Imagine your child awakens in the night with an asthma attack and needs health care. The coughing and breathing worsen—however, your child has no health insurance. You struggle to pay for food, rent and other basic living expenses and are fearful of the hospital emergency room because of potentially ruinous medical bills. What do you do?

This dilemma is familiar to thousands of parents and guardians of uninsured children and youths throughout Hawaii. As state budgets face monetary shortfalls, taxpayers should know it is cheaper to cover kids with health insurance than cover expensive hospital costs for uninsured kids. That is why federal, state and community organizations collaborated to create Keiki Care for uninsured children and youths in “;gap groups”;—those who do not qualify for public health insurance and whose parents cannot provide private health insurance. Specific provisions that discourage parents from dropping their children's private health insurance to enroll in Keiki Care include: 1) the child must be continuously uninsured for six months, 2) limited health care benefits and 3) out-of-pocket expenses.

A modest investment in Keiki Care helps Hawaii's economy because if a sudden illness or injury occurs, children are insured for emergency care, which averts personal and institutional financial crises. In fact, as the number of insured kids in Hawaii has increased, hospital emergency department data for 2000-2006 shows that visits by uninsured children and youths have declined to 3.79 percent from 5.25 percent.

Keiki Care also empowers parents by connecting their children to a pediatrician and regular preventive health care. Compelling national health care statistics published in a recent Covering Kids & Families “;State of Coverage”; report support this: Children who are uninsured are twice as likely not to receive any medical care; only 45 percent of uninsured children had one or more well-child visits in the past year compared with more than 70 percent of insured children; more than one in three uninsured children do not have personal physicians; and uninsured children are less likely to receive proper medical care for childhood illnesses such as sore throats, earaches and asthma.

Parents with uninsured children often face hard choices—pay the electric bill or pay the doctor, fill the refrigerator or fill a prescription. That is why uninsured children often go to school without annual checkups and might not participate in co-curricular activities—not only because their parents fear an injury, but also because they fear the impact medical bills could have on their family budget.

Overall, Keiki Care supports healthier children, confident parents and reliable payments to health care providers while allocating precious charity care and limited uninsured funds for others who are uninsurable.