The uninsured: each year, more than 9 million children in the U.S. go without health insurance. What happens when they get sick?

Last October, Chelsea Picard came down with a throat. It was so sore and swollen she could hardly swallow. But when the sixth-grader asked to go to the doctor, her mother delivered some bad news.

"She said I'd have to wait until she got her next paycheck," the 11-year-old from Chicopee, Massachusetts, told JS. "So I took cough drops and cough medicine, but my throat was still hurting. I had to wait it out until she got paid the following week."

Chelsea is one of 9.3 million children in the U.S. without health insurance. Often, when these children become ill, they are forced to delay medical treatment until their parents can pay the fees. In some cases, they must skip seeing a doctor altogether because a visit is too expensive.

A Costly Benefit

In recent years, the country's health-care crisis has grown worse. In 2002 (the most recent year for which there are figures), some 47 million Americans had no health insurance, an increase from 43 million in 2001.

"Unemployment [has been] at a high level," says Genevieve Kenney of the Urban Institute, a public-policy organization. "Since kids and their parents mostly get health coverage through jobs, unemployment is a big issue."

Even individuals lucky enough to receive insurance benefits through their employers are paying ever-higher premiums. It's easy to see why. Health-insurance rates jumped nearly 14 percent in 2002, the seventh straight year of increases. An aging population, increased demand for services, and the price of new technology have caused health-care costs to soar.

Some employers can no longer afford to provide insurance for their employees. Despite working up to 60 hours a week as a real estate agent, Chelsea's mother, Jennifer Picard, does not receive medical benefits. So, she had to pay $80 for Chelsea's most recent visit to the doctor. That is a sizable sum compared with the $10 or $15 an insured patient would have paid. Still, a visit to the doctor once in a while is much less expensive than the $800 a month it would cost to buy insurance for the entire family.

Access to medical services can be a problem even for families that do have health insurance.

"People think that health insurance equals health access," says Dennis Johnson, executive director of the Children's Health Fund. "But it doesn't always guarantee a child will get appropriate health care. In rural areas especially, kids often go without routine care because there just aren't enough doctors, and there is a lack of transportation."

Unhealthy Consequences

Lack of medical care can take a toll on children's health and development. Without proper treatment, common childhood ailments like sore throats, ear infections, and asthma can have serious consequences. For example, an untreated ear infection can lead to permanent hearing loss.

Uninsured children are also much less likely to receive preventive medical care, including vaccinations, dental services, and vision tests. Shavon Muhammad knows this all too well.

After his parents divorced, Shavon lost his health insurance. Although Shavon's mother worked full-time, she could not afford insurance on her modest salary. And although Shavon desperately needed glasses, he had to do without them.

"When I was in elementary school, I couldn't see dearly," says the 12-year-old from Miami, Florida. "The teacher had to move me up right in front of the blackboard. But I still had a problem."

Who Will Pay?

While more than two thirds of children in the U.S. are covered by private health insurance, roughly 27 million rely on public health-insurance programs. Medicaid and the State Children's Health Insurance Program (SCHIP) provide medical benefits for low-income children under the age of 19. These programs cover doctor visits and hospital care, among other services.

Two years ago, Shaven was enrolled in Florida's SCHIP program. Since then, he has received treatment for his asthma and allergies. And he was finally able to get glasses, which have changed his life.

"Once I got my glasses, I started to see properly," says Shaven, a seventh-grader in middle school. "Before, I was getting unhappy faces and D's. Now, I get A's and B's."

Unfortunately, no public program will come to Chelsea's aid. Her mother earns too much $50,000 a year--to qualify for Medicaid or SCHIP. So for now, Chelsea lives with the constant worry about what will happen the next time she gets sick or injured.

"I'm afraid that if we're on a long car trip and we get in an accident, we won't be able to pay for it," says Chelsea. "I'm afraid that if I have to go to the emergency room, there won't be enough money to pay for it."

Millions of other U.S. children share her anxiety.

Your Turn

THINK ABOUT IT

1. Should the federal government provide insurance for all children in the U.S.? Why or why not?

2. Are you covered by health insurance? What happens when someone in your family needs medical care?

LESSON PLANS

OBJECTIVES

Students should understand

* Millions of Americans lack health insurance and, as a result, often delay seeking necessary, but costly, medical treatment.

TEACHING STRATEGY

Ask students to discuss the possible cost of a hospital or clinic visit, including such things as X-rays, prescription drugs, ambulance service, home health care, surgery, and rehabilitative treatment. Who pays for these services?

BACKGROUND

Federal law requires that states offer Medicaid to the elderly, the disabled, low-income families, children, and pregnant women. Medicaid generally covers basic hospital services, limited nursing-home care, children's vaccinations, laboratory and X-ray services, and prenatal care.

THINKING SKILLS

CAUSE AND EFFECT: How is the health care of Americans affected by unemployment? (Many employers provide health insurance to their employees and their employees' families. But insurance coverage usually ends when an employee loses his or her job. As a result, some of the unemployed may decide to go without health insurance, either because they cannot afford it or because they fail to qualify for public insurance programs, such as Medicaid.)

COMPREHENSION: Why can't more of the uninsured utilize public health insurance programs? (Only very low-income people can qualify for Medicaid or a State Children's Health Insurance Program (SCHIP). Many of the uninsured earn too much to qualify, even though they earn too little to afford private insurance.)

ACTIVITY

INSURANCE AND POLITICS: Access to health insurance and the rising cost of health care are key issues with voters. Instruct students to select one of the Democratic presidential contenders or President Bush and write a report detailing where he stands on health-care issues.

STANDARDS

SOCIAL STUDIES, GRADES 5-8

* Individual identity and development: How uninsured Americans face difficult choices in seeking medical treatment.

* Individuals, groups, and institutions: How the increasing cost of health care has became a strain on private employers, and state and federal governments.

RESOURCES PRINT

* Romaine, Deborah, Health Care (Lucent Books. 2000). Grades 5-8.

* Wilkinson, Beth, Careers Inside the World of Health Care (Globe Fearon, 1999). Grades 5-8.

WEB SITES

* Children's Health Care www.savethechildren.org/

* Medicaid http://cms.hhs.gov/medicaid/default.asp