NEW YORK – New York Attorney General Letitia James today led a coalition of 20 attorneys general in urging congressional leaders to reject proposals that would tie an extension of Affordable Care Act (ACA) premium tax credits to new federal restrictions on abortion coverage. In a letter to Senate Majority Leader John Thune, Senate Minority Leader Chuck Schumer, House Speaker Mike Johnson, and House Minority Leader Hakeem Jeffries, Attorney General James and the coalition warn that conditioning vital health care subsidies on imposing new federal restrictions on abortion coverage would intrude on states’ authority to set health care policy and jeopardize access to essential health care for millions of residents across their states.

“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 significantly reduce monthly health insurance costs for millions of Americans by lowering what families pay for plans purchased through state and federal marketplaces. These subsidies have become a cornerstone of the ACA and are particularly critical for families with low and moderate incomes. However, the credits are set to expire at the end of the year unless Congress acts, which would cause premiums to spike nationwide.

Recent reporting indicates that some members of Congress are seeking to exploit this deadline by demanding that any extension of the subsidies include unlawful restrictions on marketplace plans that would prohibit coverage of abortion, even in states where such coverage is required or authorized under state law. The ACA already prohibits the use of federal funds for abortion. This proposal would extend that restriction by prohibiting states from requiring or even permitting plans to provide abortion coverage through other means.

Attorney General James and the coalition emphasize that the ACA was designed to give states broad flexibility in determining the benefits offered in marketplace plans, including whether to require, permit, or restrict abortion coverage. More than a dozen states currently mandate or allow abortion coverage in their marketplaces as part of their longstanding authority to protect the health, safety, and welfare of their residents. A new federal restriction would be an unprecedented intrusion on state authority over public health, an authority the Tenth Amendment gives squarely to the states.

The coalition also warns that such restrictions would have immediate and far-reaching consequences. Millions of people rely on marketplace plans that include abortion coverage. Eliminating their ability to use federal tax credits for that coverage would force patients to pay significantly more for reproductive health care out of pocket, delay medically necessary treatment, or forgo care entirely. These impacts would fall hardest on lower-income residents, people with complex pregnancies, and those living in regions where reproductive health services are already limited.

Attorney General James and the coalition also reject claims that ACA subsidies fund abortion care, noting that federal law has long prohibited the use of premium tax credits for abortion services. Under the ACA’s existing framework – a compromise reached more than a decade and a half ago – marketplace plans that cover abortion must collect and segregate a separate $1 monthly premium from enrollees to pay for abortion services. These funds do not come from federal subsidies, and in many states the amount collected from this $1 premium exceeds the total annual cost of abortion claims. The attorneys general note that efforts to suggest otherwise are misleading and are part of a broader pattern of federal attempts to restrict reproductive health care.

The attorneys general caution that any attempt to limit abortion coverage will be deeply unpopular. Public support for abortion access remains strong: 63 percent of Americans believe abortion should be legal in all or most cases, and nearly one in four people will obtain an abortion in their lifetime. The attorneys general warn that enacting a sweeping backdoor ban through ACA negotiations would counter public opinion and further erode trust in the federal government’s willingness to protect essential health care.

Attorney General James and the coalition are urging Congress to reject any proposal that uses health care subsidies as leverage to restrict reproductive rights, undermine state authority, or threaten residents’ access to safe, legal, and medically necessary health care.

Joining Attorney General James in sending the letter, which was co-led by Massachusetts Attorney General Andrea Campbell, are the attorneys general of Arizona, California, Colorado, Connecticut, Hawaii, Illinois, Maine, Maryland, Michigan, Minnesota, Nevada, New Jersey, New Mexico, North Carolina, Oregon, Rhode Island, Vermont, Washington, and the District of Columbia.