Washington, D.C. –
According to a U.S. Government Accountability Office (GAO) report (GAO-26-108995) requested by Sen. James Lankford (R-OK) and 17 other members of Congress and released last month, 1,719 Affordable Care Act (ACA) qualified health plans—representing about 26% of all qualified health plans—covered elective abortion services in 2026.
Under Section 1303 of the ACA, private insurers offering plans on the health care exchange are permitted to cover elective abortions but, in keeping with the 1976-passed Hyde Amendment, they must strictly separate federal subsidies from private premium dollars:
- No Federal Funding: Federal funds—such as premium tax credits or cost-sharing reductions—cannot be used to pay for elective (“non-Hyde”) abortion services. They may only pay for abortion care in cases of rape, incest, or life endangerment.
- Segregation of Funds: To remain compliant, insurers that choose to offer elective abortion coverage must calculate the exact cost of the abortion benefit (which must be at least $1 per enrollee per month). They must segregate those specific funds into a separate, private allocation account used exclusively to pay for those services.
The GAO report summary states:
“Federal law places requirements on the provision of non-excepted abortion services coverage, including requiring issuers to estimate the costs of this coverage at no less than $1 per enrollee, per month. All 15 selected issuers in 10 selected states from which GAO obtained information reported that the average estimated cost of this coverage was less than $1 per enrollee, per month, and that premium amounts were set to $1 to comply with federal requirements. Eleven selected issuers indicate on bills to enrollees or in plan materials that part of the premium is for non-excepted abortion services coverage. All 15 issuers reported that information about this coverage is in publicly available documents.
“According to GAO’s review of documents and interviews with Centers for Medicare & Medicaid Services (CMS) officials, the agency provides general guidance to states and issuers on how to comply with federal regulations on coverage of non-excepted abortion services. For example, CMS provides issuers templates for submitting information on coverage of these and other services on standardized benefits and coverage documents. CMS officials told GAO that the oversight of this coverage also differs based on the type of exchange. States with state-based exchanges, according to CMS officials, retain the role of regulating insurance, and as a result, maintain a prominent role in QHP certification.
“GAO identified instances where issuers’ practices may have been inconsistent with federal requirements related to non-excepted abortion services coverage. In August 2026, CMS officials stated that they would determine what actions to take, depending upon the facts of the situation.”
Other key findings from the report:
- Enrollment: An estimated 4.4 million individuals are enrolled in these abortion-covering plans.
- Plan Count: Out of 6,655 total qualified health plans nationwide, 1,719 include coverage for non-excepted abortion services (services where the pregnancy is not the result of rape or incest, or where the life of the pregnant woman is not in danger).
- State Variation: Coverage availability varies heavily depending on state laws:
- Prohibited in 14 states
- Permitted in limited circumstances in 11 states
- Generally required in 12 states and the District of Columbia
- No specific laws in 13 states
- Cost Estimates: Selected issuers estimated coverage costs for these services at less than $1 per enrollee per month, often tracking a nominal $1 premium charge to satisfy federal accounting rules, though the GAO noted some potential inconsistencies in issuer compliance
In an interview with Griffin Media Washington Bureau Chief Alex Cameron last month, Sen. Lankford discussed the report — why he requested it and why he feels it’s significant:
LANKFORD: “I simply wanted to ask a question. We’ve had something called the Hyde protections on federal funding for almost 50 years now that said, ‘Okay, we as Americans disagree on the issue of abortion, but we’ve had one agreement, and that is we don’t use federal funds to be able to pay for elective abortions. This is not about rape and incest, this is those elective abortions that are sitting out there, we don’t have federal funds that actually do that. When Obamacare, what’s called the Affordable Care Act, when that was put in place on it, there was supposed to be separate payments, that if your state is going to require abortion funding for your insurance, that had to be paid separately on that. Well, I want to just ask a question: number one, is that happening, or are funds being actually co-mingled? And what we found is about 25% or so of the insurance policies that are being done on the Affordable Care Act, on the exchanges, do offer abortion coverage. There’s the $1 that’s actually set aside, that’s the minimum amount to it. But we do have this exchange system that’s being set up, that is funded with federal dollars, that’s coordinated with federal dollars, that’s also providing for elective abortions. So we didn’t have any data on it, no one’s really asked this question. So I wanted to actually get real data on it then to ask the question, now what do we do about this?
LANKFORD: “Well, the first step was just to be able to expose it and to say this is an issue. We’ve all talked about Hyde protections. We don’t allow federal funds to be co-mingled for elective abortions. Now we know that is occurring, as well, in some administrative structure. Now we’ve got to figure out what are we going to do about that. Obviously, I’ve been pretty outspoken to say I believe every child is valuable. I just do. And I /know some people disagree with me on that. I just think every child is valuable and that we should protect the life of every child. Now we need to have that national conversation that happens behind the scenes that you can only have once you have data in front of you… So, we now know the numbers. We now know what policies those are and what states those are coming from. And then it starts a dialog with those sta/tes and with us nationally, quite frankly, to try to figure out what are we can do about this.
LANKFORD: “This is a gray area, quite frankly because, again, originally the way the Affordable Care Act was set up and it was passed into law by Democrats that even passed that said, it’s going to be separate payments. Now that’s being co-mingled. And they will say, ‘Well, the insurance companies are separating the dollars out’, but it’s not actually separate payments. Literally, the term that was used was ‘separate means the same.’ It was like, well, separate doesn’t mean the same — we’ve got to figure out what this actually means in statute and to be able to actually enforce the statute there. But then the question is administrative dollars, other dollars that are going into to support the Affordable Care Act, how much of that is going into the structure to support this? Because that’s also prohibited under Hyde. So, it’s a gray area right now, and we’re raising this as an issue to say it exists. What are we going to do about it?”
