How abortion coverage threatens to prevent a congressional deal on health care subsidies

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 long-standing 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 seemed to be near collapse at the end of the week as the abortion dispute appears intractable.

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

But movement was hard to find.

Republicans were seeking stronger curbs on abortion coverage for those who purchase insurance off the marketplaces created by the Affordable Care Act. Democrats strongly opposed any such changes, especially in the wake of the Supreme Court overturning Roe vs. Wade in 2022. And advocacy groups on both sides were pushing against any compromise that they believe would weaken their positions.

The impasse was a familiar obstacle for lawmakers who have been arguing over the health law, known widely as “Obamacare,” since it was passed 16 years ago.

“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, the health care research nonprofit.

A fight with a long history

The abortion dispute dates back to the weeks and months before President Barack Obama signed the health overhaul into law in 2010, when Democrats who controlled Congress added provisions ensuring that federal dollars subsidizing the health plans would not pay for elective abortions. The 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.

Trump weighs in

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.”

‘Zero appetite’ for changes

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, also 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.

But 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.

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Associated Press writers Ali Swenson in New York and Joey Cappelletti and Lisa Mascaro contributed to this report.