The Children's Health Insurance Program (CHIP) is now at risk of becoming the latest casualty of Washington's dysfunction, if lawmakers don't act. (Joyce Koh/The Washington Post)

If Congress fails to reach a deal to avert a government shutdown at 12:01 a.m. Saturday, federal workers won't be the only ones worrying. Parents of the 9 million children insured through the Children's Health Insurance Program, known as CHIP, are panicking because funding for the program has nearly run out.

Republicans in Congress thought they had a grand solution: They pitched Democrats a deal to do a one-month extension of overall government funding and a six-year extension of CHIP money. But President Trump tweeted Thursday morning that was a bad idea. House Speaker Paul D. Ryan (R-Wis.) says he spoke with Trump and the president is now on board, but confusion abounds in the Capitol.

There is a real chance that CHIP funding won't get renewed this week, a scenario with potentially dire consequences for kids. Colorado, Virginia and Connecticut have already sent letters to parents warning them their kids' insurance might end as early as February because of Congress's inaction. More states are expected to issue notices to parents soon.

“In Washington it may seem like just a political game, but at the state level the stakes are very real: Kids will lose health-insurance coverage and lives are on the line now,” says Heather Howard, a lecturer at Princeton University’s Woodrow Wilson School who's keeping track of which states are about to run out of funds. Both red and blue states are in trouble.

How did we get here?

CHIP funding expired in September. Congress passed a short-term Band-Aid just before Christmas to keep the program limping along a few more weeks, but CHIP is now on life support. States are scrambling to keep the program going so working-class kids don't lose the ability to go to the doctor or get needed prescriptions. Nearly 9 million children and 370,000 pregnant women receive care because of CHIP. These families make too much money to qualify for Medicaid but not enough to afford private insurance. These are the children of janitors, home health aides and store clerks, among others.

Isn't CHIP bipartisan?

CHIP has successfully cut the number of uninsured children in America in half since it was enacted in 1997, and it is often held up as a model of successful bipartisanship.

Crafted by Sens. Orrin G. Hatch (R-Utah) and Edward Kennedy (D-Mass.), CHIP has been renewed several times since its creation with broad support from both parties. “We must stop holding CHIP hostage and get this important program extended to ensure the families who rely on it get the care they need,” Hatch said this week.

CHIP appears to have the support to pass easily if it were just a stand-alone bill, but so far, Republican leaders aren't proposing that. Instead, CHIP has become a bargaining chip in the bipartisan budget fight. House Republican leaders are tacking it onto controversial bills to dare Democrats to vote against it.

“Historically, CHIP has been one of the few things that remained above the fray,” says Andy Slavitt, the former acting administrator of the Centers for Medicare and Medicaid Services from 2015 to 2017. “It’s unfortunate and kind of curious that Republicans decided to make it an issue Democrats care about this year as opposed to saying, well, it's children's health insurance, let's keep that bipartisan.”

Speaker Ryan and House Majority Whip Kevin McCarthy (R-Calif.) are trying to get enough votes for a bill to keep the government open for about another month. They added a six-year extension of CHIP to the deal. But Democrats have yet to sign on and some Republicans were also balking, even before Trump's tweet.

Here's what Republicans, Democrats and Jimmy Kimmel are saying

“At some point, we Democrats will not be held hostage to bad policies,” said House Democratic Whip Steny H. Hoyer of Maryland.

Democrats have ripped the GOP for passing a massive tax cut that costs at least $1 trillion — and possibly far more — while complaining about a program for children that costs a few billion dollars annually.

While Hoyer is a firm supporter of CHIP, he says many Democrats think short-term budget extensions are a mistake, and they are upset that there is no agreement yet to save the 690,000 immigrant “dreamers” who are on the verge of losing their protected status to stay in the United States. On the other side, some Republicans are holding out for more money for the military. CHIP may be the casualty of a massive tug-of-war game in Congress.

Republicans are trying to pin any failure to extend CHIP this week on Democrats; Democrats accuse Republicans of playing politics on CHIP for more than 100 days.

“Republicans are the ones funding CHIP completely and immediately. Democrats are the ones voting no,” a spokesman for Ryan tweeted, getting into a back-and-forth with late-night host Jimmy Kimmel.

“Shame on you for making CHIP a bargaining chip,” Kimmel responded.

Democrats have mounted a Twitter campaign of their own in recent days. “It’s been more than 100 days & Republicans continue to fail Americans & their children who desperately rely on CHIP. It’s appalling because our most vulnerable deserve affordable, quality health care,” tweeted Rep. Dwight Evans (D-Penn.).

Passing CHIP could save the government money

Some Republicans complained CHIP was too expensive in the fall, but the Congressional Budget Office reported last week that a five-year CHIP extension would cost the government $3.4 billion, while a 10-year extension would actually save the government money.

“CBO updated their score and gave us the momentum to push a long-term CHIP extension across the finish line,” Hatch says, although as recently as December Hatch himself was on the Senate floor saying, “The reason CHIP’s having trouble is because we don’t have money anymore.”

The reason a 10-year extension saves money is because if CHIP is not extended, some of the 9 million children who lose insurance would likely end up on Medicaid or a government subsidy, and those costs are expected to rise a lot faster than CHIP. Republicans repealed the individual mandate as part of the tax plan, a move that CBO says will cause most health insurance premiums to rise sharply. States cover part of the cost of CHIP, so that also helps scale back the federal government expenses.

For now, the blame game continues, leaving parents and grandparents to ask: How can lawmakers do this to my child?