headline: Abortion dispute stalls Senate negotiations on ACA subsidy revival slug: 2026-01-17-abortion-dispute-stalls-senate-aca-subs…

  • The abortion dispute has blocked what both parties describe as an otherwise achievable deal: a two-year extension of the ACA’s enhanced p…
  • Bipartisan Senate negotiations over reviving federal health care subsidies that expired Jan. 1 appeared near collapse as of Jan. 17 as a …
  • “Once we get past this issue, there’s decent agreement on everything else,” said Sen. Bernie Moreno, R-Ohio, who has led the bipartisan n…
  • The enhanced subsidies lapsed at the start of the year. Without a deal, the average subsidized enrollee faces more than double the monthl…

The abortion dispute has blocked what both parties describe as an otherwise achievable deal: a two-year extension of the ACA’s enhanced premium tax credits, which lapsed at the start of the year and had kept costs down for millions of people. Without a resolution, those who relied on the subsidies face a significant and immediate increase in health insurance costs.

Bipartisan Senate negotiations over reviving federal health care subsidies that expired Jan. 1 appeared near collapse as of Jan. 17 as a dispute over abortion coverage proved intractable, senators involved in the talks said. Republicans are seeking stronger restrictions on abortion coverage in Affordable Care Act marketplace plans; Democrats are firmly opposed to any changes.

“Once we get past this issue, there’s decent agreement on everything else,” said Sen. Bernie Moreno, R-Ohio, who has led the bipartisan negotiations.

The enhanced subsidies lapsed at the start of the year. Without a deal, the average subsidized enrollee faces more than double the monthly premium costs for 2026, according to KFF, the health care research nonprofit.

A dispute rooted in the ACA’s origins

The abortion funding fight dates to the weeks before President Barack Obama signed the health overhaul into law in 2010. Democrats in Congress added provisions ensuring that federal subsidy dollars would not pay for elective abortions — a compromise that secured enough votes from anti-abortion members of their own party to pass the legislation.

The final language allowed states to offer ACA plans covering elective abortions but required that federal money be segregated and not used for those procedures. Since then, 25 states have passed laws prohibiting abortion coverage in ACA plans, 12 have passed laws requiring it, and 13 states and the District of Columbia have no coverage limitations or requirements, according to KFF.

Some Republicans and anti-abortion groups now argue that the segregated-funds requirement is inadequate and that federal dollars effectively subsidize abortion coverage anyway.

“The two sides are passionate about [abortion] so I think if they can find a way to bring it up, they probably will,” said Ivette Gomez, a senior policy analyst on women’s health policy for KFF.

Collins proposes audits; Democrats are unmoved

Sen. Susan Collins, R-Maine, who has co-led the negotiations with Moreno, floated a potential middle ground: auditing states that allow or require abortion coverage to verify they are correctly segregating funds.

“The answer is to audit” those states and enforce the law if they are not properly segregating their funds, Collins said.

But the proposal had not won unanimous Republican support, and Democrats had not endorsed it.

“I have zero appetite to make it harder for people to access abortions,” said Sen. Chris Murphy, D-Conn.

Maine Sen. Angus King, an independent who caucuses with Democrats, said earlier that making abortion coverage harder to obtain was a “red line” for his caucus.

Trump’s comment draws anti-abortion backlash

Negotiators had grown more optimistic the previous week after President Donald Trump told House Republicans they should “be a little flexible” on rules prohibiting the use of federal dollars for abortions.

Following Trump’s remarks, the House passed a bill extending ACA tax credits for three years, with 17 Republicans voting alongside Democrats over the objections of GOP leadership. The bill carried no new abortion restrictions.

Anti-abortion groups reacted sharply. Kelsey Pritchard, a spokeswoman for Susan B. Anthony Pro-Life America, said Trump’s comments were “a complete change in position for him” that generated “a lot of backlash and outcry” from the anti-abortion movement. The group said it would not support the 17 Republicans who voted for the extension.

Those who did not back restrictions on abortion coverage “are going to pay the price in the midterms,” Pritchard said.

Shape of a potential deal

The bipartisan group had made progress on other elements of a potential agreement. A two-year framework had taken shape that would extend the enhanced premium subsidy while adding new limits, and would create an option for health savings accounts — a Republican priority — in the second year. The ACA open enrollment period would be extended to March 1 to give people more time to find coverage after the lapse in subsidies.

The abortion dispute had blocked finalization of that framework.

The two sides had been at loggerheads since the fall, when Democrats voted to shut down the federal government for 43 days to force negotiations on the subsidies. Republicans refused to engage until a small group of moderate Democrats agreed to end the shutdown. The Senate subsequently voted on and rejected a three-year extension of the tax credits.