Defunding health care for low-income children could cost families thousands of dollars a year, Yale researchers have found.

The Yale School of Medicine researchers set out to determine the exact financial effects on children of families switching from the Children’s Health Care Program to alternative insurers, focusing on children with chronic illnesses and their families. They found that a switch from CHIP — currently at risk of funding loss due to proposed cuts in federal expenditures — to Health Insurance Marketplace plans would cost families up to $2,472 each year.

CHIP provides health insurance to over eight million children in the United States. A joint venture between the federal government and state governments, it was conceived in 1997 to provide health insurance to children of the “working poor,” whose income is too low to cover health care costs, but too high to qualify for Medicaid, said Marjorie Rosenthal MED ’95, professor of pediatrics at the School of Medicine and co-author of the study.

Since its inception, CHIP’s funding has been renewed multiple times and the scope of coverage was expanded under President Barack Obama in 2009. The current expiry date for federal funding for the program is the end of September 2017, unless Congress reauthorizes it, said Alon Peltz, a postdoctoral fellow at the School of Medicine and lead author of the study. If they fail to do so, children and pregnant mothers covered by CHIP will eventually have to switch to alternate insurance options.

Rosenthal described the current threat to the program.

“One thing that has generally had bipartisan support over the years is caring for our most vulnerable populations,” Rosenthal said. “And even if you don’t buy into that, you can’t deny that children are our future.”

In the event that CHIP funding is not extended, some policy makers believe that the Affordable Care Act will cover current CHIP patients, said Cary Gross, professor at the Yale School of Medicine and co-author of the study. According to Peltz, ACA coverage comes in the form of Marketplace plans — subsidized health care plans purchased through the government which currently cover millions of people in the United States. The researchers then ran a simulation of coverage and payments for healthy children, as well as those with chronic health conditions under CHIP and Marketplace plans nationwide, Peltz added.

After analyzing the out-of-pocket costs paid by families, they concluded that a shift from CHIP to Marketplace plans would cost families an additional $233 to $2,472 annually, depending on their income level. Children with chronic health conditions will face the highest increases in health care costs, Peltz said.

It is likely that for children with conditions such as asthma or ADHD, the high costs may compel parents to cut back on doctor’s visits and medication, according to Rosenthal. Not only will that cause irreparable harm to the children themselves, it may also cost the health care system even more money, as many chronic conditions worsen without treatment and require emergency services and intervention later on, she said.

The researchers noted that making policy makers aware of the effects of health care policy on vulnerable populations was the primary goal of the paper.

An additional complication arises from the Trump administration’s statements on the Health Insurance Marketplace itself, with the president referring to it as a “disaster” on numerous occasions. The results of the study are rendered moot if the ACA and the systems it provides for are repealed, Gross said. While participating in the Marketplace is a worse solution for low-income children and their families than CHIP, it is better than having no health care at all, Peltz said.

“The current federal government keeps describing the Affordable Care Act in negative terms and describing their plan to dismantle it,” Rosenthal said. “So yeah, the marketplace as described in the article is what would take care of these children if CHIP isn’t funded but even that might get dismantled.”

Between 1997 and 2012, the rate of uninsured children in the United States fell from 14 percent to 7 percent.