Health Insurance Stability Among Rural Children Following Public Coverage Expansions

Research center:
Lead researcher:
Research staff:
Project funded:
September 2009
Project completed:
April 2014
Our recent research reveals that public expansions have substantially lowered the uninsured rate among rural children; however, it remains unclear whether this increase has provided a stable and long-term solution to uninsurance. Previously, children insured under public programs have been more likely to have a coverage gap than children with private insurance (Kogan et al. 1995). This may be due to fluctuating incomes that make children periodically ineligible for public coverage, or because renewal processes are cumbersome and families briefly lose coverage for which they are eligible. Thus, the increased reliance on public health insurance programs may make rural children more vulnerable to disruptions in insurance coverage, depending on their states' specific eligibility criteria and enrollment policies and the number of rural children affected by these policies. 

This study aims to examine changes in insurance stability among rural and urban children following CHIP expansions, and whether these changes are affected by state eligibility and enrollment policies or clusters of policies.

Using the 1996, 2001, and 2004 panels of the SIPP, we will measure rural-urban differences in uninsured spell length and frequency, sources of coverage before and after uninsured spells, movement between sources of coverage, how these measures of stability have changed over time, and the factors that relate to greater continuity of coverage among rural children. Additionally, we plan to link these data to the Rural-Urban Continuum Codes (RUCCs) to separately examine populations living in urban areas, rural areas adjacent to urban areas, and rural areas not adjacent to urban areas.