The health care financing crisis that threatens the health and wellbeing of the poor families whose story we have told in these chapters is part of a far more serious problem of equity, fairness, and access to social services that affects the health of our nation in various domains. The poor not only are exposed to serious physical and mental health risks but also forced to rely on a system of care that is fragmented and often inadequate. This vulnerability is clearly associated with the low productivity and low earnings capacities of individuals with little education and few job skills. Those individual vulnerabilities, however, are not just the result of poor personal decisions; they result in large part from the restricted opportunities available to those who grow up in low-resource barrios and ghettos. Low education and limited job skills are also the result of the threats to health to which those growing up in such circumstances are exposed. A rather large body of research, in addition to our study, documents the clear association between the lack of health insurance coverage, inadequate health care, and poor health outcomes (Institute of Medicine 2001; Institute of Medicine 2002a). It is clear as well that incomplete health care coverage of the population incurs substantial social costs (Institute of Medicine 2003a; Institute of Medicine 2003b).

The previous chapters have illustrated the importance of Medicaid and SCHIP to pregnant women and families with children.