WASHINGTON – More than 3.3 million children could lose their health care coverage if Congress does not renew the Children's Health Insurance Program, the Supreme Court strikes down subsidies in the federal marketplace and states scale back coverage.

That scenario is the most dramatic of seven situations affecting children's coverage that the Urban Institute analyzed in a report released this week.

Coverage for kids faces a number of challenges in the next few months. Funding for CHIP expires Sept. 30 absent congressional action. The Supreme Court could rule in the King v. Burwell case that federal health law subsidies are only allowed in state-run marketplaces and not in the federal marketplace, which could erode coverage for families.

And if Congress does not renew a requirement in the health care law that states must maintain coverage for children through 2019, some states could decide to scale back eligibility levels. States might decide to stop offering Medicaid coverage for kids in families with income above 138 percent of the federal poverty level. States that choose to expand Medicaid have to offer Medicaid benefits up to that amount.

The Urban Institute researchers looked at several possible scenarios in which the Supreme Court allowed tax credit subsidies to continue for people in all marketplaces. If the credits remained available but coverage under certain CHIP programs that stand apart from the Medicaid program is eliminated, the researchers estimate that about 1.1 million children would lose coverage. If Congress also got rid of the requirement that states maintain their current eligibility for children and states stopped providing Medicaid coverage for kids in families over 138 percent of the poverty level, an additional 828,000 kids would lose coverage.

Tuesday's report also examined what would happen if the Supreme Court struck down subsidies in the federal marketplace. That type of ruling would leave about 730,000 more children without coverage compared to what would occur if the marketplace tax credits were available in those states. The researchers noted that under that scenario, eligibility for Medicaid and CHIP would not change. If CHIP under standalone state programs expired on top of a court ruling eliminating subsidies in the federal marketplace, another 1.2 million kids in addition to the 730,000 kids would lose coverage.

Adding the possibility of states cancelling Medicaid coverage for families above 138 percent of the poverty level, an additional 1.4 million children would lose coverage. Altogether, those three categories of children who would lose coverage would total more than 3.3 million kids.

If none of these circumstances happen, the health care law under current law is expected to reduce the number of uninsured children by roughly half, said the report.

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