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CHIP covers 9 million kids. Its funding expired this weekend.

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The Republican effort to repeal the Affordable Care Act seems almost certainly dead for the rest of 2017 (although, given its zombielike properties, there is always a chance it rises up at an unexpected moment).

Republicans were, obviously, unable to repeal the Affordable Care Act. But it would be a mistake to think of the nine-month push to kill Obamacare as inconsequential. The focus on Obamacare repeal meant that other legislative priorities got pushed aside, and as a result, federal programs that cover about 30 million Americans are struggling.

In mid-September, key senators struck a deal to extend the budget for the Children's Health Insurance Program, which covers 9 million low- and middle-income kids. Other senators were making progress on a small package to stabilize the Affordable Care Act.

But all of that work ground to a halt as the focus abruptly turned to the Graham-Cassidy plan to repeal the ACA. Those nascent plans never made it to a Senate vote. Now we're seeing the consequences: Funding for CHIP expired this weekend — and without that stabilization package, we're expecting double-digit Obamacare premium increases.

Let's start with the CHIP program, which ran out of funding this past Saturday. This does not mean that the 9 million kids who rely on the program have suddenly lost coverage. States generally say they have enough money left over from the last appropriation to keep the program afloat through the end of the year. Ten states are expected to exhaust their funding by the end of this year, and 22 will do so within the next six months if funding is not reauthorized.

States are already starting to make plans for what happens if the CHIP program funding isn't reauthorized in the near future. Utah, for example, had asked the federal government for permission to freeze eligibility for the program if the funding doesn't come through by the September 30 deadline. The state is considering sending out notices next month saying the program will sunset at the end of 2017 if Congress still hasn't appropriated the funding by then.

Kaiser Family Foundation

"It gets worse every day," says Joan Alker, executive director of the Center for Children and Families at Georgetown University. "Starting in November, we'll really see the consequences start to add up."

Obamacare stabilization legislation was also tabled for the focus on Graham-Cassidy in the final weeks of September. Senators pulled the plug on that workthe same day that Vice President Mike Pence came to Capitol Hill to encourage Republicans to pass the repeal bill before the September 30 deadline.

If there were to be a stabilization bill, most observers expected it would include funding for the disputed cost-sharing reduction subsidies, which help cover the deductibles and copayments for low-income Obamacare enrollees. Trump has toyed with abruptly ending these subsidies; funding them for 2018 and 2019 would have brought more stability to the marketplace.

But the renewed focus on repeal meant the stability efforts died on September 19. Insurance plans had to set their final Obamacare rates for 2018 on September 27, and many assumed that — absent congressional effort — these subsidies would not be funded. This means higher premiums, as insurers assume they'll have to account for the loss of these payments.

Florida, for example, announced last week it is expecting an average rate increase of 44.7 percent — and two-thirds of that is due to the lack of CSR funding. In Georgia, Obamacare premiums are set to rise an average of 50 percent.

The effort to repeal Obamacare didn't end in Congress passing a bill that wipes the law off the books. Instead, the effort to repeal Obamacare sucked up congressional time and energy — energy that the Senate looked to be on track to use for existing health care programs. The result is these programs now have a rockier future ahead, and greater uncertainty for the people who get coverage through them.

Chart of the Day

The number of complaints filed by nursing home residents is rising

HHS Office of the Inspector General

Nursing homes received one-third more complaints in 2015 than they did in 2011 — despite having fewer residents. A new federal report shows a steep rise in complaints against nursing homes. If you dig into the report, you see that there is huge regional variation: There are nine states (including large ones like Texas and California) that have a rate of complaint higher than 60 per 1,000 nursing home residents. There are also nine states that have fewer than 15 complaints per 1,000 residents. Read the full report here.

Kliff’s Notes

With research help from Caitlin Davis

Today's top news

  • “9 million kids get health insurance under CHIP. Congress just let it expire.”: “Congress just allowed the Children’s Health Insurance Program, which provided low-cost health insurance to 9 million children, to expire. If action is not taken soon to restore the funding, the effects will become obvious in schools across the country, with many of the children in the program unable to see a doctor for routine checkups, immunizations, visits when sick and other services.” —Valerie Strauss, Washington Post
  • “Who will replace Tom Price?”: “The hunt for a new Health and Human Services secretary is on, and so far the speculation is heavily focused around one name: Seema Verma. At least in these early days, many people in the health care world think the job is hers to lose. However, the list of potential names is growing daily and we are tracking who's moving up and down the favs list.” —Sam Baker, Axios
  • “Dems look to turn ObamaCare tables on GOP in '18”: “Republicans have hammered Democrats over ObamaCare for the better half of a decade, riding promises to repeal the law into majorities in both the House and Senate. But now Democrats plan to turn the tables on the GOP, using the GOP’s failed attempts to repeal ObamaCare as a cudgel in the 2018 midterm elections.” —Rachel Roubein, the Hill

Analysis and longer reads

  • “Which States Are Hit Hardest By Failure To Fund Children’s Health Program”: “According to an analysis by the Kaiser Family Foundation, 48 of 50 states, including DC, assumed Congress would reauthorize CHIP when they wrote their 2018 state budgets. That mistaken trust in Congress is already having major consequences. At least 10 states are on track to run out of money by the end of 2017, and even those that can hold out into 2018 will pay a price.” —Alice Ollstein, Talking Points Memo
  • “In sicker communities, Trump got more votes. Is that why he won?”: “'Our results suggest that communities that are more distressed, at least in the sense that distress is measured by public health, moved from Democratic to Republican,' [lead investigator Dr. Jason] Wasfy said. 'Sicker communities overall shifted their votes toward Republican presidential voting in 2016.'” —Sharon Begley, STAT
  • “Do Pharma’s Claims On Drug Prices Pass The Smell Test? We Found 5 Stinkers.”: “The narrative from the Pharmaceutical Research and Manufacturers of America (PhRMA), a trade group, is only the rosiest, most self-serving version of the tale, say critics, and numerous independent authorities question its assertions. They say the campaign is misleading in these five ways.” —Jay Hancock, Kaiser Health News

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