Sarah, an African American mother of four young children, about whom we will learn more later, did not have medical insurance for herself and had to deal with frequent lapses in her children's coverage. All four children had serious medical problems, and Sarah faced an ongoing struggle to get them the care they needed as well as deal with her own health problems. Three of the children had asthma; the fourth child was born three months prematurely and suffered from lingering respiratory problems. Sarah's work hours and the wages she earned as a staff member at a health care facility varied from week to week, and the children's eligibility for Medicaid changed along with her income. When she was working, Sarah could not afford to take the time off for the recertification visits that were required to maintain each child's Medicaid. In order to take the children to the doctor, Sarah had to take even more time off from work, which she could hardly afford. She was not paid for the hours she took off and, like many other marginal workers, she risked getting fired if she was absent too often.

Sarah's experiences in obtaining health care for her children were typical of those of the low-income mothers we interviewed and illustrate the ways in which the instability of household health insurance relates directly to instability in work, child care, transportation, and a parent's own health problems.