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Don't Cut a Vital Lifeline for Rural Children

Valerie Borum Smith, MD, FAAP
June 21, 2017

Six-week-old Lilly was born premature and is struggling to gain weight.  She needs regular weight checks to monitor her progress, breastfeeding support for her mother, and a nutritionist to ensure her caloric intake is sufficient. Lilly’s difficulties are particularly stressful for her mother because the family lives in a rural county in northeast Texas with limited healthcare resources.
Coordinating care for children in rural areas is challenging. Lilly’s family drives an hour each way to see me. Her mother has already returned to her job, so we must work to coordinate her nutrition and lactation appointments for the same time. But, thankfully, Lilly and thousands of other children in rural Texas have health coverage through Medicaid to provide them the best chance to grow and thrive.  
A report released recently by Georgetown University Center for Children and Families and the University of North Carolina Rural Health Research Project, Medicaid in Small Town America: A Lifeline for Children, Families and Communities, confirms what many of us who care for patients in rural areas suspected: Children and families in small towns and rural areas rely on Medicaid for health coverage, and cuts to Medicaid could be devastating for rural America.

In Texas, 46 percent of children in rural areas and small towns are enrolled in Medicaid or the Children’s Health Insurance Program (CHIP), compared to 41 percent in urban areas. Across the country those numbers are similar: 45 percent of children in rural areas and small towns receive health coverage through Medicaid, compared to 38 percent of children in urban areas.  

In the mid-1980’s, the vaccine for HIB was released and thirty years later we no longer see this disease. Because of the effectiveness of this vaccine my younger partners only know of HIB meningitis through textbooks (and some of my anecdotes).

This is the recurring story of vaccine preventable diseases.

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"Children and families in small towns and rural areas rely on Medicaid for health coverage, and cuts to Medicaid could be devastating for rural America."

One promising finding from the report is that since the 2008-2009 fiscal year, the rate of uninsured adults in rural areas has dropped from 35 percent to 29 percent in Texas.   At the same time, the rate of uninsured children in those areas dropped from 18 percent to 11 percent. Gains for adults were even greater in states that expanded Medicaid.

Nationally, the researchers found a direct connection between increases in Medicaid and CHIP coverage and reductions in the rate of uninsured children in small towns and rural areas. Because of these gains, there are currently more children in the United States with health coverage than at any other time in history.

This progress is encouraging for the future of our country.  When children receive preventive care, screenings, and therapies provided through health coverage, they enter school ready to learn.  They miss fewer days of school. They have higher rates of high school graduation and college attendance. As adults, they earn higher wages and pay more taxes. Our nation simply can’t afford to lose ground in this area.

"Any policy or legislation that results in fewer healthcare resources in our rural areas is bad for our country."

The U.S. Senate currently is considering whether to cap Medicaid funding in its version of health care reform, which would fundamentally change the way the program works for the 37 million U.S. children who depend on it. This goes far beyond rolling back the Medicaid expansion created in the Affordable Care Act and will create deep cuts to existing programs, shifting the burden to states for care for children, the disabled and the elderly.  

Capping Medicaid funding could have a ripple effect in rural areas, impacting residents who aren’t directly covered by the program. Hospitals, clinics and physicians serving our state’s small towns and rural communities see a significant number of patients covered by Medicaid.  Reducing coverage in these areas will result in increased emergency department visits and uncompensated care that will drive up costs for everyone and put rural hospitals at risk of closing their doors.

Last year, the organization I work for served families from 30 counties across northeast Texas.  Families are driving 50-100 miles for pediatric care because in many small towns and rural counties there are no pediatricians.  Any policy or legislation that results in fewer healthcare resources in our rural areas is bad for our country.

If citizens in our rural communities are to thrive, they must have access to quality medical care.  For these communities, Medicaid is a lifeline to health and future prosperity. The proposed cuts to Medicaid will disproportionately affect states with large rural areas, and hardworking Americans who live in small towns, and rural communities across our nation will suffer as a result.

The views expressed in this article are those of the authors, and not necessarily those of the American Academy of Pediatrics. ​​​

​​​Ab​out the ​​Author

Valerie Borum Smith, MD, FAAP, a member of the American Academy of Pediatrics and the Texas Pediatric Society, is a pediatrician at St. Paul Children's Clinic in Tyler, Texas. She is on Twitter @ValerieBSmithMD. This post is based on an article first published in the Dallas Morning News.

Additional Information

AAP Medicaid Policy Statement

Medicaid ( 

AAP Children's Health Care Coverage Fact Sheets

Georgetown University Health Policy Institute Snapshot of Children's Coverage