21 States Challenge ACA Tax Credit Extension with Abortion Coverage Restrictions

Arizona Attorney General Kris Mayes has allied with a coalition of 21 states urging Congress to reject proposals that would condition the extension of the Affordable Care Act's (ACA) Enhanced Premium Tax Credits on prohibiting abortion coverage in ACA insurance plans.

The letter emphasizes that such restrictions would violate state sovereignty, conflict with existing state laws, and endanger access to essential health services. The ACA tax credits, which help reduce healthcare costs for millions, are set to expire at year-end, and the coalition warns that linking their extension to abortion restrictions would raise premiums and limit comprehensive reproductive care for hundreds of thousands of residents.

The coalition highlights that no federal funds are used for abortion coverage in states like Arizona, where enrollees pay separate fees for such services. The proposed stipulation by some Republican lawmakers attempts to impose a federal ban on abortion coverage through Medicaid subsidies, contradicting established state regulations. States have historically maintained authority over healthcare policy, and this move threatens that autonomy by linking federal subsidies to federal policy limitations.

Research underscores the health consequences of limiting abortion access, with increased risks of severe maternal complications in states enforcing restrictions after Roe v. Wade was overturned. The coalition argues that maintaining coverage is critical for protecting public health and safety. This effort reflects broader federal attempts to restrict reproductive rights, following past proposals affecting access to abortion in federal healthcare programs, such as Veterans Affairs medical centers.

Attorney General Mayes and the coalition seek congressional support to uphold states' rights to regulate health plans, preserve affordable coverage options including reproductive services, and reject legislation that would impose a backdoor federal abortion ban through ACA subsidy arrangements. The joint letter represents a significant inter-state effort to preserve healthcare policy independence amid evolving federal legislative debates.