Previous research has shown that emergency department (ED) visits and potentially avoidable hospitalizations have increased since the enactment of the Affordable Care Act (ACA) and the implementation of Medicaid expansion under the ACA in 39 states. There is growing concern about the use of EDs for non-urgent ED visits and subsequent hospital admissions as they are costly, inefficient, and may be a hindrance to providing care to patients in truly urgent or emergent conditions. This project will update some key evidence on access to care, using ambulatory care sensitive condition-related ED visits as a proxy. The investigators will utilize the State Emergency Department Databases to explore the burden of these diseases in rural pediatric populations relative to urban populations and what individual and societal factors play a role in any discrepancies that may be found. This project will advance our understanding of the extent to which rural residents are relying on inpatient care, and the role that a lack of insurance and other patient-level factors play in the reliance on EDs and hospitals for care that could be adequately addressed in ambulatory settings. The findings from this project will potentially underscore the importance of a paradigm shift to less reliance on hospital care and more reliance on preventive strategies for rural Americans.