Today marks two years since Roe contra Wade was overturned—to horror, or celebration, depending on whom you asked. In the aftermath, 14 states enacted total abortion bans in 2023 alone. In response, other states rushed to protect access—including Colorado, which passed laws affirming the right to abortion and shielding patients and providers from legal threats across state lines.

But if you thought the battle was over—for now, at least—think again.

Tucked inside the One Big Beautiful Bill Act (OBBBA)—a sweeping federal budget bill passed by the U.S. House of Representatives in May and now under consideration in the Senate—is a provision that could make accessing abortion even harder, even in states where it’s legal.

We’re sharing this because access to abortion has real fiscal implications—and because everyone deserves to know what’s at stake, especially when legislation this complex and consequential is moving with little public attention. The OBBBA is a Trojan horse: wrapped in jargon, but carrying policies that would have real, harmful effects on people’s lives. It’s designed to disempower people already living on the margins—those just trying to get by—while delivering massive benefits to the ultra-wealthy. From restricting health care options to slashing economic supports, the OBBBA trades away dignity and opportunity for the many in exchange for even more power and privilege for the few.

One provision of the OBBBA would reinstate federal funding for cost-sharing reductions (CSRs) under the Affordable Care Act—a change that on the surface looks like a win for affordability. But there’s a catch: federal law prohibits CSR funding from going to health plans that cover abortion, except in extremely narrow cases such as rape, incest, or life endangerment. This restriction is made explicit in Section 44126 of the OBBBA (pages 338–339), which bars federal Medicaid funds from going to any entity that provides abortion services outside those exceptions. That means in a state like Colorado—where abortion is legal and constitutionally protected—low-income people could still lose access to affordable health plans that include abortion coverage. And that loss would fall hardest on those already navigating systemic barriers to care: people of color, young people, and low-wage workers.

Learn more about CSRs and “silver loading” from this KFF explainer.

That means in a state like Colorado—where abortion is legal and constitutionally protected—low-income people could still lose access to affordable health plans that include abortion coverage. And that loss would fall hardest on those already navigating systemic barriers to care: people of color, young people, and low-wage workers.

At the Colorado Fiscal Institute, we’ve written about how abortion access is directly linked to economic opportunity. Our research shows that abortion bans worsen health outcomes, limit earnings, raise Medicaid costs, and reduce workforce participation—especially among women and people of color. Meanwhile, states that protect access, such as Colorado, California, and New York, see stronger labor force participation and more equitable economic outcomes.

This is what’s really at stake in the OBBBA: not just tax breaks for billionaires, but the quiet erosion of people’s ability to make decisions about their health, families, and economic futures.

Abortion is health care—and you can’t talk about economic justice without talking about access to health care. When people are denied the ability to make decisions about their own bodies and futures, their economic freedom is denied too. We can’t let Congress trade away that freedom for a windfall to the wealthiest few.