Anti-abortion lobbying plays role in GOP opposition to ACA premium credit extension

Enhanced tax credits that were provided under the American Rescue Plan Act of 2021 and have subsidized the cost of premiums for people who buy health insurance policies through Affordable Care Act marketplaces are set to expire at the end of the year.

If Congress does not act to renew the credits, some 22 million Americans will see sharp increases in the cost of their health insurance. According to KFF, without the subsidies, the cost of insurance through the ACA marketplace will rise 26% on average starting in 2026. 

On Nov. 18, in a post on social media, President Donald Trump told Congress not to “waste your time and energy on anything” related to health care other than “SENDING THE MONEY DIRECTLY BACK TO THE PEOPLE, WITH NOTHING GOING TO THE BIG, FAT, RICH INSURANCE COMPANIES, WHO HAVE MADE $TRILLIONS, AND RIPPED OFF AMERICA LONG ENOUGH.”

NBC News reported that most Republicans in Congress oppose extending the funding for the enhanced tax credits, although some, including Virginia Rep. Jen Kiggans and Pennsylvania Rep. Rob Bresnahan, noted that allowing the credits to expire without a replacement in place would harm their constituents.

One issue Democratic lawmakers working to extend the subsidies are confronting is Republican opposition to coverage of abortion care by plans provided through ACA marketplaces. 

“That’s the message that we’ve shared with a lot of our Democrat colleagues: You can’t do it under your existing framework, and you’re never going to get any Republican votes because we believe strongly taxpayer dollars should not go to fund abortions,” Republican Sen. Mike Rounds of South Dakota said, according to the Washington Post. “It’s pretty clear Republicans are solid on that particular issue.”

Federal funding for abortion care is prohibited by the Hyde Amendment, a provision that has been included in federal budgets every year since 1976. However, some ACA marketplace plans in California, Colorado, Illinois, Maine, Maryland, Massachusetts, Minnesota, New Jersey, New York, Oregon, Vermont, and Washington require ACA marketplace plans to cover abortions, KFF reports, using funding contained in their own state budgets. But 25 states have banned insurance plans under the ACA marketplace from covering abortions. 

“This attempt is from a really strong lobbying push from the anti-abortion movement to even further restrict plans,” Anna Bernstein, principal federal policy adviser at the Guttmacher Institute, told the American Independent. “It’s really just trying to get a complete elimination of abortion coverage in the marketplace and would have ripple effects to private insurance coverage more broadly.” 

On Nov. 7, Marjorie Dannenfelser, president of the anti-abortion organization Susan B. Anthony Pro-Life America, sent a letter to Republican senators that said: “Since Democrat offers to pass a ‘clean’ extension of these ACA subsidies would extend funding of elective abortion coverage through Obamacare, Susan B. Anthony Pro-Life America strongly opposes and will score against any such offers – even for one year. A vote for this extension is a vote for abortion coverage. Votes will be scored, and double-weighted, in each member’s profile on SBA Pro-Life America’s National Pro-Life Scorecard.” 

Louisiana Republican U.S. Sen. Bill Cassidy on Nov. 17 proposed replacing subsidies for ACA premiums with direct payments to individuals’ tax-advantaged health savings accounts and encouraging those enrolled in ACA insurance plans to switch to policies with lower premiums but higher deductibles. Cassidy said, “If you look at the broad outlines of what I’m speaking of, it is clearly the broad outlines of what the president is speaking of.”

“It’s not clear exactly what mechanism they want to use to further restrict abortion coverage, especially given how restrictive it is already in the private insurance market, but especially with the ACA marketplace,” Bernstein said. 

In an email to the American Independent, Wisconsin Democratic Sen. Tammy Baldwin said: “Wisconsinites want health care they can afford, not more excuses from Republicans who have no plan to lower costs. If Republicans want to jack up premiums on 22 million people, they should just say that instead of lying to Americans.”

David Cohen, a professor of law at the Drexel University Thomas R. Kline School of Law, said in an email to the American Independent: “Anti-abortion Republicans are doing what they do best — picking an abortion fight when there is no cause to do so. Their single-minded focus on further restricting abortion access is at odds with what the American people want, but that hasn’t stopped them before and won’t stop them from trying again now.”