WASHINGTON (AP) — There is broad bipartisan support in the House and Senate for reviving federal health care subsidies that expired at the beginning of the year, but disagreements over abortion coverage are threatening to block any compromise and leave millions of Americans with higher premiums.
Despite significant progress, bipartisan Senate negotiations on the subsidies appeared near collapse at the end of the week as the abortion dispute proved intractable. Sen. Bernie Moreno, R-Ohio, who has led the talks, told reporters, “Once we get past this issue, there’s decent agreement on everything else,” though movement toward an agreement remained limited.
Republicans have sought stronger curbs on abortion coverage for people who buy insurance through options outside the marketplaces created by the Affordable Care Act, while Democrats have opposed changes—especially after the Supreme Court overturned Roe v. Wade in 2022. Advocacy groups on both sides have also pressed against any compromise they said would weaken their positions.
KFF’s Ivette Gomez said the two sides are deeply invested. “The two sides are passionate about (abortion) so I think if they can find a way to bring it up, they probably will,” Gomez said.
The abortion dispute has long shaped debates over the health law. Democrats who controlled Congress added provisions in the period before President Barack Obama signed the 2010 health overhaul that ensured federal dollars subsidizing health plans would not pay for elective abortions. Under the final language, states could offer ACA plans that cover elective abortions, but federal money could not pay for those procedures, and states were required to segregate funding for them.
KFF has reported that 25 states have passed laws prohibiting abortion coverage in ACA plans, 12 have passed laws requiring abortion coverage, and 13 states and the District of Columbia have no coverage limitations or requirements. The article says some Republicans and anti-abortion groups argue the segregated funding requirement is a “gimmick” that allows taxpayer dollars to pay for abortions.
Senators involved in the negotiations said a possible compromise has been to investigate some states to ensure they are segregating the money correctly. Sen. Susan Collins, R-Maine, said, “the answer is to audit” those states and enforce the law if they are not properly segregating their funds, but the article says the proposal was unlikely to win unanimity from Republicans and Democrats had not signed on.
The article also describes a shift in tone 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 came just before a House vote on Democratic legislation that would extend ACA tax credits for three years; the article says 17 Republicans voted with Democrats on the extension over objections from GOP leadership, and the House passed the bill with no new abortion restrictions.
Anti-abortion groups reacted quickly. Susan B. Anthony Pro-Life America spokeswoman Kelsey Pritchard said the group would not support the 17 Republicans who voted for the extension and said 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 from voters opposed to abortion rights. Pritchard said lawmakers who did not support changes to reduce abortion coverage “are going to pay the price in the midterms,” adding, “We’re communicating to them that this isn’t acceptable.”
Democrats have argued the abortion fight is diverting attention from extending the COVID-era subsidies that expired on Jan. 1 and had kept costs down for people with health coverage. The article says KFF reported the average subsidized enrollee is facing more than double the monthly premium costs for 2026. It also says the sides have been haggling since Democrats voted to shut down the government for 43 days as they demanded negotiations on extending the subsidies, and Republicans refused to negotiate until a small group of moderate Democrats agreed to end the shutdown.
After the shutdown ended, Republicans made clear they would not budge on the subsidies without changes related to abortion, the article says. It adds that the Senate voted on and rejected a three-year extension of the tax credits, and that Angus King, an independent who caucuses with Democrats, said making it harder to cover abortion was a “red line” for Democrats and that Republicans were going to “own these increases” in premiums.
The bipartisan group has been discussing parts of an agreement, including a two-year deal that would extend enhanced subsidies while adding new limits and also creating, in the second year, the option of a health savings account that Trump and Republicans prefer. The article says the ACA open enrollment period would be extended to March 1 to allow more time for people to figure out their coverage plans after the interruption of the enhanced subsidy, but it says the abortion issue continues to block a deal as Democrats seek to protect the compromise that helped pass the ACA 16 years ago.
Sen. Chris Murphy, D-Conn., said, “I have zero appetite to make it harder for people to access abortions.”
The AP report lists Ali Swenson in New York and Joey Cappelletti and Lisa Mascaro as additional contributors.
CC0: This article is in the public domain (CC0). AI disclosure: algorithmically generated by Main Street Independent’s News Article Generator framework. Human review: not_triggered.