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There are just days of CHIP funding left

The program is about to run out of funding as Congress fights over extending it.

US Capitol Bill Clark/Getty Images
Dylan Scott covers health care for Vox. He has reported on health policy for more than 10 years, writing for Governing magazine, Talking Points Memo and STAT before joining Vox in 2017.

The Children’s Health Insurance Program, lacking long-term funding authorization since October, is about to start running out of money.

The program, which covers 9 million American children, is at the center of Congress’s government shutdown showdown this week. Republicans are attaching a six-year CHIP extension to a short-term spending bill in a gambit to deter Democrats from shutting down the government over an immigration impasse. Democrats are furious, given that the Republican majority has allowed the program to go without long-term funding for this long.

The Trump administration has said state reserves for CHIP could start to dry up as soon as Friday — maybe, at best, the current funding could last through the end of the month. But after that, without congressional action, kids could be frozen out of health coverage or dropped off the rolls.

Congress has been courting disaster with CHIP, failing to extend funding long-term when it ran out in September. States have begged them to act, and Congress approved a package in December to help states keep running their programs through March. But the short-term relief is insufficient to last that long.

“We appreciate that Congress included funding for CHIP in the continuing resolution that runs through January 19, 2018,” Johnathan Monroe, a spokesperson for the Centers for Medicare and Medicaid Services, said in a recent statement. “However ... we are unable to say with certainty whether there is enough funding for every state to continue its CHIP program through March 31, 2018.”

Based on the administration’s estimates, the short-term CHIP money should be enough to fund all states through January 19 or possibly the end of the month.

Several states, including Connecticut and Colorado, have notified families that their coverage could end if Congress doesn’t extend CHIP’s funding. Georgetown’s Center for Children and Families estimated that 1.7 million children in 24 states could be at risk of losing CHIP coverage by the end of February.

Many Republicans and Democrats want the program to be extended. Lawmakers in both parties in the Senate and the House hope to extend CHIP funding for five years or more. There were disputes between the parties over how to pay for the program, but even that problem has been eliminated: The Congressional Budget Office estimates that after Republicans repealed the Affordable Care Act’s individual mandate in their tax bill, funding CHIP for six years or longer costs nothing — down from $8.3 billion prior to the mandate’s repeal.

(This gets wonky, but the gist is that repealing the mandate drives up premiums in the ACA markets. So if kids are covered by CHIP instead of the ACA, as many of them would be if CHIP were not extended, it’s cheaper for the federal government.)

But Republicans have dithered on CHIP for months, prioritizing a last-ditch run at Obamacare repeal and their tax overhaul. An extension that did pass the House in November was loaded with cuts to the ACA and Medicare, which made it untenable for Democrats.

But now, with Democrats threatening to shut down the federal government until a solution is found for the Deferred Action for Childhood Arrivals program, Republicans have decided to attach a six-year extension — with no spending cuts attached — to a short-term spending bill. They are transparently using a CHIP extension as leverage to avert a government shutdown.

Democrats are, of course, apoplectic. They are arguing that a CHIP extension is insufficient, given the other issues — disaster relief for Puerto Rico, community health center funding, and, most importantly, a permanent DACA fix — that Republicans have neglected to address over the last few months.

“They’re talking about six years, which is less than the amount that it should be,” Sen. Richard Blumenthal (D-CT) told me of CHIP. “We have to view all of the elements that are necessary for us to address as parts of what we should approve. They all need to be included.”

According to the Trump administration itself, CHIP is about to start running out of funding in a matter of days or weeks, while its future is stuck in this congressional quagmire.