Republicans Focus on Abortion Funding in ACA Subsidy Deal

As pro-life advocates closely monitor whether the Trump administration’s agreement to extend Affordable Care Act (ACA) subsidies will include funding for abortion, a prominent Senate Republican emphasized that this matter is a key concern for his party.

“Republicans are very, very, very concerned about that,” stated Sen. Bill Cassidy from Louisiana.

Cassidy, who chairs the Senate Health, Education, Labor, and Pensions Committee, has proposed legislation that would direct subsidies straight to individuals enrolled in Obamacare instead of to insurance companies. This approach aims to repurpose existing funds for enhanced premium tax credits to create flexible spending accounts (FSAs) for those eligible under the ACA.

It’s important to note that Obamacare is not subject to the Hyde Amendment, which restricts taxpayer funds for abortions. Therefore, Senate Republicans are trying to figure out how to prevent abortion coverage under the proposed FSAs.

“We’re in the midst of drafting the legislation, and I believe the administration shares our concerns. Figuring out how to structure the HSAs accordingly is part of that process,” Cassidy mentioned.

To resolve the ongoing 43-day shutdown, Senate Majority Leader John Thune has suggested giving Democrats a vote on an ACA funding bill by mid-December.

So far, the Trump administration has been quiet on this particular angle of the bipartisan ACA deal.

“They are keeping things quite private,” noted a senior Republican Senate staffer. “We’re listening closely to what the White House might recommend.”

Despite this, Cassidy is optimistic that Trump will align with Republican and pro-life concerns about ensuring that the ACA expansion does not inadvertently fund abortions.

As Republicans continue working on their strategy to stop FSAs from covering abortion, a bill put forward by Rep. Josh Brecheen from Oklahoma could serve as a useful framework. His proposed legislation aims to clarify that expenses related to abortions are not qualified medical expenses eligible for reimbursement from certain tax-exempt accounts.

Under this proposal, any abortion costs—except for specific excluded cases—would not count as qualified medical expenses for reimbursement from health savings accounts or flexible spending accounts.

It’s likely that Democrats will resist agreeing to a deal that restricts abortion funding. However, the Trump administration has another potential route for preventing taxpayer dollars from supporting abortions through the ACA.

The IRS has the authority to declare abortion as not a qualified medical expense, which would consequently mean that FSAs and HSAs could not be put toward abortion plans. Unfortunately, the Treasury Department did not reply to requests for comments on this matter.

During his first term, Trump instated a rule mandating health insurers to send customers a separate bill for elective abortion coverage, distinct from their ACA premium. Nonetheless, guidelines to exclude abortion from HSAs have never been codified.

Sen. Rick Scott from Florida, who is collaborating with Cassidy and Sen. Roger Marshall on discussions with Democrats about a possible ACA compromise, shares Cassidy’s dedication to ensuring that ACA subsidies do not fund abortions.

“Democrats are shutting down the government because they are insisting on funding for free abortions,” Scott asserted.