A timely analysis from our friends at the Urban Institute this week quantifies the high stakes of the current deal making around CHIP. The outcome, along with the looming Supreme Court decision, will determine whether we move backwards on our success covering children or maintain the strong system of coverage that has successfully served low-income children for decades.

Researchers looked at what would happen to children’s coverage under a number of scenarios. As MACPAC watchers know, the Urban team found that 1.1 million more children would become uninsured with inaction on CHIP if the ACA is maintained. This analysis looked at the additional impact on kids if:

• The Supreme Court King vs. Burwell ruling halts tax credits that help families pay for coverage in the 34 states with federally-facilitated marketplaces (FFM); and
• The ACA’s maintenance of effort (MOE) for children’s coverage is discontinued, as recently proposed by the Hatch-Upton-Pitts discussion draft on CHIP.

Without new CHIP funding, if a SCOTUS ruling ends tax credits for federal marketplace coverage, the number of uninsured kids would rise by 1.9 million uninsured kids in 2016 – 800,000 more children than if the tax credits stay intact.

But what if lawmakers reach a deal that extends CHIP but removes the ACA’s MOE requirement? The analysis doesn’t try to anticipate state decision points, but it does show the potential maximum impact of the MOE’s demise. If tax credits in FFM states stand, an additional 2 million kids could go uninsured without the federal MOE protections. The number rises to 3.3 million kids that could end up uninsured if federal marketplace support and MOE went away. (If you need a refresher on why the MOE remains a critical protection for kids my colleagues Sean Miskell and Joan Alker recently reminded us that states have historically responded to budget pressures by cutting kids coverage in its absence.)

Need a visual to go with all of these numbers? The interactive tool below can help you get you your mind around the various scenarios.

While the variety of numbers and outcomes can get complicated, the implication here is quite simple: Inaction, delayed action, or an extension of CHIP that includes recently proposed policy changes would make more children uninsured. A clean and quick extension of CHIP for four years— with no rollbacks to current CHIP program law– will be important to continue our nation’s historic progress, providing budget stability for states, coverage stability for kids, and peace of mind to families.