This is the web version of VoxCare, a daily newsletter from Vox on the latest twists and turns in America’s health care debate. Like what you’re reading? Sign up to get VoxCare in your inbox here.

This was the worst-case scenario for the Children's Health Insurance Program.

In mid-September, I spoke with some prominent advocates, and they had two primary fears as the September 30 deadline to extend CHIP's funding drew closer:

The funding authority would be allowed to lapse. The CHIP negotiations would be complicated by more partisan issues like Obamacare.

Now both fears have come to pass.

vox-mark Sign up for the newsletter VoxCare Get our newsletter in your inbox once a week. Email (required) By signing up, you agree to our Privacy Notice and European users agree to the data transfer policy. For more newsletters, check out our newsletters page Subscribe

CHIP's funding expired on October 1, and the program has now gone four weeks without being extended. States are on the clock: The Georgetown University Center for Children and Families reported that six states expect to run out of money by the end of the year or by early January.

They are planning contingencies. Some can keep covering kids through their Medicaid programs, though they will have to find the money to pay their share. Other states could send children to the Affordable Care Act's marketplaces to buy coverage. But the fear is that some number of young Americans will become uninsured if CHIP is not extended before states run out of funds.

You would think that would motivate Congress to act. But instead, Republicans and Democrats in the House are digging in, feuding over — just as CHIP advocates feared — Obamacare and other programs.

"This is a huge mess," Bruce Lesley, president of First Focus, told me. "We have the perfect storm for kids to lose coverage."

The problem is offsets — spending cuts to pay for CHIP's funding for the next five years. Congress needs to find about $8 billion in savings.

House Republicans proposed cutting Obamacare's public health fund, cutting the grace period for Obamacare enrollees who fail to make premium payments, repealing the law's Independent Payment Advisory Board, and making some smaller cuts to Medicare and Medicaid as their plan for offsets.

Democrats balked, as you might expect, and the two sides had agreed to go back into negotiations. A vote in the House would wait, with the hopes that a compromise could be reached.

But on Thursday, according to the Hill, House Republican leaders announced that the chamber would vote on its CHIP bill next week — and it doesn't sound like there was a bipartisan breakthrough.

"Only yesterday I was told Democrats said they don't want to do anything and we should just go forward," House Majority Leader Kevin McCarthy (R-CA) said. "That is not the way this place should work."

So it sure sounds like a partisan bill is coming out of the House, and that's a huge problem. The CHIP legislation needs 60 votes in the Senate, which will require some Democratic buy-in.

Sens. Orrin Hatch (R-UT) and Ron Wyden (D-OR) had reached their own agreement on extending CHIP, but they never said how they would pay for it. They still haven't.

Meanwhile, the House is stuck in this offsets battle, apparently at an impasse.

"The March of Dimes is deeply distressed that the House is moving forward on a vote that is likely to result in a partisan vote on CHIP," Cindy Pellegrini, who oversees federal policy at the March of Dimes, said in an email. "We are urging both parties to continue negotiations with the goal of reaching a bipartisan agreement on this critically important program."

What's particularly maddening is the two parties don't actually disagree about CHIP itself. The fight is over Obamacare and entitlements.

"GIven that CHIP funding is less than one-half of 1 percent of mandatory outlays, they could find bipartisan agreement on the offsets without too much trouble I believe," Joan Alker at Georgetown told me, adding it was "unfortunate" that the House was moving forward with partisan offsets.

This is exactly what CHIP advocates had feared for the past few months. Now, four weeks after the deadline, there is still no resolution in sight to get this program that covers 9 million of America's children funded again.

Chart of the Day

States fall short with medication-assisted treatment for exiting prisoners. The Pew Charitable Trusts has a big new report on health care in US prisons. There is a lot to unpack here, but this stuck out to me: Most states don't provide medication-assisted treatment for substance abuse for prisoners upon reentry. That is in spite of the evidence that providing the medications helps prevent relapses for individuals leaving prison, Pew said.

On a related note, if you want to understand the opioid emergency that President Trump declared today, Vox's German Lopez has all the details.

Kliff’s Notes

With research help from Caitlin Davis

Today's top news

“Siding With Trump, Judge Clears Way for Trial Over Health Subsidies”: “A federal judge sided with the Trump administration on Wednesday in a ruling against 18 states that sought to compel the federal government to pay subsidies to health insurance companies for the benefit of millions of low-income people.” —Robert Pear, New York Times

“A federal judge sided with the Trump administration on Wednesday in a ruling against 18 states that sought to compel the federal government to pay subsidies to health insurance companies for the benefit of millions of low-income people.” —Robert Pear, New York Times “Undocumented teen immigrant has the abortion she sought for weeks”: “The abortion ended the girl’s individual court challenge in a case that drew widespread attention and evoked the incendiary issues of abortion rights and illegal immigration. But the broader legal battle over whether the federal government may continue to dissuade, and even block, undocumented teens in its custody from having abortions is still pending in U.S. District Court in Washington.” —Maria Sacchetti and Ann E. Marimow, Washington Post

“The abortion ended the girl’s individual court challenge in a case that drew widespread attention and evoked the incendiary issues of abortion rights and illegal immigration. But the broader legal battle over whether the federal government may continue to dissuade, and even block, undocumented teens in its custody from having abortions is still pending in U.S. District Court in Washington.” —Maria Sacchetti and Ann E. Marimow, Washington Post “Maryland regulators approve higher health insurance rates”: “The Maryland Insurance Administration approved the increases that are expected to affect roughly 96,000 people who buy silver plans through the state’s health insurance exchange. Regulators acted in response to President Donald Trump’s decision to halt payments to insurers under the Obama-era health care law he has been trying to undo for months.” —Associated Press

Analysis and longer reads

“Trump health official Seema Verma has a plan to slash Medicaid rolls. Here’s how”: “With a broad overhaul of Obamacare stalled in Washington, one of President Trump’s top health care leaders is drawing the outlines of sweeping changes to Medicaid that could pare enrollments and cut costs without congressional approval.” —Casey Ross, STAT

“With a broad overhaul of Obamacare stalled in Washington, one of President Trump’s top health care leaders is drawing the outlines of sweeping changes to Medicaid that could pare enrollments and cut costs without congressional approval.” —Casey Ross, STAT “What to expect from Trump's first ACA enrollment season”: “With a shorter open-enrollment window, fewer intermediate deadlines and barely any money for consumer outreach, this enrollment season will look a lot different from the four before it.” —Sam Baker, Axios

“With a shorter open-enrollment window, fewer intermediate deadlines and barely any money for consumer outreach, this enrollment season will look a lot different from the four before it.” —Sam Baker, Axios “Nurse depression can lead to medical errors, study finds”: “New research from Ohio State University reveals more than half of nurses across the country are depressed, which makes them prone to medical errors. More than half of nurses who participated in the national survey — 54 percent — reported poor physical and mental health.” —Bernie Monegain, Healthcare Finance

Join the conversation

Are you an Obamacare enrollee interested in what happens next? Join our Facebook community for conversation and updates.