The Future of Health Care Subsidies: A Battle Over Abortion Coverage
The ongoing debate over health care subsidies in Congress is facing a new challenge: the contentious issue of abortion coverage. While there is broad bipartisan support for reviving federal health care subsidies that expired at the beginning of the year, disagreements over abortion coverage threaten to derail any compromise. This could result in higher premiums for millions of Americans.
Despite significant progress, bipartisan Senate negotiations on the subsidies seemed to be near collapse at the end of the week as the abortion dispute appears intractable. Sen. Bernie Moreno, R-Ohio, who has led the talks, stated, 'Once we get past this issue, there’s decent agreement on everything else.' However, movement on this issue has been elusive.
The abortion dispute dates back to the weeks and months before President Barack Obama signed the health overhaul into law in 2010. Democrats who controlled Congress added provisions ensuring that federal dollars subsidizing the health plans would not pay for elective abortions. This compromise came after negotiations with members of their own party whose opposition to abortion rights threatened to sink the legislation.
The final language allowed states to offer plans under the ACA that cover elective abortions, but said that federal money could not pay for them. States are now required to segregate funding for those procedures. Since then, 25 states have passed laws prohibiting abortion coverage in ACA plans, 12 have passed laws requiring abortion coverage in the plans, and 13 states and the District of Columbia have no coverage limitations or requirements, according to KFF.
Some Republicans and anti-abortion groups now want to make it harder for the states that require or allow the coverage, arguing that the segregated funds are nothing more than a gimmick that allows taxpayer dollars to pay for abortions. Senators involved in the negotiations said a potential compromise was to investigate some of those states to ensure that they are segregating the money correctly.
Sen. Susan Collins, R-Maine, who has led the negotiations with Moreno, said, 'the answer is to audit' those states and enforce the law if they are not properly segregating their funds. But that plan was unlikely to win unanimity from Republicans, and Democrats have not signed on.
Negotiators were more optimistic last week, after President Donald Trump told House Republicans at a meeting that 'you have to be a little flexible' on rules that federal dollars cannot be used for abortions. Those words from the president, who has said little about whether he wants Congress to extend the subsidies, came just before a House vote on Democratic legislation that would extend the ACA tax credits for three years. After his comments, 17 Republicans voted with Democrats on the extension over the objections of GOP leadership and the House passed the bill with no new abortion restrictions.
Anti-abortion groups reacted swiftly. Kelsey Pritchard, a spokeswoman for Susan B. Anthony Pro-Life America, said the group would not be supporting the 17 Republicans who voted for the extension. Trump’s comments were 'a complete change in position for him' that brought 'a lot of backlash and outcry' from the anti-abortion movement and voters opposed to abortion rights, she said. Those who did not support changes to the ACA to reduce abortion coverage 'are going to pay the price in the midterms' this year, Pritchard said. 'We’re communicating to them that this isn’t acceptable.'
Democrats say the Republican effort to amend the law and increase restrictions on abortion is a distraction. They have been focused on extending the COVID-era subsidies that expired on Jan. 1 and had kept costs down for millions of people in the United States. The average subsidized enrollee is facing more than double the monthly premium costs for 2026, according to KFF.
The two sides have been haggling since the fall, when Democrats voted to shut down the government for 43 days as they demanded negotiations on extending the subsidies. Republicans refused to negotiate until a small group of moderate Democrats agreed to vote with them and end the shutdown. After the shutdown ended, Republicans made clear that they would not budge on the subsidies without changes on abortion, and the Senate voted on and rejected a three-year extension of the tax credits.
Maine Sen. Angus King, an independent who caucuses with Democrats, said at the time that making it harder to cover abortion was a 'red line' for Democrats. Republicans are going to 'own these increases' in premiums, King said then.
The bipartisan group that has met in recent weeks has closed in on parts of an agreement, including a two-year deal that would extend the enhanced subsidy while adding new limits and also creating the option, in the second year, of a health savings account that Trump and Republicans prefer. The ACA open enrollment period would be extended to March 1 of this year, to allow people more time to figure out their coverage plans after the interruption of the enhanced subsidy.
However, the abortion issue continues to stand in the way of a deal as Democrats seek to protect the carefully crafted compromise that helped pass the ACA 16 years ago. 'I have zero appetite to make it harder for people to access abortions,' said Sen. Chris Murphy, D-Conn.
The future of health care subsidies and the role of abortion coverage in the negotiations remain uncertain. As the debate continues, the fate of millions of Americans' access to affordable health care hangs in the balance.
