The Role of Public versus Private Health Insurance in Ensuring Health Care Access & Affordability for Low-Income Rural Children

More than 35.6 million children were enrolled in Medicaid or the Children’s Health Insurance Program (CHIP) in December 2016— accounting for just over half of total Medicaid and CHIP enrollment.1 Medicaid and CHIP are particularly important in rural areas where 77.1 percent of children in households with income below 200 percent of the federal poverty level (FPL) are covered by public insurance compared with 72.2 percent of children in urban areas.2 Given the large proportion of rural children covered by public insurance, it is critically important to understand the role of public health insurance in ensuring access to affordable health care for these children. Some research indicates that public coverage better protects families from cost-related barriers3 and improves access,4,5 quality,4 and outcomes6 compared to private coverage, while other studies identify barriers to seamless primary care7,8 and limited access to specialty care for children covered by public coverage.9-11 Though these prior studies have sometimes yielded mixed results, taken in aggregate they suggest children with public health insurance have generally fared as well as their privately insured counterparts on many key access measures.12,13