An Estimated 3 Million Children of High School Age Are Uninsured, But the Extent to Which This Is a Barrier to Sports Programs Is Unknown

Of the 13 million children without basic health insurance, more than 3 million are of high school age (14- 18).Substantial differences in the uninsured rate among children of high school age exist across states. The extent to which any of these children are prevented from participating in high school sports is unknown. In our survey of high school athletic associations, officials were unaware of any instance in which a high school student was prohibited from playing high school sports due to a lack of health insurance. Some states and school districts require high school student athletes to have basic health insurance prior to and while participating in a sports program. Our survey of high school athletic association officials found that only 10 states and the District of Columbia have a statewide requirement that student athletes have health insurance to participate in a sports program. Some School Districts and Other Organizations Offer Insurance and Care Options to All High School Athletes

School districts and health care organizations in the locations we visited have developed strategies to make athletic accident insurance available to student athletes and to provide access to athletic accident-related care. Most school districts provided catastrophic athletic accident insurance to all student athletes regardless of their insurance status and also offered health insurance to student athletes free of charge or at low cost. In addition, in all 18 school districts we reviewed, including hospitals, medical centers, and sports assisted local school districts by offering free medical services to student athletes. In most of the school districts we contacted, this insurance coverage commences when the athlete’s medical bills reach $25,000. In addition to catastrophic injury insurance, 17 of the 18 school districts we reviewed either provide free supplemental athletic accident insurance to student athletes or offer athletic accident insurance to student athletes for a fee. Nine school districts we reviewed offer students the opportunity to purchase low-cost athletic accident insurance. In these districts, the student athlete may purchase an athletic accident policy through the school. However, school officials also reported that instances of uninsured students requiring athletic accident care were infrequent. Finally, some districts use local health providers to conduct pre- participation exams. We also sought to determine the number of uninsured high school students in the United States, the extent to which the lack of health insurance posed a barrier to participation in high school athletic programs, and the strategies health care organizations and school districts have developed to assist student athletes with health insurance or health care. All districts were among the largest in the nation.
Why GAO Did This Study

Pursuant to a legislative requirement, GAO reviewed high school interscholastic athletics, focusing on the: (1) number of uninsured high school students in the United States and the extent to which the lack of health insurance poses a barrier to participation in high school athletic programs; and (2) strategies school districts have developed to provide health insurance and health care to high school sports participants.

What GAO Found

GAO noted that: (1) in 1998, an estimated 3.4 million uninsured children were of high school age; (2) among highly populated states, there were wide differences in the percentage of uninsured children of high school age; (3) GAO was unable to identify any national, state, or local information on the extent to which these high school students were prevented from participating in athletic programs because they lacked basic health insurance; (4) the officials of the 51 athletic associations GAO surveyed were unaware of any instance in which a high school student was prohibited from playing high school sports because he or she lacked health insurance; (5) however, according to these officials, while 10 states and the District of Columbia require high school students to have health insurance before joining a school's athletic program, the other 39 states leave this decision to the discretion of local school districts; (6) in 17 of the 18 large school districts, district policy required student athletes to have health insurance to participate in high school sports; (7) in addition, many of these districts required student athletes to document insurance coverage before participating in sports; (8) however, school officials in four of these large districts reported that they did not have the resources to monitor the accuracy of health insurance information before or during a sport's season; (9) 16 of the 18 school districts provided free catastrophic athletic accident insurance to all student athletes regardless of their insurance status; (10) in most cases, the catastrophic accident policy would cover all medical costs once a family's expenses exceeded $25,000; (11) further, in all school districts GAO reviewed, local schools have adopted strategies to provide access to low-cost athletic accident insurance to student athletes; (12) in eight school districts, free supplemental athletic accident insurance was automatically provided to all student athletes; (13) in nine districts, the families of student athletes were given the opportunity to purchase low-cost athletic accident insurance; (14) school officials in these districts reported that instances of uninsured student athletes requiring athletic accident care were addressed through such activities as accident trust funds established at the school district level and through direct community involvement; and (15) private organizations such as hospitals and clinics assisted local school districts by offering free medical services to student athletes for sports-related injuries and other services such as pre-participation physicals or injury evaluation.