During the 1980s and 1990s there were great increases of health insurance coverage for poor children through the Children’s Health Insurance Program (CHIP) and extended Medicaid eligibility. Problems remain for the small number of children with serious medical conditions whose care is a high proportion of total health care expenditures on children. We report on the adequacy of health insurance coverage for a sample of children with serious and rare illnesses treated at the single tertiary care pediatric hospital in Indiana. One-third of privately insured children in our data had inadequate insurance. Compared to families with inadequate health insurance families with adequate insurance were 50 percent less likely to delay care for themselves and 67 percent less likely to delay care for a child. Our research identifies policy relevant deficiencies in private health coverage for seriously ill children ineligible for either Medicaid or CHIP
