Last night’s surprise election results raise many, many questions about what will happen next year to the Affordable Care Act, Medicaid and CHIP. There is a long road ahead but let’s start by taking stock of a few things we know.

As readers of SayAhhh! know, the Children’s Health Insurance Program (CHIP) is running out of money next year and must be extended by Congress. That means public coverage for children will be squarely on the Congressional agenda. There are many different ways the Republican majority could go on CHIP, and it’s very hard to say which direction they will take. But if history is any guide, we can expect that they will push for less federal money going in to the program and more state flexibility which translates to fewer protections for children.

But the future of CHIP and children’s coverage is wrapped up with larger health policy questions such as whether the ACA is repealed and the fundamental question of what will be on the table for CHIP’s big sister – the Medicaid program. All of these programs are intertwined and there are many interactions legislatively and substantively depending on how the timing of the debate unfolds.

Everybody knows that Donald Trump campaigned on a promise to repeal the Affordable Care Act, but few are aware that he also talked about block-granting Medicaid. Block-granting Medicaid is a radical proposal that could imperil coverage for millions of kids and families – depending on the size of the cuts and the loosening of federal guarantees of coverage, benefits, and cost-sharing that currently exist. On the plus side, candidate Trump said he didn’t want anyone to lose coverage so let’s hope he sticks to that.

I was involved in the block grant debate twenty years ago when Speaker Newt Gingrich led the House of Representatives. Interestingly, the debate has moved away from block granting to more of a discussion of a per capita cap for those who want to make major structural changes to the Medicaid program. Both would likely be extremely harmful for low-income children and families.

Today Medicaid covers 37 million children. Few are aware of how important Medicaid is to children. (See our factsheet on Medicaid’s role for children.)

As readers of SayAhhh! know, we have reached historic levels of coverage for children (95% of kids were covered in 2015) thanks to the good work of Medicaid, CHIP and the ACA. Whether we continue down this path, or make a U-turn remains to be seen. Here at CCF we plan to keep working hard to ensure that all children and their families have access to quality affordable coverage.