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CHIP’s budget lapsed 23 days ago. Congress has done nothing.

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The Children's Health Insurance Program provides coverage to 9 million low- and middle-income children.

It has now been 23 days since the federal government let the program's funding lapse — with no clear resolution in sight.

This is an unprecedented moment for the CHIP program. Giving health insurance to low-income children is not controversial. The program has never courted the same controversy that the Affordable Care Act has. Instead, CHIP typically has widespread bipartisan backing among legislators on both sides of the aisle. Bills to expand CHIP typically pass with wide margins.

But in 2017, CHIP has — somewhat surprisingly — become less of a priority. The program's budget lapsed on September 1, and there has not been a rush on Capitol Hill to fix it.

The program's structure does allow some wiggle room. Most states have money left over from the last appropriation, in 2015, to keep the program up and running. There is no evidence that any children have lost coverage yet because of the funding lapse.

But we're getting closer and closer to a turning point. Because the longer Congress goes without funding CHIP, the less money state programs have to continue their coverage. Politico reports that there are already five states that have received emergency funding to keep their CHIP programs up and running.

This ranges from a $3.6 million grant to Minnesota to a $177 million grant to California. Most of the states receiving this funding say they now have enough money to run the program through the end of the year, but make no guarantees after that. And some of these states are statutorilyrequired to shut down their programs if the federal funding comes to a halt.

Both the House and the Senate have bills to extend the CHIP program. But the House bill contains controversial offsets that would cut the Affordable Care Act and Medicare. This has left the CHIP debate at a standstill, with no clear resolution in sight.

And if CHIP isn't funded soon, it is going to leave states with some tough decisions. Do they put a halt on enrollment? Do they send letters to CHIP families, letting them know that the program may sunset at the end of the year, as Utah has proposed? On the one hand, this would give families time to make other plans if the funding doesn't come through. On the other, it could create false panic if Congress does finish CHIP funding in the next few weeks.

These aren't theoretical conversations for states They are very real. They affect millions of vulnerable children — and are only happening because Congress hasn't acted.

Chart of the Day

Charles Gaba

Joshua Peck, the former head of marketing for Healthcare.gov, predicts the smaller advertising budget will lower enrollment. The Trump administration has cut the Obamacare advertising spending from $100 million down to $10 million. Peck says this is "the least harm the administration’s outreach cuts could have — this is a best case scenario." Read more here.

Kliff’s Notes

Your daily top health care reads, with research help from Caitlin Davis

News of the day

  • “Schumer: Bipartisan health care bill 'has a majority'”: “Senate Minority Leader Chuck Schumer said Sunday that the Alexander-Murray bipartisan health care bill has support from a majority of senators, and he urged Senate Majority Leader Mitch McConnell to bring it to the floor 'immediately.'” —Rebecca Morin, Politico
  • “McConnell says Trump needs to provide clarity on health care”: “Senate Majority Leader Mitch McConnell (R-Ky.) said he is ready to move a bipartisan health-care bill but first needs clarity from President Trump on what he is willing to sign.” —Tory Newmyer, Juliet Eilperin, and Sean Sullivan, Washington Post
  • “I.R.S. Says It Will Reject Tax Returns that Lack Health Insurance Disclosure”: “Despite President Trump’s pronouncements, not only is Obamacare not dead, there are signs that his administration is keeping it alive. In the latest signal that the Affordable Care Act is still law, the Internal Revenue Service said this week that it is taking steps to enforce the most controversial provision: the tax penalty people face if they refuse to obtain health insurance.” —Reed Abelson, New York Times
  • “Scoop: Trump enlists family, Cabinet, Congress in opioid response”: “The Trump administration this week will make its official declaration of the opioid crisis as a national public health emergency, and President Trump will speak Thursday on combating the epidemic.” —Mike Allen and Jonathan Swan, Axios

Analysis and longer reads

  • "‘Catastrophic’ policies part of sweeteners in latest health care bill": "The Senate bill would expand the use of so-called 'catastrophic’' health plans for individuals. Currently only young adults up to age 30 or those who qualify for 'hardship waivers’' can buy them. The Senate bill, sponsored by Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.), would allow anyone to buy them, regardless of age or income level." —Andy Miller, Georgia Health News
  • “Health Advocates Gear Up for Open Enrollment”: “Consumer groups and some state officials, facing new pressure to show the Affordable Care Act remains in place after President Donald Trump declared it dead, have begun launching urgent outreach programs to sign people up for health coverage during the coming open-enrollment period.” —Stephanie Armour and Michelle Hackman, Wall Street Journal

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