Illustration: Brendan Lynch / Axios
A provision that could make it more difficult for ACA marketplace plans to cover abortions was retained in the Senate HELP Committee's portion of the reconciliation bill released Tuesday night.
Why it matters: It shows that Senate Republican leadership is still open to the possibility of tough abortion votes in the budget debate despite needing the support of moderate senators.
What's inside: Funding cost-sharing reduction payments (CSRs) to insurers in ACA marketplaces is the only health-related measure in the HELP title, with the remainder largely focused on student loan and other education provisions.
- HELP would begin funding the payments in 2026.
- But the language states that CSR payments can't be used for state health plans that provide coverage of abortions.
- There is an exception for instances to save the life of the mother or because of rape or incest.
Catch up quick: House Republicans added the restriction late in their reconciliation debate via a manager's amendment, as they sought ACA changes that would reduce the federal subsidies that defray premium costs.
- Adding the abortion restriction means that states that support abortion rights will have to choose whether to keep covering the procedure or forgo CSR funding, which could itself limit access.
Yes, but: As we reported this week, it's still possible that the abortion restriction could conflict with the Byrd Rule's requirement that reconciliation policies have a budgetary effect.
- But removing the abortion restriction could doom the entire CSR funding provision, because some Republicans are insisting on its inclusion.
- It's still unclear whether moderates Susan Collins and Lisa Murkowski would support the provision if it remains intact, since both support abortion rights.
