A report released today by First Focus shows that in rural parts of the country, children are covered by public insurance sources (Medicaid and the Children’s Health Insurance Program, or CHIP) at a rate higher than their urban counterparts. In 2012, Medicaid and CHIP covered 47 percent of rural children compared to 38 percent of urban children. Both groups of children are uninsured at the same rate, about 9 percent.

Since its enactment in 1997, CHIP along with Medicaid has reduced the number of uninsured children by half. States implement CHIP in their own style and provide outreach and enrollment services that meet the need of the population of their state. In rural areas, those efforts are increasingly important as more and more children are covered by public programs and less on coverage through their parents’ employers.

From the report:

Figure 1 shows the type of insurance coverage for rural and urban children from 2000 to 2012. The overall trends in the type of health insurance coverage for children were similar in rural and urban areas, but the trends are more advanced or more pronounced in rural areas. Since 2000, the percent of children with employer-based health insurance has steadily decreased and the percent with public health insurance has steadily increased for children in both urban and rural areas.

The increase in public health insurance has been particularly rapid since 2007. For rural children, the share with public health insurance went from 37 percent in 2007 to 47 percent in 2012, and among urban children it went from 30 percent in 2007 to 38 percent in 2012. This is a big increase over a relatively short period. The economic downturn following 2008 led to more children being eligible for public health insurance because they lived in poor or near-poor families and during this period fewer employers were offering health insurance. The Census Bureau’s Current Population Survey shows the percent of rural workers (age 25-64) with employer-sponsored health insurance went from 64 percent in 2008 to 58 in 2013 and the number of rural children in low-income families went from 5.2 million to 5.8 million over the same time period.

In rural America the share of children with public health insurance is now nearly the same as the percent with employer-based health insurance – 49 percent with employer-based health insurance compared to 47 percent with public health insurance. This underscores the extent to which children in rural America are heavily reliant on public health insurance for health care. Moreover, the trajectory is clear. Figure 1 shows that on average the percent of children on public health insurance has risen almost 2 percentage points a year since 2007, while the share of employer-based health insurance has fallen about one percentage point a year. If the trajectory seen in the 2007 to 2012 period continues, by 2014 or 2015 the share of rural children with public health insurance will pass those with employer-based health insurance.

Figure 1

Of the 50 counties with the highest rates of uninsured children, 45 are in rural areas (i.e. outside of a metropolitan area). The majority of the counties with highest rates of uninsured children are in the Southwest, with 24 counties of the 50 counties located in Texas, 5 in Nevada and 3 in Arizona. Other states with a large number of counties with high rates of uninsured children are Montana with 8 and Alaska with 7. Moreover, a large number of the rural counties with high rates of uninsured children are located in some of the most remote parts of the country.

CHIP funding will end in September 2015 unless Congress acts to keep it. Children and families all over the country are depending on Congress to do the right thing and keep CHIP coverage available for them. This report shows that children who depend on CHIP live in every section of the country, and often in the most rural areas where other options are limited.

A summary of the report is available here.