After US healthcare subsidies lapsed at the end of last year, millions of Americans were hit with skyrocketing monthly premiums that many simply can’t afford. The ongoing struggle in Congress to renew the Affordable Care Act (ACA) subsidies is once again caught up in a well-known issue in US politics: abortion.
On Thursday, congressional leaders announced they had come to a bipartisan agreement to use a spending bill aimed at reforming parts of the US healthcare system, particularly targeting corporate middlemen who have been blamed for increasing prescription drug prices. However, this deal doesn’t tackle the subsidies. It could also fall apart as Democrats and Republicans are fracturing over how to support government spending following the recent fatal shooting of Alex Pretti by federal officers in Minneapolis.
Earlier this month, the House passed a bill to revive the subsidies with help from 17 Republican votes, but the Senate has yet to address it. As negotiations drag on, some states have extended their open enrollment periods until the end of January.
However, a resolution may not arrive soon enough. Republicans insist on additional restrictions regarding abortion coverage within ACA plans before moving forward, while Democrats argue that’s off the table.
“Once we get past this issue, there’s decent agreement on everything else,” Bernie Moreno, a Republican senator from Ohio involved in discussions about the subsidies, told reporters.
Introduced during Covid’s peak, these subsidies helped reduce costs for 90% of ACA enrollees-mostly individuals who don’t get healthcare through an employer like gig workers or small business owners. Now, average premium costs have surged from around $900 to over $1,500 annually according to an analysis by health policy group KFF.
“People are very, very price-sensitive and it can become very expensive,” said Alina Salganicoff, KFF’s leading expert on women’s health policy. Compared to this time last year, roughly 800,000 fewer individuals have signed up for plans through ACA’s marketplace so far.
Abortion rights have always been a contentious topic in discussions about the Affordable Care Act since it began. In 2010 anti-abortion Democrats nearly derailed the whole initiative before agreeing to support it provided it included specific language reaffirming the Hyde amendment. This amendment prevents federal funds from being used for abortions except in cases of rape or incest or when medical emergencies occur.
Nonetheless, states can provide plans on ACA marketplaces that cover abortion if those plans do not depend on federal funds. Twelve states mandate that marketplace plans include abortion coverage while another 13 plus Washington D. C. allow them to do so.
“The effort by anti-choice groups to rehash what is already settled in federal law is nothing more than an attempt to further encroach on women’s full reproductive rights,” Jeanne Shaheen, a Democratic senator from New Hampshire stated. “It’s crucial for us to find a way forward that ensures millions of Americans can afford their health insurance.”
However, opponents of abortion claim that current compromises violate principles laid out by Hyde amendment.
“The whole little workaround – that it’s required by states and not by feds – is ridiculous,” said Kristi Hamrick vice president of media and policy for Students for Life of America which is a powerful anti-abortion group. “It poses no threat; it will collapse if there’s no agreement on Hyde.”
If Congress changes rules about abortion coverage during its debate over ACA subsidies then people living in those twelve states where such coverage is mandated could instantly lose their healthcare options according to Salganicoff.
“I don’t see it as violating the spirit of Hyde amendment at all; these are separate funds,” Salganicoff explained. “It’s not like those federal subsidies are being used for abortion services; I don’t see evidence supporting that.”
Supporters of Hyde amendment have long seen it as non-negotiable among congressional Republicans but Donald Trump recently suggested they be “a little flexible” regarding Hyde earlier this month.
“You gotta work something,” Trump remarked at a GOP gathering. “You gotta use ingenuity.”
Yet Trump’s advice might have backfired according to someone familiar with Congressional talks who shared that his comments caused many Republicans instead dig in saying: ‘There actually is no movement on this issue’.”
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