Never ones to let a crisis go to waste, anti-abortion advocates are trying to hijack the ongoing negotiations over extending the Affordable Care Act’s enhanced premium tax credits (ePTCs) to attack abortion coverage in the ACA Marketplaces. They are outright ignoring the history and letter of the ACA, which explicitly prevents any federal funding from being used to cover abortion services. Instead, they are peddling false claims about taxpayer funding in their demands for a “complete application” of the Hyde Amendment, a federal budget rider that has long restricted federal funding for abortion coverage to narrow exceptions for cases of rape, incest, or life endangerment, to any ePTC extension.
In contrast to their bogus claims, Section 1303 of the ACA unequivocally prohibits any federally funded premium tax credits or cost-sharing reductions from being used to pay for abortion coverage. It goes even further by requiring Marketplace insurers to charge each enrollee at least $1 in a separate abortion premium that must be maintained in a segregated account abortion claims may ONLY be paid out of that account. Federal law is extremely clear that any claims for abortion services may ONLY be paid using these segregated funds. Additionally, an executive order further clarified that the ACA “maintains current Hyde Amendment restrictions governing abortion policy and extends those restrictions to” Marketplace plans.
Instead of treating it like the basic health care service it is, the ACA delegated regulation of abortion coverage to the states, allowing them to ban or mandate abortion coverage in private and Marketplace plans. In response, more than half (twenty-six states) enacted coverage bans. Only twelve states require Marketplace plans to provide comprehensive abortion coverage and the remaining eleven states plus the District of Columbia have no coverage restrictions or mandates. For many Marketplace enrollees, where you live often determines whether or not your insurance plan provides coverage for abortion care.
Comprehensive insurance coverage represents one of the most important factors in facilitating equitable abortion access. When people don’t have insurance coverage of abortion, it forces them to pay out-of-pocket for services, with the average costs ranging from $500 to well over $1000. These costs can be catastrophic for the average household and research has shown that the unexpected out-of-pocket costs can force pregnant people to defer paying for rent, utilities, and other basic necessities. Some are forced to delay obtaining care in order to raise enough funds, pushing them further into the pregnancy and escalating the costs. Abortion coverage is crucial for ensuring people can get access to the care they need, when they need it. Insurance coverage can be the difference in preventing people from draining their bank accounts or being forced to carry a pregnancy to term. Comprehensive coverage is a crucial part of destigmatizing abortion and treating it just like the basic health care service it is – which is exactly why anti-abortion advocates attack coverage policies so fervently.
So, what do tax credits have to do with abortion? Nothing. But let’s be clear – the current push to “apply” Hyde to an ePTC extension isn’t based in reality. These are not good faith arguments but rather an attempt to rewrite the history and letter of the ACA in service of an ideological agenda to eliminate all abortion access through any means necessary. Hijacking the ePTC negotiations and risking the health care of millions of people simply provides a new opportunity for these extremists to further target abortion coverage and undermine access.
Caving to the false claims peddled by those demanding a “complete application” of Hyde would fundamentally disrupt the Marketplaces across the country. This will further threaten the viability of the individual market in states that are already facing questions about whether the ACA can survive in an environment in which federal policymakers are intent on making coverage more expensive and harder to get. Lawmakers must not capitulate to another thinly-veiled attempt to weaken the ACA. Those in Congress who believe in reproductive freedom and affordable health care access must reject these attempts to use the time-sensitive ePTC negotiations to hold Marketplace abortion coverage hostage.
The ePTCs must be permanently extended to ensure the millions of people in the U.S. who currently rely on them can continue to access affordable health insurance. They have been crucial for making affordable health insurance accessible for millions of Marketplace enrollees. If these essential affordability protections are allowed to expire at the end of the year, almost 4 million people will lose coverage and the average household will pay 75% more for its premiums. Swift action to secure a permanent extension and avoid these coverage losses and price hikes is urgently needed. But the price of such a deal cannot be Marketplace abortion coverage.
