21-State Coalition Urges Congress to Protect ACA Tax Credits and State Abortion Coverage Authority

A coalition of 21 states led by Massachusetts Attorney General Andrea Joy Campbell sent a letter urging Congress to reject proposals linking the extension of Enhanced Premium Tax Credits under the Affordable Care Act (ACA) to restrictions prohibiting abortion coverage in ACA insurance plans. This coalition argues that such restrictions violate state sovereignty, conflict with existing laws, and reduce access to critical healthcare services. The ACA's tax credits, which help millions afford healthcare, are set to expire, and conditioning their extension on abortion coverage bans could lead to increased healthcare costs and limited reproductive care for many Americans, including thousands in Massachusetts. The coalition highlights that federal funds do not finance abortion services in Massachusetts or the other states, countering claims by some lawmakers. Existing laws prevent federal dollars from paying for abortions, and plans covering abortion services typically charge enrollees separately for these costs. The letter emphasizes the importance of states' rights to regulate healthcare policies tailored to their residents, consistent with the ACA's framework. The discussion is framed within broader concerns about reproductive healthcare access, especially following recent legal changes affecting abortion rights. States that restrict abortion services have reportedly seen increases in negative health outcomes such as sepsis and pregnancy-related deaths. The coalition views the proposed abortion coverage restrictions as a continuation of federal attempts to limit access to reproductive healthcare, referencing prior federal efforts that faced legal challenges. This action reflects ongoing tensions between federal policymaking and states’ regulatory authority over healthcare and reproductive services. The letter requests congressional leadership to uphold state sovereignty by rejecting measures that would constrain affordable, comprehensive healthcare options, including reproductive health coverage. The coalition includes attorneys general from diverse states, signaling a broad consensus on protecting state-level healthcare governance and access to reproductive care.