The White House’s health care proposal has encountered a major hurdle as numerous Republican lawmakers are demanding an expansion of abortion restrictions, which the administration has yet to address, causing tension and uncertainty.
For many GOP members, an expansion of abortion restrictions within Obamacare is essential in their tentative health care plan. However, the White House’s decision to exclude the abortion issue from its tentative framework has caught Republicans off-guard, leaving them unsure of the president’s stance on the matter. According to two aides who were granted anonymity to disclose private discussions, this silence has left them in the dark.
The contentious issue surrounding the Hyde amendment, which prohibits federal funding for abortion, is merely one of several challenges that must be addressed before a healthcare deal can be reached that extends expiring Affordable Care Act subsidies. This disagreement also comes on top of GOP backlash against other aspects of the White House’s health policy framework that were leaked recently.
“No Republican has voted for Obamacare or an extension or expansion of it,” said a senior Senate Republican aide, who was allowed to speak candidly. “Asking members to do that without including Hyde would be impossible for many.”
While the White House didn’t comment on the president’s stance, its proposal for a two-year extension of the ACA’s enhanced subsidies, accompanied by conservative-favored limitations, including a cutoff for higher-income individuals and a requirement for monthly payments, was not accompanied by an indication of whether it supported the GOP’s demand for prohibiting any insurance plan receiving federal subsidies from covering abortion services.
Gavin Oxley, a spokesperson for Americans United for Life, suggested that the White House would be beneficial to publish its stance on the Hyde amendment to give lawmakers a clearer understanding of the next steps. He also emphasized that not weighing in on this issue or proceeding without abortion restrictions could jeopardize the broad coalition that helped re-elect President Trump.
“We believe the Administration and pro-life leaders in Congress will come to the table in good faith with a plan that includes Hyde,” he said. “But should it not, we will be prepared to reject such a plan.”
House and Senate Republicans, alongside anti-abortion groups that have spent months lobbying Congress and the White House, oppose any extension of the subsidies that doesn’t bar all insurance plans in the individual market from covering abortion. According to a source who was granted anonymity, including abortion funding restrictions is a ‘red line’ for a wide range of Republicans.
“We don’t have any details on this plan, but Senator Young supports Hyde protections and believes they should apply to any taxpayer-funded health care spending,” said Leah Selk, the spokesperson for Republican Sen. Todd Young of Indiana.
The hard line for Republicans has created a narrow window for bipartisan agreement, if any, before the end of the year when the subsidies are set to expire and cause premiums to skyrocket. Democrats, who need Democratic votes to clear the filibuster in the Senate to advance most legislation, have declared that abortion restrictions would be a non-starter in the ongoing negotiations.
“Instead of working with Democrats to fix the health care crisis they created, Republicans now want to hold women’s health care hostage and force their radical agenda on the American people,” said Sen. Ron Wyden of Oregon, the top Democrat on the Finance Committee over much of the U.S. health system, in a recent floor speech. “I have one thing to say to that: not on my watch.”
Realizing the political consequences, the White House’s decision to sidestep the abortion question was intended to allow the administration to avoid the immediate threat it could have posed to the plan’s viability, said a Republican aide with knowledge of the discussions — even if it has had the opposite effect.
“Look, it’s no secret that this administration is not rushing to put a lot of political capital on the issue of abortion if they can avoid it,” said Patrick Brown, a fellow with the conservative think tank Ethics and Public Policy Center, which has been a key player in the debate over abortion restrictions in Obamacare. “It’s not something I think they have any interest in highlighting.”
The abortion standoff is just one of many factors complicating a proposed deal to extend insurance subsidies. Persistent divisions remain over who should qualify for such subsidies, the generosity of them, and the scope of health services covered.
Any agreement would need Trump’s blessing, granting Republicans political cover to support an extension of the health reform law they have opposed for over a decade. However, given the difficult landscape, conservative lobbyists are doubtful that passage is possible even if Trump endorsed abortion restrictions. Those closely watching lawmakers indicate that it’s unlikely an, the subsidies could secure the required 60 votes in the Senate — or even 50.
“It’d be very difficult, even if they do it through reconciliation,” said Tom McClusky, the director of government affairs for Catholic Vote. “On the subsidies alone, I think you have a large enough contingent on the Republican side that don’t want them renewed at all — regardless of if you can somehow miraculously figure out the protections of Hyde.”
Since its introduction over a decade ago, the Affordable Care Act has prohibited federal subsidies from paying for abortions, allowing states the discretion to determine whether health insurance plans in the individual market could cover abortion using other funding sources.
Half of the states have opted to ban all coverage of abortion on their Obamacare markets, including some where abortion itself is legal, like Pennsylvania and Arizona. In the remaining 25 states, abortion coverage through Obamacare is either allowed or required, though any claims paid out regarding the termination of a pregnancy come from a separate account that doesn’t use any federal subsidies.
If Congress passes an Obamacare subsidy extension that includes the abortion restrictions conservatives are demanding, it would compel roughly a dozen states where abortion coverage is mandatory to make a tough decision: change their laws or risk losing billions of dollars. In the states where abortion coverage is allowed but not required, it would be up to individual insurance plans whether to lose federal funding or drop abortion coverage.
After nearly a year of the Trump administration clawing power away from Capitol Hill and dictating everything from spending to military action, some anti-abortion advocates are bewildered by the lack of a firm message on how the Hyde amendment’s ban on abortion funding applies to Obamacare.
“It’s in tension with this administration’s broader approach to dealing with Congress, which has been very heavy-handed — sort of, ‘We are calling the shots. Sit back and let us drive,’” said Brown. “But it would be their preference to sit in the back seat on that issue specifically.”
Benjamin Guggenheim contributed to this report.