About 4.7 percent of children under 19 were uninsured last year, down by about two-thirds from 1997, when the child health program was created. More than eight million children are insured through CHIP.
“We know that states are going to run out of money pretty quickly,” Representative Greg Walden, Republican of Oregon, the chief author of the bill to pump money into CHIP, said this week. “They are pounding on our door, as they should.”
Republicans and Democrats in the House and the Senate have agreed to provide money for the child health program for five years and for community health centers — another popular program — for two years. They have also agreed to delay cuts in federal payments to hospitals that treat a disproportionate share of uninsured and Medicaid patients.
But the question of how to pay for these measures, a cost of roughly $23 billion, has made further progress uncertain.
House Republicans want to take money from a fund created by the Affordable Care Act that pays for a wide range of public health efforts, like preventing diabetes, vaccinating children, reducing the use of tobacco and fighting the opioid epidemic.
To help offset the cost of new spending, the House Republican bill would shorten the grace period for consumers who fail to pay their share of premiums for health insurance purchased through a marketplace established under the Affordable Care Act. Several hundred thousand people could lose coverage as a result, and the government would save money because it would no longer subsidize their insurance, the Congressional Budget Office says.
Republicans say that some states have used the prevention fund as a slush fund, and that some consumers have abused the grace period to obtain a full year’s coverage while paying premiums for only nine months.
Democrats are outraged that Republicans insist on offsetting every dollar of new spending on the child health program while pushing a tax bill that could add as much as $1.5 trillion to federal budget deficits over 10 years.
“None of the tax cuts being talked about are paid for,” said Representative Anna G. Eshoo, Democrat of California.
Representative Frank Pallone Jr. of New Jersey, the senior Democrat on the Energy and Commerce Committee, said the bill effectively pays for two worthy health programs by undermining the Affordable Care Act.
“This is robbing Peter to pay Paul,” Mr. Pallone said. “Republicans are taking money from the Prevention and Public Health Fund to pay for CHIP and community health centers.”
On the other side of the Capitol, senators have been working in a spirit of bipartisan comity, though they too have not agreed on how to pay for CHIP and community health centers. They are unlikely to accept the cuts in the House Republican bill.
The chairman of the Senate Finance Committee, Orrin G. Hatch, Republican of Utah, takes immense pride in having created the child health program in collaboration with Senator Edward M. Kennedy, Democrat of Massachusetts, in 1997, when Bill Clinton was president and Republicans controlled both houses of Congress. Mr. Hatch is working now with Senator Ron Wyden of Oregon, the senior Democrat on the committee.
The last three presidents, Mr. Clinton, George W. Bush and Barack Obama, were ardent supporters of community health centers. But funds for that program were allowed to expire last month.
Dr. Neil S. Calman, the president and chief executive of the Institute for Family Health, which operates 31 community health centers in New York, said the uncertainty over federal funding “affects every decision” he makes. He has deferred hiring doctors and nurses and put off purchases of dental chairs and other equipment because “we know we soon won’t have the money.”
“I just don’t understand why the parties can’t get together to figure out how to provide the money for a program they both support,” Dr. Calman said.
While Congress squabbles, state officials agonize over the uncertainty.
Carrie Williams, a spokeswoman for the Texas Health and Human Services Commission, said the state expected to exhaust its CHIP funds in January or early February and was already making preparations because state law requires officials to notify families at least 30 days before coverage is ended. The Texas program covers more than 400,000 children.
Cathy Caldwell, director of the CHIP program in Alabama, said state officials would have to revise computer eligibility systems, notify families and perform many other tasks before funds run out in February or March. “With such a short timeline,” she said, “I don’t know how we could get it all done.”
“We assume that funding will be continued,” Ms. Caldwell said. “But we have a great fear. What if it’s not? There would be real disruption.”
Nathan Checketts, the deputy director of the Utah Health Department, said he was confident that Congress and President Trump would eventually fund the program, but he was not sure they would act in time to prevent a gap in coverage for children.