When subsidies for US healthcare plans expired at the end of last year, millions of Americans saw their monthly premiums suddenly hit eye-watering, unaffordable levels. But the congressional fight over reviving the Affordable Care Act (ACA) subsidies has gotten stuck on a familiar snag in US politics: abortion.
Congressional leaders said on Thursday they had reached a bipartisan deal to use a spending bill to overhaul elements of the US healthcare system, with a focus on corporate middlemen who have been accused of raising prescription drug prices, but the deal does not address the subsidies. The deal could also fall apart, as Democrats and Republicans are now splintering over whether and how to back government spending measures in the wake of federal officers’ fatal shooting of Alex Pretti in Minneapolis.
Although the House passed a bill earlier this month to revive the subsidies, with the aid of 17 Republicans, the Senate has yet to take up the issue. With negotiations dragging on, a handful of states have extended their open enrollment periods to the end of January.
But a change may not be reached in time. Republicans have refused to move forward without more restrictions on abortion coverage within ACA plans, while Democrats say that’s a nonstarter.
“Once we get past this issue, there’s decent agreement on everything else,” Bernie Moreno, a Republican senator from Ohio who’s played a key role in talks about the subsidies, told reporters.
First introduced at the height of Covid, the subsidies lowered costs for 90% of ACA enrollees, who tend to be individuals who don’t receive healthcare through an employer, such as contract and gig workers, stay-at-home parents and small business owners. Now, the average enrollee’s premium costs has more than doubled, from about $900 to more than $1,500 annually, according to an analysis by the health policy group KFF.
“People are very, very price-sensitive, and it can become very, very expensive,” said Alina Salganicoff, KFF’s lead expert on women’s health policy. Compared to this point last year, about 800,000 fewer people have so far signed up to buy plans through the ACA’s marketplace.
Abortion rights has been a sticking point in debates over the Affordable Care Act since its inception. Anti-abortion Democrats nearly torpedoed the entire bill in 2010, before agreeing to support it as long as it contains specific language affirming the Hyde amendment. That amendment, which dates back to the 1970s, blocks the use of federal funding to pay for abortions except in cases of rape, incest or medical emergencies.
However, states can offer plans on the ACA marketplace that cover abortion if those plans don’t rely on federal dollars. Twelve states require that marketplace plans include abortion coverage, while another 13 and Washington DC permit them to do so.
“The effort by anti-choice groups to rehash what is already settled in federal law is nothing more than an attempt to further encroach on the ability of women to have full reproductive rights,” Jeanne Shaheen, a Democratic senator from New Hampshire, said in a statement. “It is critical for us to find a path forward to ensure millions of Americans can afford their health insurance.”
But anti-abortion opponents say the current compromise violates Hyde amendment’s principles.
“The whole little workaround – that, well, it’s required by the states and not by the feds – is ridiculous,” said Kristi Hamrick, vice president of media and policy for the powerful anti-abortion group Students for Life of America. “It’s no threat to us that it will collapse if there’s not an agreement on Hyde.”
If Congress were to change the rules around abortion coverage as part of its fight over the ACA subsidies, the people who live in the 12 states where abortion coverage is mandated could immediately lose their health care, Salganicoff said.
“I don’t see it as violating the spirit of the Hyde amendment at all. These are separate funds,” Salganicoff said. “It’s not like those federal subsidies are being used to pay for abortion services. I don’t see the evidence of that.”
Support for the Hyde amendment has long been non-negotiable among congressional Republicans, but Donald Trump urged them to be “a little flexible” on Hyde earlier this month.
“You gotta work something,” Trump told a GOP gathering. “You gotta use ingenuity.”
But Trump’s advice may have had the opposite effect, according to a source familiar with the discussions in Congress. The president’s comment, the source said, “actually had a lot of Republicans digging in and saying: ‘There actually is no movement on the issue’.”
Abortion opponents have grown increasingly frustrated with the Trump administration over its first year back in power. While the administration announced Thursday that it would investigate Planned Parenthood over government loans, ban the use of fetal tissue from abortions in some government research, and expand an anti-abortion policy to block foreign aid for groups that promote diversity, equity and inclusion (DEI) initiatives, anti-abortion activists have been disappointed by the administration’s lack of action on abortion pills.
“Last I checked, there’s a midterm election coming,” Hamrick said. “The voter intensity on the part of pro-life voters in the Republican coalition of social conservatives, national security conservatives and economic conservatives relies heavily on the grassroots. That means pro-life conservatives, social conservatives. This is no time for the GOP to be anything less than eloquent and active in pursuing our vote.”
