Less than two months ago we released our annual report looking at the nation’s progress in covering uninsured children. As regular readers of Say Ahhh! know this year we found widespread and unprecedented progress in reducing the number of uninsured children with the nation reaching a historic milestone of 95% of children covered in 2015 thanks to Medicaid, the Children’s Health Insurance Program, and the Affordable Care Act (ACA). We are down to 3.5 million uninsured children under 18. This is a national achievement that we can all be proud of.

Today, researchers at the Urban Institute released a sobering new analysis, which examines the impact of a partial repeal of the ACA. As a recent New York Times article detailed, Congressional leaders have announced their intention to move very quickly to repeal the ACA in January without a replacement plan in place. The report provides a wealth of information on the impact of a bill that looks like the reconciliation bill that was passed by Congress and vetoed by President Obama in January 2016, including increasing the number of uninsured by 29.8 million in 2019. Additionally, the report projects a loss of federal funding to states on health care for the nonelderly nationwide of $1.3 trillion from 2019 to 2028.

But what immediately jumped out at me was the staggering impact an ACA repeal would have on the number of uninsured children – which would more than double under this scenario. According to Urban’s analysis, the number of uninsured children under the age of 18 would increase by about 4 million. The child uninsurance rate would more than double, increasing from 4% to 9%.

Even more dismaying is that this is a conservative estimate for the following reason – the Urban analysis assumes no change to the “maintenance-of-effort” provision that requires states to maintain their current levels of Medicaid and CHIP coverage. The reconciliation bill vetoed in January 2016 actually eliminated the MOE as well, and it is due to expire in 2019 under current law. States will likely have more flexibility to limit children’s coverage under most conceivable scenarios in 2019, and they may well have less federal money to pay for it, which may be an incentive to do so. And as readers of Say Ahhh! know, Medicaid (in particular) and CHIP are the big players when it comes to coverage for children.