Washington — There is broad bipartisan support in the House and Senate for reviving federal health care subsidies It ended at the beginning of the year. But the long-standing disputes ended Abortion coverage They threaten to obstruct any settlement Leaving millions of Americans with higher premiums.
Despite significant progress, bipartisan Senate negotiations over benefits appeared to be on the verge of collapse over the weekend as the dispute over abortion appears intractable.
“Once we get past this issue, there will be a decent agreement on everything else,” Sen. Bernie Moreno, R-Ohio, who led the talks, told reporters.
But movement was hard to find.
Republicans were seeking stronger restrictions on abortion coverage for those who buy insurance on the marketplaces created by the Affordable Care Act. Democrats have strongly opposed any such changes, especially in the wake of the Supreme Court overturning Roe v. Wade in 2022. Advocacy groups on both sides have been pushing against any compromise they believe will weaken their positions.
The impasse has been a familiar obstacle for lawmakers who have been wrangling over the health law, widely known as Obamacare, since its passage 16 years ago.
“Both sides are passionate about (abortion), so I think if they can find a way to bring it up, they probably will,” said Yvette Gomez, a senior policy analyst on women’s health policy at KFF, a nonprofit health care research organization.
The dispute over abortion dates back to the weeks and months before President Barack Obama signed health reform into law in 2010, when Democrats who controlled Congress added provisions ensuring that federal dollars supporting health plans would not cover the costs of elective abortions. This compromise came after negotiations with members of their party, whose opposition to abortion rights threatened to overturn the legislation.
The final language allowed states to offer plans under the Affordable Care Act covering elective abortions, but said federal funds could not pay for them. Countries must now separate funding from these measures.
Since then, 25 states have passed laws prohibiting abortion coverage in ACA plans, 12 states have passed laws requiring abortion coverage in plans, and 13 states and the District of Columbia have no restrictions or requirements for coverage, according to KFF. Some Republicans and anti-abortion groups now want to make it more difficult for states to require or allow coverage, arguing that separate funds are little more than a gimmick that allows taxpayer money to pay for abortions.
Senators involved in the negotiations said a possible compromise would be to investigate some of those states to ensure they are separating the funds correctly.
Sen. Susan Collins, Republican of Maine, who led the negotiations with Moreno, said the “solution is to audit” those states and enforce the law if they do not properly separate their funds.
But this plan is unlikely to win unanimous approval from Republicans, and Democrats have not signed on to it.
Negotiators were more optimistic last week, following President Donald Trump He told House Republicans at a meeting That “you have to be a little bit flexible” about rules preventing federal dollars from being used for abortions.
Those words came from the president, who has said little about whether he wants Congress to extend the benefits, ahead of a House vote on Democratic legislation that would extend the Affordable Care Act’s tax credits for three years. After his remarks, 17 Republicans voted with Democrats for the extension, despite the objections of the GOP leadership and the Republican Party. The House of Representatives approved the bill With no new restrictions on abortion.
The reaction from anti-abortion groups was swift.
Kelsey Pritchard, spokeswoman for Susan B. Anthony Pro-Life America, said the group would not support the 17 Republicans who voted for the extension. She said Trump’s comments represented a “complete change of heart for him” and sparked “a lot of backlash and anger” from the anti-abortion movement and voters opposed to abortion rights.
Pritchard said those who did not support changes to the Affordable Care Act to reduce abortion coverage “will pay the price in the midterms” this year. “We are telling them this is unacceptable.”
Democrats say Republican efforts to amend the law and increase abortion restrictions are a distraction. They focused on extending coronavirus-era benefits that expired on January 1 It kept costs low for millions of people in the United States. The average subsidized enrollee faces more than double monthly premium costs for 2026, also according to KFF.
The two sides have been negotiating since the fall, when Democrats voted to shut down the government for 43 days as they demanded negotiations on extending support. Republicans refused to negotiate until a small group of moderate Democrats agreed to vote with them End the shutdown.
After the shutdown ended, Republicans made clear they would not budge on benefits without changes to abortion. The Senate voted on it and rejected it Extending tax breaks for three years.
Maine Sen. Angus King, an independent who caucuses with Democrats, said at the time that making it more difficult to cover abortion was a “red line” for Democrats.
King said at the time that Republicans would “own these increases” in insurance premiums.
The bipartisan group that met in recent weeks has moved closer to reaching parts of an agreement, including a two-year agreement that would extend the enhanced subsidies while adding new limits and also creating an option, in the second year, for a health savings account favored by Trump and Republicans. The ACA’s open enrollment period will be extended through March 1 of this year, to allow people more time to figure out their coverage plans after the enhanced subsidies are cut off.
But the abortion issue still stands in the way of a deal as Democrats seek to protect the carefully crafted compromise that helped pass the Affordable Care Act 16 years ago.
“I have no desire 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, Joey Cappelletti and Lisa Mascaro contributed to this report.