Shirley Garcia lives on the edge of welfare.
What pushes her over, she says, is lack of health insurance.
Ms. Garcia, 35, has children ages 10, 12 and 14. She works in a sales job five days a week that pays $4.50 an hour and provides no benefits. She baby-sits to earn extra money.
"I worked in a factory until two years ago for $5.50 an hour, but my son and I both got sick with asthma," said Ms. Garcia (not her real name). "I had to go on welfare because I had no benefits."
She received Aid to Families with Dependent Children for one year; much of that time, her son was hospitalized. Despite Medicaid, Ms. Garcia incurred $800 in medical bills and still is paying off the debt.
"I hate welfare so much I stayed on it only until we both got better," Ms. Garcia said. "I have a new job, but still no health benefits. If we get sick, I'll be on welfare again."
She is described by Kathryn Edin, a sociologist with the Russell Sage Foundation in New York, as being "precariously employed."
Ms. Edin, who is researching the choices women make between work and welfare, said lack of health insurance is a major roadblock to employment.
"It's the No. 1 thing women say they fear they'd lose out on if they left AFDC," said Ms. Edin, who did similar research in Chicago and will study women in San Antonio, Texas, Boston and rural Minnesota.
Though the Family Support Act guarantees those who leave welfare for work medical benefits for a year, she said, that's not enough.
"The women say, when they ultimately are dropped from Medicaid they're left without health insurance because their employers don't offer it," she said.
Another scenario, Ms. Edin said, is that of "women who quit their jobs and go on welfare when they get pregnant, because they can't afford to pay the medical bills."
Even when insurance is provided, she said, "the women have to make co-payments for their kids, and they can't afford to."
For Ms. Garcia and women like her, Ms. Edin said, "National health care and subsidized child care and housing are essential in any package of benefits these women would need to make it in a low-wage job."
President Bush's health-care proposals include financial aid for families below the poverty level. He suggests offering vouchers of up to $3,750 to buy health insurance.
But basic coverage costs at least $5,000 at a health maintenance organization, and equivalent coverage in other types of plans may cost even more, according to the non-profit Women's Research and Education Institute in Washington.
It concludes that the voucher would "not meet the needs of financially strapped families for affordable access" to medical care. It adds that to buy the kind of coverage needed, a family "would have to supplement the voucher with at least $1,250 a year, a hefty percentage of average income for poor families."
A study of 11,494 U.S. workers by Karen Seccombe, a sociologist at the University of Florida, showed almost 40 percent get no health insurance from their employers.
* Shared power: Subordinates believe women leaders are better at sharing power and information. The sharing tended to create more loyalty and less criticism during a crisis.