A congressional fight over abortion coverage in Obamacare plans is shaping up as an existential battle for anti-abortion organizations.
Anti-abortion advocates have ramped up the pressure on Republicans as the legislature attempts to hammer out a solution to the expiration of enhanced subsidies for Affordable Care Act insurance plans passed by Democrats as part of COVID-19 pandemic relief efforts, even as the White House has reportedly asked the activists to stand down.
Opponents of abortion have long argued that subsidies for plans offered through the Obamacare exchanges effectively allow for federal dollars to flow to abortion services.
Because Obamacare is not funded annually through the appropriations process, it is not required to follow the rules of the Hyde Amendment, which prohibits federal funding for abortions, except in rare instances of rape, incest, or life-threatening complications.
But President Donald Trump and his advisers are reportedly putting pressure on Republicans in Congress not to insist on Hyde restrictions on Obamacare subsidies, in the hope of coming to some sort of agreement to pass a bill through the 60-vote majority in the Senate.
Whether congressional Republicans stand with the anti-abortion movement in defiance of the White House will be a significant test for anti-abortion organizations, who have lost a degree of political clout in the GOP since the overturning of Roe v. Wade in 2022.
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Kelsey Pritchard, communications director for Susan B. Anthony Pro-Life America, told the Washington Examiner that permanently incorporating Hyde Amendment language into a GOP Obamacare reform package would be the largest victory for the anti-abortion movement since the Dobbs v. Jackson Women’s Health Organization Supreme Court decision, which overturned Roe.
“We’ve never had Hyde protections, and to see the Republicans hold strong on this would be a huge policy victory for the pro-life movement, showing our might and how important it is that Republicans remember and respect their pro-life values and the pro-life base out there, because they can’t win elections without them,” Pritchard said.
Anti-abortion movement at odds with Trump 2.0 post-Roe
The fight over abortion in the Obamacare subsidies marks the most recent of several conflicts between the Trump administration and the anti-abortion wing of the Republican Party.
During his 2024 presidential campaign, Trump took credit for appointing the three Supreme Court justices who ultimately overturned Roe, but he also strong-armed the GOP convention into removing long-standing anti-abortion language from the party platform. He also repeatedly refused to endorse a 15-week abortion ban, despite pressure from his base, including his previous vice president, Mike Pence.
Tensions between the anti-abortion movement and the Trump administration mounted this week with reports that the Food and Drug Administration has been slow-walking a long-promised safety review of the abortion pill mifepristone to push it beyond the 2026 midterm elections. In response, leading anti-abortion advocates called for FDA Commissioner Dr. Marty Makary to be fired. The White House has stood behind him.
Religious conservatives in particular have interpreted the response to Trump from some of the leading anti-abortion groups as a sign of weakness and disorganization since Dobbs.
Patrick T. Brown, fellow at the conservative Ethics and Public Policy Center, told the Washington Examiner that overturning Roe was “kind of a unifying goal for a lot of conservatives” and that the movement has had a difficult time coalescing since then.
Brown said that the push from anti-abortion groups to apply Hyde language to Obamacare subsidies, with or without support from Trump, “is just another example of how the post-Roe policy is very tricky for the pro-life movement.”
“This White House is not one that wants to put a lot of political capital behind the issue of abortion,” Brown said.
Hyde on the horizon in GOP bill
GOP strategist Gregg Keller told the Washington Examiner that whether Hyde language ends up in the Republican Obamacare reform bill will depend on House Speaker Mike Johnson (R-LA), largely due to his role in ensuring Republicans maintain a majority in the lower chamber after the 2026 elections.
Johnson has been a staunch opponent of abortion and was a key figure in making sure that the One Big Beautiful Bill Act, the major GOP tax and spending bill passed this summer, defunded Planned Parenthood, a long-term goal of the anti-abortion movement.
Keller said that he believes Johnson “is going to stick with the pro-life groups on this issue.” From there, he said it would be a matter of how much the Republican caucus trusts him to follow his lead.
A spokesperson for Johnson did not respond to the Washington Examiner’s request for comment on where the Republican leader stands on including Hyde Amendment language.
But the fateful test for the anti-abortion movement will come first in the Senate, which is scheduled to vote on the GOP’s Obamacare subsidies on Thursday.
The Republican legislation, written by Sens. Mike Crapo (R-ID) and Bill Cassidy (R-LA), lets the expiring enhanced subsidies lapse and instead replaces them with health savings accounts for patients who purchase high-deductible insurance plans on the exchange.
The Crapo-Cassidy bill prevents those HSA dollars and other federal Obamacare subsidies from being used to fund elective abortions or gender transition medical services, a provision that some advocates have dubbed “Hyde-plus.”
Senate Majority Leader John Thune (R-SD) has said in recent weeks that a compromise measure with Democrats for a one-year extension of the subsidies would not pass without Hyde provisions. More recently, he has softened his rhetoric, suggesting the anti-abortion language may not be a top priority.
“There are conversations that continue, but as you know, the Hyde issue is a difficult and challenging one on both sides,” Thune told reporters last week.
2026 election implications leverage
At least three anti-abortion groups have warned both the White House and GOP lawmakers that they will score any legislation regarding the expiring enhanced subsidies ahead of next year’s elections.
SBA Pro-Life America, Students for Life, and the Family Research Council each told the Washington Examiner that they have communicated to GOP lawmakers that they will be recording each member’s vote on Obamacare bills with Hyde language and use it in their respective “pro-life scorecards,” which track the anti-abortion records of lawmakers.
Kristi Hamrick, vice president of media for Students for Life, told the Washington Examiner that holding politicians accountable in this way is “the beauty of democracy.”
“We will score the vote, and we will hold people accountable for how they vote on this. There are a lot of reasons to think that Obamacare is a hot mess, and there are a lot of reasons to fix it, but to extend it makes no sense, either fiscally or morally,” Hamrick said.
Several of the anti-abortion groups are also pouring millions of dollars into the 2026 midterm election cycle, with SBA Pro-Life investing $80 million to boost the GOP’s efforts to keep majorities in both the House and Senate. The money will be spent in four battleground states by contacting 10.5 million voters, including knocking on 4.5 million doors in Iowa, Georgia, Michigan, and North Carolina.
Pritchard from SBA said that 60% of voters oppose taxpayer funding of abortion, a sign that Democrats are “out of step on this specific part of the issue.”
“Republicans need to lean in on that and remember that their stance here is the popular one, and they should just never take their pro-life base for granted,” Pritchard said. “It’s not a smart political move.”
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At the same time, Trump would put Republican members in a tough position if he tried to muscle through legislation without prohibitions on abortion coverage. But Tony Perkins, president of the Family Research Council, said that lawmakers are likely more concerned about preserving their careers as Trump enters a lame-duck era after 2026.
“Who’s going to be around longer?” asked Perkins. “I’ve been here in D.C. for 20 years. There is an element of self-preservation … Do you want someone running against you that pointed out that you voted for federal funding of abortion if you’re running in a solid conservative district from a red state?”
