A U.S. Supreme Court decision against the Obama administration in the King v. Burwell case, coupled with Congress not reauthorizing the Children's Health Insurance Program, could mean roughly 1.9 million children lose health insurance coverage.
“The combination of both policies would mean a lot of progress we've made over the last 20 years would be wiped out,” said Lisa Dubay, a senior fellow at the Urban Institute.
The total number of children impacted includes 730,000 who would lose insurance because they would no longer qualify for subsidies and 1.1 million children now in CHIP, according to an analysis by the Urban Institute.
Uninsured rates for the group have dropped from 13% in the mid-1980s to roughly 7% today, primarily because of expanding childhood eligibility for public health programs, Dubay said.
But the end of CHIP and a negative Supreme Court decision isn't the worst-case scenario. Bills are circulating on Capitol Hill that would allow states to rollback eligibility for children to receive coverage.
If marketplace tax credits were eliminated in states without their own exchanges, separate CHIP programs ended and all states limited Medicaid eligibility to children with incomes below 138% of the federal poverty level, 3.3 million children would be uninsured.
A King v. Burwell decision is expected in June. House Speaker John Boehner and Minority Leader Nancy Pelosi are proposing a two-year extension of CHIP without the eligibility rollback proposals being shopped by some conservative lawmakers. The extension is now being included in a proposed congressional "doc fix" deal. But some Democratic senators already have voiced opposition, saying they want a four-year extension.
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