positive effects on children’s school performance de-
clined in subsequent years. But Head Start ‘‘gradu-
ates’’ are more likely to complete high school and less
likely to repeat a grade or be placed in special educa-
tion classes. Their families are also more likely to ben-
efit from measures such as mental health services,
nutrition education, and social services for the child
and family.
See Also: EARLY INTERVENTION PROGRAMS
Bibliography
Conger, John J. ‘‘Hostages to Fortune: Youth, Values and the Pub-
lic Interest.’’ American Psychologist 43 (1988):291–300.
Lee, V. E., Jeanne Brooks-Gunn, E. Schnur, and F. Liaw. ‘‘Are
Head Start Effects Sustained? A Longitudinal Follow-Up
Comparison of Disadvantaged Children Attending Head
Start, No Preschool, and Other Preschool Programs.’’ Child
Development 61 (1990):495–507.
Zigler, Edward F., and Sally J. Styfco. ‘‘Head Start: Criticisms in a
Constructive Context.’’ American Psychologist 49 (1994):127–
132.
Zigler, Edward F., and Jeanette Valentine, eds. Project Head Start:
A Legacy of the War on Poverty. New York: Free Press, 1979.
Sarit Guttmann-Steinmetz
HEALTH INSURANCE
Health insurance is a prepayment plan that provides
services or monetary reimbursements for medical
care needed because of illness or disability. Health in-
surance is provided to individuals either through vol-
untary plans that are commercial or nonprofit or
through obligatory national insurance plans that are
usually connected with a Social Security program.
Medical Coverage for America: Past and
Present
Health insurance in the United States originated
around 1850 as voluntary programs through cooper-
ative mutual benefit and fraternal beneficiary associa-
tions, as well as through some commercial companies,
industries, and labor unions that offered limited cov-
erage. President Theodore Roosevelt instigated the
idea for government health insurance in the early
1900s, but his concept never materialized because of
the public’s fear of socialized medicine.
Over time, many plans were developed by socie-
ties of practicing physicians, but it was the communi-
ty-sponsored, nonprofit service plans based on
contracts with hospitals and subscribers that drew the
greatest enrollment. Under the name ‘‘Blue Cross
and Blue Shield,’’ these plans extended coverage to
dependents while excluding coverage of accidents
and diseases covered by workers’ compensation laws,
but their limitations—such as excluding those who
could not afford the coverage and senior citizens—led
to their downfall and subsequent restructuring in the
mid-1990s.
In 1965 the federal government created two na-
tional health insurance programs: Medicare for the
elderly and Medicaid for the poor. The Health Main-
tenance Organization (HMO) Act was passed by Con-
gress in 1973 to provide low-cost alternatives to
hospitals and private doctors through employer-
based plans.
While there are many health insurance options
available in the country, the United States remains
the only Western industrial nation without some form
of comprehensive national health insurance. Accord-
ing to the U.S. Bureau of the Census, 15.5 percent of
the population was without health insurance coverage
in 1999, and 13.9 percent of the uninsured were chil-
dren (under age eighteen). Even though the unin-
sured rate for children decreased between 1998 and
1999, poor children continued to represent the high-
est number without health insurance coverage, mak-
ing up 28.2 percent of all uninsured children in 1999.Providing Children with Health
Insurance
Health insurance plays a critical role in ensuring
that children access the health care they need—and
without it, the health status of children and the well-
being of families is jeopardized. Studies have shown
that lack of health insurance affects children in all as-
pects of their lives, not just their health. Those with-
out primary or preventive care generally use
inappropriate, more expensive services and have
more serious medical problems. Their neglected
health problems cause them to miss school and fall
behind in their studies, possibly affecting future edu-
cational and employment opportunities, and may
prevent them from achieving their full potential.
Because of the serious consequences of the lack
of health insurance, providing children with medical
care is a constant area of concern for the U.S. govern-
ment. There are three major sources of health insur-
ance for children in the United States: employment-
based or privately purchased; Medicaid; and the State
Children’s Health Insurance Program.
According to the Census Bureau, 68.9 percent of
children were covered by an employment-based or
privately purchased health insurance plan in 1999.
Privately purchased plans can be bought through nu-
merous health insurance companies. While full-time
employees may receive the option of health-care cov-
erage for themselves and their families through pay-
deduction contributions, this coverage is often not
guaranteed.174 HEALTH INSURANCE