U.S. Senate Majority Leader John Thune

Although the United States remains the only country in the developed world that lacks universal health care, the number of Americans who had no health insurance decreased considerably because of the Affordable Care Act of 2010, a.k.a. Obamacare. Pre-ACA, the National Library of Medicine estimated that around 50 million Americans went without health insurance; in May 2024, under then-President Joe Biden, the U.S. Department of Health and Human Services (HHS) estimated the number to be around 25.5 million — or roughly 7.7 percent of the U.S. population — during 2023's fourth quarter.

But thanks to cuts to Medicaid and Obamacare during Donald Trump's second presidency, the number of Americans without health insurance is expected to soar. The Congressional Budget Office, in August, projected that 14 million Americans will lose health insurance in the coming decade.

In an article published on September 24, Politico reporters Benjamin Guggenheim, Meredith Lee Hill and Alice Miranda Ollstein detail a "messy political battle" among GOP lawmakers in Congress: the fight over ACA subsidies — a fight that, they report, is being complicated by the abortion issue.

"Republican leaders on Capitol Hill were already looking at a messy political battle over the looming expiration of billions of dollars in Obamacare subsidies," the reporters explain. "Then, the anti-abortion advocates showed up. With a possible government shutdown less than a week away, Democrats' big ask is that Republicans agree to extend the Affordable Care Act subsidies, which were expanded by Congress in 2021 and are set to sunset at the end of the year."

Guggenheim, Hill and Ollstein continue, "Insurance premiums are likely to skyrocket this fall without an extension, and some Republicans are open to cutting a deal, mindful that a failure to act could have dire consequences in the midterms. But now, prominent anti-abortion groups are wading into the debate, pounding the halls of Congress to make their case that the enhanced tax credits for ACA insurance premiums function as an indirect subsidy for services designed to end pregnancies. The argument could make conservative Republicans who already loathed the policy dig in further against greenlighting an extension."

The abortion issue, according to the Politico reporters, is "setting the stage for a major internal GOP power struggle that could pit hardliners against moderates in more competitive districts" — and could make it harder for House Speaker Mike Johnson (R-Louisiana) and Senate Majority Leader John Thune (R-South Dakota) to "allow a bipartisan deal to go through."

"The Hyde Amendment, named for the late Rep. Henry Hyde (R-Ill.), bars the use of federal funds to pay for abortion except in cases of rape or incest or when the mother's life is at risk," Guggenheim, Hill and Ollstein note. "Democrats argue the ACA already has guardrails to ensure that the law complies with the Hyde Amendment. They say the health law requires that insurance plans segregate premiums for abortion and non-abortion services into different accounts. But opponents of abortion call that firewall a gimmick, arguing the tax credits effectively subsidize plans that cover abortion regardless of how the premiums are divvied up."

Read the full Politico article at this link.