Republicans and Democrats have returned from the longest government shutdown in U.S. history to find themselves in the same standoff that began it: a looming fight over the future of Affordable Care Act subsidies.
And, more specifically, whether taxpayer dollars should be tied in any way to abortion coverage, The Washington Post reported Monday.
Democrats have demanded a vote next month to extend the ACA’s premium subsidies, which are set to expire at the end of the year and have already sparked a 26% spike in projected 2026 premiums.
But Republicans insist that any extension must strengthen long-standing protections that prevent federal money from subsidizing abortion. The issue is quickly becoming the central obstacle to any bipartisan agreement.
Sen. Mike Rounds, R-S.D., said Republicans are united in their position that taxpayers should not be forced to support health plans that fund or facilitate abortion.
“You’re never going to get any Republican votes,” Rounds said, “because we believe strongly taxpayer dollars should not go to fund abortions.”
According to the Post, Rounds said Republicans have consistently delivered that message to Democrats throughout negotiations.
Democrats argue the subsidies already follow the Hyde Amendment, the decades-old federal ban on taxpayer-funded abortions.
Sen. Tina Smith, D-Minn., accused Republicans of picking a fight that could doom the negotiations, saying the GOP’s demands show they are “not serious” about extending the credits, according to the report.
The shutdown ended only after Senate Democrats accepted a promised vote on a future subsidy bill.
Now, with less than a month to craft legislation that can attract at least 13 Republican votes, both sides are navigating the same divide that has defined nearly every major healthcare debate for the past decade.
Republicans want to go further than the ACA’s current framework, which requires insurers that offer abortion coverage to collect a separate $1 monthly premium — a surcharge originally crafted as a political compromise during the Obama administration.
While Democrats say this satisfies Hyde, pro-life leaders and many GOP lawmakers argue the surcharge is an accounting gimmick that still enables taxpayer-facilitated abortion coverage.
“The surcharge is a joke,” said Marjorie Dannenfelser, president of Susan B. Anthony Pro-Life America, which has warned senators that voting for an extension without tighter restrictions would be heavily weighted in the organization’s scorecard.
She told the Post that she has spoken to nearly every Republican senator and expects the caucus to hold firm.
Beyond abortion, Republicans have floated other reforms — including income caps and minimum premium payments — but the abortion provision is the most non-negotiable, the report said.
Democrats warn that the GOP proposal could force insurers to drop abortion coverage entirely or create conflicts with the 12 states that mandate abortion coverage in all fully insured plans. In those states, roughly 3.7 million ACA enrollees could lose access to subsidized marketplace plans if the Republican provision became law.
Pro-abortion-rights organizations are urging Democrats not to compromise.
Amy Friedrich-Karnik of the Guttmacher Institute said Democrats must “remain firm” against any additional abortion restrictions.
Despite the sharp divide, some lawmakers still express hope for a deal.
Sen. Lisa Murkowski, R-Alaska, one of the few Republicans open to extending the subsidies without changes, noted that Congress has navigated Hyde-related impasses before.
“It’s not easy,” she said, “but we deal with it.”
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