By Sabrina Siddiqui, Laura Kusisto and Lindsay Wise
WASHINGTON -- As congressional Republicans weighed how to approach the fight over extending Affordable Care Act subsidies, powerful antiabortion groups saw an opportunity.
Led by Susan B. Anthony Pro-Life America, antiabortion activists began to pressure Republicans during the fall government shutdown to further restrict abortion coverage from insurance plans made cheaper by ACA subsidies at the heart of the dispute.
The activists' warning was simple: Extending subsidies without such limits was a line Republicans must not cross to keep social conservative support in next year's midterm elections.
"If you demotivate the pro-life voters and tell them we don't have something to offer you, it is a disaster to the Republican Party," said Frank Cannon, chief political strategist at Susan B. Anthony Pro-Life America.
Those lobbying efforts are how abortion access became a sticking point as Congress faces a critical deadline next week to extend the subsidies before Dec. 15, the end of the open enrollment period for ACA coverage that takes effect in January. The popular healthcare subsidies expire at the year's end, and conservative activists are intensifying their campaign on Republicans to ensure that the money isn't used to indirectly fund abortions.
A clash over abortion adds another layer of complexity to the continuing debate over reforming or ending the subsidies, which benefit about 20 million Americans, and further imperils the narrow prospects of reaching a deal. Republicans were already inclined to let the subsidies lapse, given longtime conservative opposition to the Obamacare healthcare law.
Democrats secured a promise from Republicans to hold a vote on healthcare by the second week in December in exchange for voting to end the 43-day shutdown. President Trump's advisers recently began drawing up a healthcare plan that included a two-year extension of the subsidies, but House Speaker Mike Johnson (R., La.) warned the White House that most House Republicans were opposed to continuing them.
"I think the Republican conference really wants to find a path forward to take care of people that have no place else to go to get their health insurance," said Sen. Mike Rounds (R., S.D.). But he cautioned, "We have never, as Republicans, ever voted to use taxpayer money to fund abortions, and we're not going to start now."
The healthcare law, which broadened insurance access primarily through the creation of new health exchanges and an expansion of Medicaid, has been a top target of conservatives since its passage more than 15 years ago. Republicans have tried and failed to repeal the law in several high-profile fights.
ACA marketplace plans can offer abortion coverage, but existing law bars the use of federal funds toward abortion, except in cases of rape or incest or to save a mother's life. Subsidies can be used to pay for a plan that covers abortion, but enrollees have to pay a small out-of-pocket sum for the specific cost of the abortion coverage to ensure federal money isn't used for that. The antiabortion activists argue the subsidies indirectly fund abortion services.
Democrats have proposed extending the subsidies for three years -- as is. Republicans have yet to coalesce around their own plan. But Senate Majority Leader John Thune (R., S.D.) described the existing language around abortion as one of "the big sticking points" in talks about the subsidies' future. Other Republicans agreed.
"If my tax dollars are being used to be able to take human life, especially the life of an infant, I have a problem with that," said Sen. James Lankford (R., Okla.).
When some antiabortion Democrats voted in 2010 for the healthcare law without the restrictions abortion opponents wanted, Susan B. Anthony rallied social conservative voters against them in that year's midterm elections. Antiabortion activists say the fight this year has similar stakes.
Democrats argue that existing safeguards are sufficient and have accused Republicans of using abortion as an excuse to let the subsidies lapse and further dismantle the law.
"I think this is being viewed as an opportunity by anti-choice groups to try and expand a nationwide abortion ban as part of any legislation. And that's a nonstarter," said Sen. Jeanne Shaheen (D., N.H.), a key player in bipartisan talks about a possible short-term extension of the subsidies.
Twenty-five states prohibit abortion coverage in ACA marketplace plans altogether, according to the healthcare nonprofit KFF, while others either defer to insurers or require that individual plans in their state cover abortion.
Democrats and their allies say prohibiting the use of subsidies to purchase plans that cover abortion would set up a conflict with states that require plans to include the coverage.
"Antiabortion organizations and congressional Republicans are really trying to falsely pit affordable healthcare against abortion coverage," said Georgeanne Usova, national director of Planned Parenthood's political arm.
Monthly insurance bills for ACA enrollees are expected to more than double on average should the subsidies expire. Some GOP lawmakers, particularly those in competitive seats, have said they are concerned their party will be blamed for sharp increases in healthcare costs in next year's midterms.
More than half of ACA marketplace enrollees said it would have a major impact on their decision to vote in the midterms, and on which party's candidate they would support, if their overall healthcare expenses increased by $1,000 next year, according to a new KFF poll released Thursday. Most enrollees said that Congress should extend the enhanced tax credits, and about one in four indicated "very likely" going without insurance next year if premiums double.
Write to Sabrina Siddiqui at sabrina.siddiqui@wsj.com, Laura Kusisto at Laura.Kusisto@wsj.com and Lindsay Wise at lindsay.wise@wsj.com
(END) Dow Jones Newswires
December 07, 2025 05:00 ET (10:00 GMT)
Copyright (c) 2025 Dow Jones & Company, Inc.
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