News
Healthy Students Learn Best

Teachers and school nurses--in both NEA and AFT--point out problems of students who come from families without health insurance.

Janice Lowry doesn't know who among her students has health insurance and who does not. But she always knows when a child has been seeing a doctor regularly.

Students who go to the doctor routinely don't come to school sick, says Lowry, a first-grade teacher at Metz Elementary School in Austin, Texas, and a member of Education Austin, a joint affiliate of NEA and the American Federation of Teachers (AFT). "They are in class when they need to be, and not in class when they don't."

Educators such as Lowry long have known that a child's success in school is linked to regular attendance and access to health care. Unfortunately, the latter is becoming more elusive.

Today, nearly 41 million people in the United States lack health coverage, and 9 million of these are children. Studies show that children whose families have no insurance are less likely to have a regular health care provider, less likely to have seen a doctor in the last year, and more likely to delay or avoid medical care when it is needed.

Access to affordable, quality health care--not only for NEA and AFT members, but for all Americans--is among the issues now being tackled by the NEAFT Joint Council.

A January 2002 report from the council's health care subcommittee spotlights the alarming number of uninsured families and warns: "Children are disproportionately affected and our members, as educators, cannot ignore the implications of working with populations of children and their families who lack health insurance coverage."

The Price in Learning
A sick student can't concentrate, says Janice Lowry. For an ailing child, "doing school work is not of the utmost importance."

School work can be just as hard for students who fail their vision or hearing screenings and don't get help, Lowry adds. "I see those students struggling and having a hard time with letters and symbols."

Lowry also points out that a child who has a contagious illness creates an additional problem: Other students get sick. "I have some kids," she says, "whose parents keep them out much longer than the school policy requires and some parents who don't keep them out long enough."

Medical experts say that uninsured children often don't get proper care for poor vision or for common childhood illnesses such as iron-deficiency anemia, asthma, sore throats, and earaches.

These conditions can be controlled. Left untreated, they have the potential to become chronic illnesses or lifelong disabilities.

Unfortunately, families with no health insurance often cannot afford to think about the long-term problems their children may face. "The working poor just don't have the funds," says Ann Babler, a parent support specialist at Metz Elementary and a member of Education Austin. "When you have to decide between putting food on the table or going to the doctor, you're going to put food on the table."

As a result, "uninsured children often have to use hospital emergency rooms as their primary health care provider," adds Carole Paladino, a certified school nurse in New Jersey's Millville school district. That's because their parents "cannot afford regular office visits, maintenance medications, and/or have difficulty finding providers that accept patients covered by Medicaid or the New Jersey Children's Health Insurance Program."

Paladino, a member of the Millville Education Association/NEA, points out that uninsured children with chronic illnesses such as asthma miss more school days than usual because they go without maintenance medications that prevent major flare-ups--which in return require emergency care.

"When children do visit the emergency room for asthma or acute dental care," Paladino concludes, "they are only being treated on an emergency basis and thus lack proper long-term regular care."

Finding Care Alternatives
Many parents of uninsured children have jobs that do not offer health benefits and pay wages so low that these parents cannot afford to buy health insurance on their own. Health care today is often too expensive for low- or even middle-income families. In 2000, the annual cost for an average health policy through an employer was $2,426 for an individual and $7,035 for a family.

This means that teachers and school nurses have had to become experts at finding health care alternatives for students who need care but lack coverage.

Marilyn Lawson, a school nurse at Harper Middle School in Houston and a member of the Houston Federation of Teachers/AFT, says, "It's a challenge to work with families who don't have coverage, because it's hard for them to keep up with regular care."

If a child needs a pair of glasses or a visit to the doctor, "I've got to find the resources to get them care," points out Dorothy Marks, a school nurse in the Chicago Public Schools and a member of the Chicago Teachers Union/AFT.

When an uninsured student comes to Marks with a health problem, it's often at a critical stage. "Some students are embarrassed to come see me because they know their parents can't afford the treatment that will make them better," Marks says.

But Marks lets her students and their parents know that there are resources available to children who don't have insurance--although getting them takes time.

"Sometimes," Marks notes, "parents have to bite the bullet" and pay for medical care out of pocket. The alternative is to watch their children's health slowly deteriorate.

In most cases, however, schools can rely on community or school-based clinics and public hospitals that offer care to the uninsured. There also are public programs that can help fill some of the gaps in insurance coverage.

Thanks to the expansion of programs such as Medicaid and the State Children's Health Insurance Program (SCHIP), more and more children from low-income families are eligible for public health insurance.

NEA and AFT support efforts such as "Covering Kids," a public awareness campaign aimed at reaching families of the nearly 5 million uninsured children who are eligible for SCHIP. An initiative of The Robert Wood Johnson Foundation, "Covering Kids" (www.coveringkids.org) seeks to connect uninsured children to low-cost and free health coverage programs in every state and the District of Columbia.

Each year this campaign, along with allied organizations at the national and local level, conducts a national back-to-school effort to help states inform parents of eligible children about the availability of SCHIP and Medicaid. The effort includes media advertising and enrollment drives in Latino and African-American communities.

In Texas--home to the largest number of uninsured children in the country--the SCHIP program makes it much easier to get students the services they need.

"Before SCHIP, there were very few low-cost services available," says parent support specialist Babler. "Now you don't feel like your hands are so tied."

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This article, second in a series on health care issues and how they affect educators, is a project of the NEAFT Partnership. A primary aim of the partnership is to keep members of both unions informed about joint programs and activities in areas of common concern. AFT staff writer Adrienne Coles wrote this article, which also appears in the February issue of AFT's American Teacher magazine.

SCHIP: Meeting The Health Care Needs of Children

Expansion of health coverage through Medicaid and the State Children's Health Insurance Program (SCHIP) has significantly reduced the number of uninsured children in recent years.

Seventy percent of uninsured children are eligible for low-cost or free health care coverage under Medicaid and SCHIP. Both programs are available in every state and the District of Columbia.

Enacted in 1997, SCHIP provides health care coverage for children in families that earn too much to qualify for Medicaid but cannot afford private health insurance. Since the program began, the percentage of children with coverage has increased for the first time in many years.

Today, more than 4 million children are enrolled in SCHIP. Once enrolled, children are eligible for a variety of benefits, which vary from state to state. Most children can get regular checkups, immunizations, eyeglasses, visits to doctors, prescription drug coverage, and hospital care.

"It is a wonderful initiative that has provided health insurance to many children around the country," says American Federation of Teachers staffer John Abraham. Despite SCHIP's success, "we may have to fight to keep the program in place," he adds.

At present, the program relies too heavily on a state to do its part--by using appropriated funds to get children enrolled.

Under SCHIP, a state has three years in which to use the funds it receives for a given year. If it does not spend the money within that time, the federal government redistributes a portion of the unused money to other states that already have spent their allotment. Any remaining unused money must be given back to the U.S. Treasury.

Twenty-five states had forfeited $1.2 billion in unspent SCHIP funds as of last October. Many states had to surrender their money because they received more than they could spend in the time allotted. Unless new legislation is passed to extend the deadline for states to use their funds, more than $3 billion could be lost by the end of 2003.

Ironically, because of scheduled reductions in federal funding, states may have to drop nearly 900,000 children from the SCHIP program between next year and 2006. The timing of these funding reductions could not be worse as states struggle with budget problems and health care costs continue to grow.

In the meantime, NEA and AFT will push lawmakers to support more adequate funding for SCHIP, to expand coverage for more children and their parents, and to maintain their eligibility for the Medicaid program.

--Adrienne Coles