WASHINGTON — Senate Republicans say they’re open to extending a pot of Affordable Care Act funds that will expire at the end of the year — but only if Democrats acquiesce to stricter abortion restrictions on insurance plans.
The demand presents a significant hurdle to reaching a bipartisan deal to extend ACA funding designed to avoid major premium hikes next year for more than 20 million Americans, as Democrats are adamant that existing abortion guardrails under Obamacare are sufficient.
If the funds are not extended by the end of the year, some people insured under Obamacare could see their bills rise by thousands of dollars per month, raising concerns that millions will choose to go uninsured.
Senate Majority Leader John Thune, R-S.D., said there will be a negotiation about an extension after the government reopens. He said one condition will be stricter rules pertaining to the Hyde amendment, which bars federal funding from being used for abortion.
To satisfy Democratic demands to comply with the Hyde amendment when Obamacare passed in 2010, the law does not allow federal funds to cover abortions. Some states allow people insured under Obamacare to access abortion coverage using state or other funding. Republicans want to change that.
“That’s what we’re going to negotiate,” Thune told reporters before the Senate passed the bill to end the government shutdown. “A one-year extension along the lines of what [Democrats] are suggesting, and without Hyde protections — there’s just not even, doesn’t even get close.”
Thune’s demand for more stringent abortion limits on Obamacare money is backed by colleagues, including Sen. Mike Rounds, R-S.D., an outspoken proponent of extending the ACA funds, as well as Sens. Steve Daines, R-Mont., and Mike Lee, R-Utah.
Rounds warned that “you won’t get any” Republican votes to extend the money without more stringent abortion limitations.
“That’s the message that we shared with a lot of our Democratic colleagues is 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,” he said. “They have a different point of view, but it’s pretty clear that Republicans are solid on that particular issue.”
But Democrats say there’s no way they’ll agree to that.
Sen. Jeanne Shaheen, D-N.H., responded with a flat “no” when asked if there’s any way Democrats agree to stricter abortion limitations in order to extend the ACA funds.
“It’s a nonstarter,” Shaheen told NBC News, pointing to existing guardrails on abortion funding built into the ACA. “It’s not an issue. We already dealt with that issue.”
Other Democrats share her opposition to changing those rules.
Behind the push is a pressure campaign by Susan B. Anthony Pro-Life America, an influential group fighting to ban abortion in the U.S., to condition Republican support for ACA funding on tougher abortion restrictions.
“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,” SBA President Marjorie Dannenfelser told senators in a letter dated Nov. 7 and shared with NBC News. “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.”
Katie Keith, a Georgetown Law professor and founding director of its Center for Health Policy and the Law, said existing law bans any federal funds from flowing to abortion care through ACA plans, including the premium tax credits and cost-sharing reduction payments, consistent with the Hyde amendment.
States have the option to create separate revenue streams where enrollees can pay a surcharge to gain abortion coverage through their plans. Twenty-five states ban abortion coverage through ACA marketplaces entirely. The rest are split between requiring it through additional state funding or deferring to insurers.
Still, even for states that allow ACA plans to cover abortion, “there are strict segregation requirements,” Keith said. “Since the law was enacted, no federal funds flow toward abortion care.”
She said the same rule applies to Medicaid funding.
“What critics of the current policy are arguing is they want Hyde plus-plus. This goes far beyond what Hyde requires,” she added. “It’s not about federal funds flowing toward the care, it’s about federal funds flowing toward coverage, even if it’s financed separately. … They want to knock out abortion coverage fully.”
And if the SBA proposal becomes law, it would create a serious conflict with the dozen blue states that use their own funds to permit abortion coverage through the ACA marketplaces.
“It could knock out federal subsidies for coverage altogether in those states if those funds cannot flow,” said Keith, who worked a stint in the Biden administration before returning to Georgetown.
Daines, who sits on the Finance Committee that oversees health policy, said additional Hyde protections have “got to be in there, absolutely” — in any ACA deal.
“We’ve got the language for it, the Hyde language,” he said. “Hyde has been a longstanding principle here of not allowing the federal taxpayers to be used for abortion.”
Shaheen, a moderate Democrat who is not seeking re-election next year, is the author of a permanent ACA funding extension. She also helped craft the deal to reopen the government. She said she’s open to other reforms to the enhanced ACA tax credits, such as income-based limits, but going beyond existing abortion limitations is a red line.
Other Democrats take a similar view.
“I don’t think you’re going to get Democratic votes talking about abortion,” said Sen. Chris Murphy, D-Conn. “But there are conversations you can have about the structure of the subsidies once you get into a negotiation. I’ve heard their concerns about income caps and no-premium plans.”
Sen. Brian Schatz, D-Hawaii, said the GOP’s abortion demand seems like a smokescreen to disguise the party's unwillingness to continue that money, which was first passed during the Covid pandemic in 2021 and extended the following year. The subsidies limit premiums to 8.5% of an enrollee's income.
“At that point, they’re just unserious about extending the ACA [funds],” he said. “Once they get into restrictions on abortion, everyone knows what that means. It means that they would like to say they’re for extending ACA, but that they don’t have the votes to do it right now.”
Schatz indicated that President Donald Trump, who softened his position on abortion during the 2024 campaign and said it should be left up to states, can steer his party to a viable solution.
“This is solved in 10 seconds if Donald Trump wants it solved,” Schatz said.
