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Senate Republicans are demanding tougher abortion restrictions in exchange for extending key Affordable Care Act funds set to expire at the end of the year, setting up another partisan clash over health care and reproductive rights.
Majority Leader John Thune, R-S.D., said any deal to renew the enhanced ACA subsidies — which keep premiums down for more than 20 million Americans — must include new rules reinforcing the Hyde Amendment’s ban on federal abortion funding. Democrats immediately rejected the idea, calling it a “nonstarter.”
“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 said before the Senate passed a stopgap spending bill to end the government shutdown.
The expiring ACA funds, first boosted under the 2021 COVID relief law, have capped premiums at 8.5% of household income. Without renewal, some enrollees could see monthly costs rise by thousands of dollars — a blow Democrats warn could drive millions off coverage.
Republicans argue current ACA rules still allow abortion coverage in some state-based insurance markets, even though federal money cannot be used to pay for the procedure. They want to tighten those limits, citing concerns from Susan B. Anthony Pro-Life America, a prominent anti-abortion group that has vowed to “score against” any extension without stricter restrictions.
“Taxpayer dollars should not go to fund abortions,” said Sen. Mike Rounds, R-S.D. “You won’t get any Republican votes without stronger limitations.”
Democrats counter that existing law already complies with the Hyde Amendment and accuse Republicans of trying to rewrite long-settled policy.
“It’s a nonstarter,” said Sen. Jeanne Shaheen, D-N.H., who helped craft the government funding deal and is sponsoring a permanent ACA funding bill. “We already dealt with that issue.”
Health law experts back up Democrats’ interpretation. Katie Keith, a Georgetown Law professor and director of the Center for Health Policy and the Law, said no federal ACA funds have ever gone toward abortion care. Instead, she said, a few states use their own revenue streams to cover abortion under separate accounts.
“What critics are arguing for is Hyde plus-plus,” Keith said. “This goes far beyond what Hyde requires.”
The issue threatens to complicate post-shutdown negotiations in Congress, where Democrats view the ACA subsidy extension as a must-pass measure before the year’s end. Republicans, meanwhile, see it as leverage to score long-sought victories on abortion policy.
Sen. Brian Schatz, D-Hawaii, called the GOP’s stance “unserious” and suggested the fight could be resolved quickly if former President Donald Trump intervenes.
“This is solved in 10 seconds if Donald Trump wants it solved,” Schatz said.
Whether Trump, who softened his abortion rhetoric during the 2024 campaign, chooses to wade in remains unclear. But with the subsidies set to lapse in less than three months, the stakes for both parties — and for millions of Americans’ health coverage — are rising fast.
