“Where did you graduate from high school?” Insurance as Education Reform

February 18, 2016

by William F. Tate, Edward Mallinckrodt Distinguished University Professor in Arts & Sciences; Dean, Graduate School and Vice Provost for Graduate Education

“My ear hurts.” “It’s hard to breathe.” “I feel afraid and it won’t go away.”

Imagine learning to read or doing a science project with otitis media or asthma. Picture taking a major exam while experiencing the symptoms of a crippling anxiety disorder. Many students miss classes, experience increased difficulties with illness, and go untreated because they lack the resources to secure a health care provider. Too many students do not have health care coverage. The 2011 US Census Bureau estimates indicate 9.4% of young persons under 18 (7 million) were without health insurance. Nearly 14% of children living in poverty are uninsured. The uninsured rates for African American and Hispanic children are 10.2% and 15.1% respectively.

St. Louis City and St. Louis County contribute more than 13,000 youth to this national problem (Jones, Harris, and Tate, 2015). This may seem to be an insignificant number. However, think about it in relation to the famous St. Louis question, “What high school did you attend?” The uninsured figure is roughly equal to the enrollment of 6.5 Lafayette High Schools, 7 Mehlville High Schools, or 13 Clayton High Schools. None of these communities would view this as acceptable. Our region should not accept this state of affairs either.

According to an Institute of Medicine (2002) report, uninsured children have less access to health care, are less likely to have a regular source of primary care, and use medical and dental care less often than children with insurance coverage. Like families, educators are on the front lines of child and adolescent health. Uninsured children may experience adverse consequences on cognitive tasks and in social interactions, and ultimately educational attainment.

Investing in insurance coverage for children living in poverty has the potential to be a powerful form of education reform.

We know that insured children do better in school. In a May 2014 National Bureau of Economic Research working paper, Sarah Cohodes and her colleagues reported that the expansion of public health care in the form of Medicaid reduced high school drop out rates, increased college attendance, and improved the rate of college degrees earned. This finding is consistent with the literature on achievement in education. Raudenbush (2012) argued that school quality and home environment are positively correlated. However, for any given generation, variation in cognitive skills is explained far more by home resources and environment than variation in school environment. This pattern suggests that investing in insurance coverage for children living in poverty has the potential to be a powerful form of education reform.

The relationship between high school completion and insurance coverage is of particular concern for African Americans in the St. Louis region. In 2012, according to the Missouri Department of Elementary and Secondary data, over two thousand African American 9-12 graders were classified as high school dropouts in St. Louis City and St. Louis County. One in ten African American 9-12 graders were classified as high school dropouts in the region. Unless they resume their education, this places them at high risk for both lower incomes and poorer health. These students are likely to earn about $7,000 less per year than high school graduates.

Setting up children to succeed at the youngest ages has powerful health, education, and societal effects.

As stated in the For Sake of All report (Purnell, Camberos, and Fields, 2015), envision a region with increased purchasing power (ranging from $347,000 to $739,410 per graduate), higher tax receipts to support services and schools, and lower costs for social services and unemployment assistance. Using earnings estimates alone, St. Louis gains $694 million to $1.5 billion across a generation, if the 2012 African American cohort completed high school. Think about this effect year after year. For many of these students, health insurance would have been an important protective factor supporting their high school completion.  It is not too late for future cohorts of students.

Solutions exist. Setting up children to succeed at the youngest ages has powerful health, education, and societal effects. Medicaid expansion in Missouri is a start. The state of Missouri has an opportunity to expand Medicaid to many more working families experiencing the stresses of limited resources. There has been progress. Medicaid and the Children’s Health Insurance Program have provided needed coverage for many children.

Visualize thirteen Clayton High Schools worth of children with health insurance coverage. Many more St. Louisans will live longer and get to answer a different question, “Where did you graduate from high school?”

This post is part of the February 2016 “Racial Disparities” series of the Institute for Public Health’s blog. Subscribe to email updates or follow us on Twitter and Facebook to receive notifications about our latest blog posts.



DeNavas-Walt, C., Proctor, B.D., Smith, J. C. (2012, September). Income, poverty, and health insurance coverage in the United States: 2011. Washington, DC: U.S. Department of Commerce. Retrieved from https://www.census.gov/prod/2012pubs/p60-243.pdf

Jones, B. D., Harris, K. M., & Tate, W. F. (2015). Ferguson and beyond: A descriptive epidemiological study using geospatial analysis. Journal of Negro Education, 84(3), 231-253.

Purnell, J., Camberos, G., & Fields, R. (Eds.) (2015). For the sake of all. A report on the health and well-being of African Americans in St. Louis and why it matters for everyone (revised edition. Retrieved from https://forthesakeofall.files.wordpress.com/2015/08/for-the-sake-of-all-report-2.pdf

Institute of Medicine. (2002). Health insurance is a family matter. Washington, DC: National Academies Press.

Raudenbush, S. W. (2012). Can school improvement reduce racial inequality? In W. F. Tate (Ed.), Research on schools, neighborhoods, and communities: Toward civic responsibility (pp. 233-248). Lanham, MD: Rowman & Littlefield.

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