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One hundred days ago, Congress let the funding for the Children’s Health Insurance Program expire. For one hundred days, a program that covers 9 million American children has been left in this strange limbo, with the worst consequences being averted but nonetheless creeping closer.

On Friday, if you missed it, we got a new warning from the Trump administration: The short-term CHIP extension that passed in December, which was supposed to last through March, could actually only guarantee the program would stay funded through January 19 — or maybe the end of the month.

Within the next two weeks, states could start running out of CHIP funding, which could force them to freeze enrollment or drop kids off the rolls.

Also on Friday, we learned that the price tag for extending CHIP for five years has shrunk dramatically. The CBO estimated the five-year extension Congress is considering now costs only $800 million, down from $8.3 billion, after Republicans repealed the individual mandate in their tax bill.

The mechanics are wonky, but this is the gist: Repealing the mandate increases ACA premiums; because ACA coverage is the alternative to CHIP for many kids, it would cost the federal government more if CHIP were to end and those children moved to the ACA markets. That makes extending CHIP cheaper, from the government’s point of view.

That’s a drop in the bucket for Congress. Yet here we are, 100 days in, and Congress hasn’t figured out when they’re going to resolve this.

So what happens if kids are frozen out of coverage or their state is forced to drop them? It is true that many of kids could get coverage through the ACA markets (though Alabama’s CHIP director has warned reporters: “A fair amount of our children we think will become uninsured.”)

But that still has real consequences for the kids and their families.

Some research from 2014 published in Health Affairs is instructive. Comparing Medicaid and CHIP coverage to employer-sponsored plans, researchers from the Urban Institute found that less than 10 percent of families enrolled through Medicaid or CHIP had difficulty paying any of their children’s medical bills, while 19 percent of families with private insurance — roughly twice as many — did have trouble.

Medicaid and CHIP are simply more generous than private insurance: 69 percent of families in those programs reported no out-of-pocket costs for medical care, compared to 22 percent for those with private insurance.

That likely contributes to another foreseeable outcome: Families with private coverage were more likely to forgo health care they needed because it was unaffordable. The differences were relatively slight, but still consistent across several kinds of care:

6.4 percent of Medicaid/CHIP families skipped medical care because it was unaffordable; 8.9 percent of employer-covered families did.

of Medicaid/CHIP families skipped medical care because it was unaffordable; of employer-covered families did. 7.9 percent of Medicaid/CHIP families didn’t purchase prescription drugs because of their cost, versus 9.6 percent of families with private coverage.

of Medicaid/CHIP families didn’t purchase prescription drugs because of their cost, versus of families with private coverage. 9.2 percent of Medicaid/CHIP families missed dental care because it was unaffordable; 15.7 percent of those with private coverage did the same.

Perhaps it goes without saying, but this chart from Georgetown University’s Center for Children and Families also makes clear that kids covered by Medicaid and CHIP fare far better on accessing care than uninsured children.

We find this to be true again and again across multiple studies.

(Just a note: Medicaid and CHIP are so intertwined that researchers often analyze them in tandem when looking at these issues for children.)

”These studies consistently show that CHIP has improved access to and affordability of care for kids,” Jenny Kenney at the Urban Institute, who has conducted some of this research, told me by email.

The story here is pretty clear: Medicaid and CHIP provide coverage comparable to private health insurance at a lower cost to families. If Congress continues to leave CHIP unfunded, families have basically two options: enroll in ACA coverage or become uninsured. Health care could become unaffordable for millions of families, and they could be forced to skip needed appointments and treatments.

This is what Congress is risking, in a very real way, as we are now days away from states running out of CHIP funding.

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Chart of the Day

Extending CHIP is so cheap. We published an earlier version of this chart, when extending CHIP for five years cost $8 billion. Now the scales are even more lopsided. In the context of the GOP’s ginormous tax cuts for corporations and other businesses — or even in the context of the White House’s $18 billion request for a border wall — children’s health coverage costs nothing. It’s like one of those scale models that shows you how much smaller Earth is than Jupiter.

Kliff’s Notes

Today’s top news

“Democrats move to offense on health care; seek ‘big ideas’”: “With Republicans unable to agree on their vision, Democrats are debating ideas that range from single-payer, government-run care for all, to new insurance options anchored in popular programs like Medicare or Medicaid.” —Ricardo Alonso-Zaldivar, Associated Press

“With Republicans unable to agree on their vision, Democrats are debating ideas that range from single-payer, government-run care for all, to new insurance options anchored in popular programs like Medicare or Medicaid.” —Ricardo Alonso-Zaldivar, Associated Press “Short-term CHIP patches threaten to undermine state programs”: “Congress’ short-term funding patches for the Children’s Health Insurance Program have put states in the precarious position of running on fumes. But the temporary solutions may do more harm than good as they hamstring CHIP’s future.” —Susannah Luthi, Modern Healthcare

“Congress’ short-term funding patches for the Children’s Health Insurance Program have put states in the precarious position of running on fumes. But the temporary solutions may do more harm than good as they hamstring CHIP’s future.” —Susannah Luthi, Modern Healthcare “Koch-backed group urges passage of ‘Right to Try’ bill allowing experimental drugs for terminal patients”: “Freedom Partners Chamber of Commerce, a conservative nonprofit associated with the Koch brothers, has launched a media campaign backing legislation that would allow terminally ill patients to try medicines that haven’t been approved by the Food and Drug Administration.” —Kimberly Leonard, Washington Examiner

Analysis and longer reads

“Why Idaho believes it can let insurers lift some Obamacare requirements”: “Idaho wants to let insurers sell private insurance plans that don’t comply with requirements of the Affordable Care Act, Gov. Butch Otter said Friday morning. Such a move would be aimed at middle-class uninsured Idahoans, including the self-employed. Otter and other officials believe the market also could include people in Idaho’s insurance gap, who can’t afford insurance but don’t qualify for Obamacare subsidies or Medicaid.” —Audrey Dutton and Nate Poppino, Idaho Statesman

“Idaho wants to let insurers sell private insurance plans that don’t comply with requirements of the Affordable Care Act, Gov. Butch Otter said Friday morning. Such a move would be aimed at middle-class uninsured Idahoans, including the self-employed. Otter and other officials believe the market also could include people in Idaho’s insurance gap, who can’t afford insurance but don’t qualify for Obamacare subsidies or Medicaid.” —Audrey Dutton and Nate Poppino, Idaho Statesman “Colorado signs law mandating that hospitals post self-pay prices”: “Bringing down the cost of healthcare requires patient involvement, but so far most consumers have shown a marked lack of interest in comparison shopping. It’s not that people aren’t willing to go out of their way, or trade hospital prestige or distance to save money, according to a new KelloggInsight report. It’s just that pricing is not being presented in a simplified enough way for consumers to make informed decisions.” —Susan Morse, Healthcare Finance

“Bringing down the cost of healthcare requires patient involvement, but so far most consumers have shown a marked lack of interest in comparison shopping. It’s not that people aren’t willing to go out of their way, or trade hospital prestige or distance to save money, according to a new KelloggInsight report. It’s just that pricing is not being presented in a simplified enough way for consumers to make informed decisions.” —Susan Morse, Healthcare Finance “How Trump’s HHS nominee’s drug company ‘gamed’ a patent”: “Critics say the brand-name drugmakers are ‘gaming’ the patent system, finding all sorts of ways to protect monopolies and delay competition from generics. And Alex Azar — the former president of Eli Lilly’s U.S. operations, now poised to become the top U.S. health official — professes to oppose such tactics.” —Sarah Karlin-Smith, Politico

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