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How abortion coverage threatens to prevent a congressional deal on health care subsidies

At the end of the week, bipartisan Senate negotiators appeared near collapse as the abortion dispute blocked a deal to revive enhanced ACA marketplace subsidies expired on Jan. 1.
Republicans in Congress sought stronger curbs on abortion coverage in ACA marketplace plans, but Democrats in Congress resisted altering the Affordable Care Act compromise after the Supreme Court decision overturning Roe v. Wade .
Negotiators had narrowed a two-year compromise to extend enhanced subsidies with added limits and an HSA option, while states remain divided: 25 prohibit, 12 require, and 13 plus DC have no abortion coverage limits.
The stalemate risks higher costs for enrollees as millions of ACA enrollees face more than double monthly premiums for 2026, despite the House of Representatives passing an extension with 17 Republicans voting with Democrats.
The dispute has roots in pre-2010 negotiations, as the original ACA compromise barred federal funds for elective abortions while allowing state plans to cover them, but some critics call segregated funds a `gimmick` and warn of midterm elections consequences this year.

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