The looming expiration of Obamacare subsidies for tens of millions of Americans has more lawmakers — particularly vulnerable Republicans — sweating the political fallout and ready to compromise.
But odds for a deal remain slim, and an unresolved fight over abortion could lower them to zero.
Ahead of the expected standoff, abortion-rights and anti-abortion groups are barnstorming Capitol Hill, warning members that there will be political consequences for them in next year’s midterm elections if they cave.
“This is a bright red line,” said Marjorie Dannenfelser, president of SBA Pro-Life America, one of the groups most active in lobbying on the issue. “The pro-life movement has been unequivocal: No Hyde, no deal … We will score against every such attempt, now and in the future.”
The House is up at bat after the Senate’s failure last week to pass either Democrats’ multi-year clean extension of the health insurance subsidies or Republicans’ alternative plan that would have funneled money into health savings accounts and imposed new national restrictions on abortion and gender-affirming care.
House GOP leaders are trying to rally their fractious caucus around a bill that takes no action on the expiring subsidies, creates several new programs aimed to steer consumers away from Obamacare’s exchanges, and imposes new national abortion restrictions.
But several swing district Republicans broke ranks Wednesday morning to back Democrats’ bill that would extend the subsidies with no additional abortion restrictions, raising the possibility that it could not only come to the House floor but pass out of the chamber. Republicans, however, are expected to put forward amendments to curb abortion access, which could doom its passage.
And if even one of the House’s dueling proposals ekes out majority support, its chances of Senate approval remain dim.
A bipartisan group of roughly 20 senators huddled Monday night in an attempt to negotiate a last-minute agreement on a two-year extension of the subsidies that includes income caps and fraud prevention measures.
Senators confirmed to POLITICO that they discussed abortion in that meeting. But they have so far failed to come up with a solution agreeable to all sides on how the decades-old Hyde Amendment — a budget rider that prohibits federal spending on abortion — should apply to Obamacare.
South Dakota Republican Mike Rounds, who participated in the gathering, called abortion the “number one” hurdle, even as “a group of us really want to fix this issue.”
SBA Pro-Life America is one of dozens of anti-abortion groups who have declared any bill that doesn’t impose additional abortion restrictions a “non-starter,” and said any Republican who votes for such a bill will be penalized in future elections.
Groups on the other side have been equally adamant, threatening consequences for Democrats who may be considering accepting additional abortion restrictions in order to prevent the insurance subsidies from lapsing.
Planned Parenthood Action Fund and Reproductive Freedom for All — the group formerly known as NARAL — jointly announced that they, like their anti-abortion counterparts, will score the vote and withhold support going forward from members who fold.
“Reproductive Freedom for All is working across the country to ensure our 4 million members know what’s at stake and which lawmakers are playing politics with their lives,” said Emily Steinert McDowell, the group’s associate director of federal policy.
The question of insurance coverage of abortion — which nearly doomed passage of the Affordable Care Act 15 years ago — reared its head again this year as enhanced subsidies that Democrats created in 2021 and renewed in 2022 neared their December 2025 expiration date.
Until now, the law has upheld an uneasy compromise — barring federal subsidies from paying for abortions, but leaving it up to states to decide whether the health insurance plans on their individual markets could cover the procedure using other funding.
Half of states have opted to ban all coverage of abortion on their Obamacare markets, including some where abortion itself is legal, like Pennsylvania and Arizona. In the remaining 25 states, abortion coverage through Obamacare is either allowed or required, though any claims paid out involving the termination of a pregnancy come from a separate account that doesn’t use federal subsidies.
Anti-abortion groups and their GOP allies on the Hill have called this structure a “gimmick.” They have long argued that any federal subsidies to insurance plans that cover abortion free up resources for the procedure — despite the funding coming from separate accounts — and are pushing for national rules barring any plan that receives a subsidy from covering the procedure.
Sen. Josh Hawley (R-Mo.), who recently launched his own anti-abortion group, told reporters there are several policy options to achieve this. He pointed to a bill that he recently introduced that bans ACA plans from covering abortion or transgender procedures, and also suggested reviving a 2019 Trump administration rule that required insurers to send consumers two separate bills: one for abortion care and the other for everything else.
A federal court overturned the rule in 2020 because of concerns that it created new hurdles for patients to get care.
The bill House Republicans plan to take up Wednesday would accomplish the same goal in a different way — denying cost-sharing reduction payments to insurers in the 13 states that require abortion coverage: California, Colorado, Delaware, Illinois, Maine, Maryland, Massachusetts, Minnesota, New Jersey, New York, Oregon, Vermont and Washington.
New Jersey Rep. Frank Pallone, the top Democrat on the House Energy and Commerce Committee, accused Republicans at Tuesday’s Rule Committee meeting of pursuing a “backdoor ban on abortion,” and other Democrats made it clear that the party will oppose any attempts to expand the existing abortion restrictions in the ACA.
Seizing on such comments, anti-abortion groups lobbying lawmakers in the final days of 2025 signaled that they will try to convince voters to blame Democrats for their health insurance premiums going up heading into next year’s midterms.
“Our sole ask is to include Hyde provisions,” Gavin Oxley, a spokesperson for Americans United for Life, said in an interview. “If the Democrats are not willing to come to the table on that issue, then they are the ones who are going to be at fault for Americans not having health coverage.”
