Moving toward universal coverage has the potential to increase access to care and improve the health and well-being of uninsured children and adults. The effects of health care reform on the more than 25 million children who currently have coverage under Medicaid or the Children's Health Insurance Program (CHIP) are less clear. Increased parental coverage will help these children since many have uninsured parents with unmet health needs. However, proposals to move children from Medicaid and CHIP into a new health insurance exchange could make these children worse off through the potential loss of benefits and legal protections and possible exposure to higher cost-sharing. At the same time, if reimbursement rates are higher in the exchange than paid under Medicaid and CHIP, children's access to providers could improve. This brief provides background information on current coverage and access to care for low-income children and considers the potential implications of shifting children with public coverage into exchange plans. It closes with a discussion of how health care reform could be structured to take these implications into account. (Contains 2 tables and 56 notes.)