New York Attorney General Letitia James has led a group of 20 attorneys general in urging congressional leaders to reject proposals that would link the extension of Affordable Care Act (ACA) premium tax credits to new federal restrictions on abortion coverage. The coalition sent a letter to Senate Majority Leader John Thune, Senate Minority Leader Chuck Schumer, House Speaker Mike Johnson, and House Minority Leader Hakeem Jeffries expressing concern that such measures would interfere with states’ authority over health care policy and limit access to essential services for millions.
“Congress should be working to lower health care costs, not using Americans’ coverage as leverage to advance a dangerous anti-abortion agenda,” said Attorney General James. “Health care decisions belong to patients and their doctors, and the federal government has no right to take that choice away. Any backroom deal that attempts to force a backdoor national abortion ban endangers Americans and must be rejected.”
The ACA premium tax credits help reduce monthly insurance costs for many Americans by lowering what families pay for plans through state and federal marketplaces. These subsidies are particularly important for low- and moderate-income families but are set to expire at the end of the year unless Congress acts. If they expire, premiums could rise across the country.
Reports have indicated that some lawmakers want any extension of these subsidies tied to new restrictions on marketplace plans prohibiting abortion coverage—even in states where such coverage is required or allowed by law. The ACA already bars federal funds from being used for abortion services, but this proposal would go further by stopping states from requiring or permitting plans to offer abortion coverage through other means.
Attorney General James and her colleagues argue that the ACA was intended to allow states flexibility in deciding which benefits marketplace plans provide, including rules about abortion coverage. Over a dozen states currently require or permit such coverage as part of their role in protecting residents’ health and welfare. Imposing new federal limits would represent an unprecedented challenge to state control over public health—a power reserved for states under the Tenth Amendment.
The coalition warns that these proposed restrictions could have immediate effects: millions rely on marketplace plans covering abortion services, and removing their ability to use tax credits for this purpose could increase out-of-pocket costs, delay necessary treatment, or cause some people—especially those with lower incomes or complex pregnancies—to skip care altogether.
They also dispute claims that ACA subsidies fund abortions. Under current law, marketplace plans covering abortion must collect a separate $1 monthly premium from enrollees specifically for those services; these funds do not come from federal subsidies. In many cases, the amount collected exceeds annual costs related to abortion claims.
Public support remains strong for access to abortion: 63 percent of Americans believe it should be legal in all or most cases, according to recent polling data. Nearly one in four people will obtain an abortion during their lifetime. The attorneys general warn that imposing new restrictions through ACA negotiations would go against public opinion and further erode trust in the government’s commitment to safeguarding essential health care.
Joining Attorney General James on this letter were Massachusetts Attorney General Andrea Campbell (co-lead), along with attorneys general from Arizona, California, Colorado, Connecticut, Hawaii, Illinois, Maine, Maryland, Michigan, Minnesota, Nevada, New Jersey, New Mexico, North Carolina, Oregon, Rhode Island, Vermont, Washington State and the District of Columbia.