Abortion may prove a landmine in ACA subsidy push

Abortion politics are colliding with ongoing efforts in Congress to extend enhanced subsidies for Affordable Care Act coverage.

Why it matters: Renewing the premium subsidies even for a year beyond their Dec. 31 expiration was always going to be politically tricky because of the cost. Now there's the added complication of restricting any funds from being used on abortions.

Driving the news: Anti-abortion groups and some GOP lawmakers are pushing to attach the Hyde Amendment, which bans federal funding for abortion in most instances, to any subsidy extension.

• Democrats say the ACA already has a mechanism to segregate taxpayer funds so they're not used to pay for the procedure and accuse Republicans of using the debate as a backdoor way to expand abortion restrictions.
• Without a resolution, premiums for more than 20 million ACA enrollees will increase over 75% on average if the subsidies expire, according to KFF.

What they're saying: A coalition of anti-abortion groups led by Susan B. Anthony Pro-Life America urged lawmakers this week to include a "complete application" of the Hyde Amendment to any subsidy extension, dismissing the requirements already in place as an "accounting gimmick."

• "Any funding for Obamacare … is forced taxpayer funding of abortion — unless such funds are definitively limited to coverage that excludes elective abortion," the groups said in a letter.
• "Any action on ACA subsidies must include strong protections for Hyde," Gabby Wiggins, a spokesperson for Sen. Steve Daines (R-Mont.), told Axios. Daines is a leader on anti-abortion issues in the Senate.

The other side: "You're not going to be able to make progress on that if you start handing out right-wing trophies," Sen. Ron Wyden of Oregon, the top Democrat on the Senate Finance Committee, told Axios.

• Ryan Stitzlein, a vice president at Reproductive Freedom for All, said Republicans are looking for "a backdoor abortion ban for those who cannot pay for services out of pocket."

The big picture: It's not clear how hard Republicans will push on the abortion issue. ACA funding faces other obstacles at this point.

• It's not clear that sufficient GOP support exists for a clean extension of the subsidies anyway. Some Republicans view it as too costly and a handout to insurance companies.
• But top GOP leaders have expressed some openness in recent weeks, aware of the political peril of allowing a major premium increase in an election year.

Abortion curbs are so divisive that they could kill a well-crafted compromise. Debate about the Hyde Amendment helped torpedo a bipartisan effort to shore up the ACA in 2018.

• The issue also almost stopped the ACA from becoming law in the first place, before Democrats worked out a delicate funding compromise among themselves.
• With Republicans now in charge of Congress, it's perhaps not surprising that the issue is back.