some families are excluded from the participation rate calculation.) Activities creditable toward meeting these standards are focused on work or are intended to rapidly attach welfare recipients to the workforce; education and training is limited. Federal TANF funds may not be used for a family with an adult that has received assistance for 60 months. This is the five-year time limit on welfare receipt. However, up to 20% of the caseload may be extended beyond the five years for reason of "hardship", with hardship defined by the states. Additionally, states may use funds that they must spend to meet the TANF MOE to aid families beyond five years. TANF work participation rules and time limits do not apply to families receiving benefits and services not considered "assistance". Child care, transportation aid, state earned income tax credits for working families, activities to reduce out-of-wedlock pregnancies, activities to promote marriage and two-parent families, and activities to help families that have experienced or are "at risk" of child abuse and neglect are examples of such "nonassistance".