Sen. Josh Hawley (R-Mo.) is pushing a new “No Taxes on Healthcare Act” that would let households deduct up to $25,000 in out‑of‑pocket medical costs, including health insurance premiums they pay themselves.
This proposed deduction would be in addition to the standard deduction, which most taxpayers currently claim.
The proposal comes on the heels of a massive 2025 Trump/GOP tax and spending bill that offers taxpayers several new deductions for car loan interest, overtime pay, and tip income.
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However, Hawley’s proposal, which would have to clear significant political hurdles to advance in Congress, wouldn’t replace the Affordable Care Act (ACA) premium tax credits.
Those credits, which help millions of Americans afford health care premiums, have been at the heart of debate on Capitol Hill since the government shutdown.
So, will there be significant changes to health care tax breaks in 2026?
‘No taxes on health care?
In a release about the bill, Hawley points out that “nearly 41 percent of adults in the United States have some form of debt stemming from medical expenses. In the last year alone, a recent Gallup report found that 31 million Americans borrowed money to pay for healthcare.”
To address that, Hawley’s bill would expand the existing medical expense deduction, which currently is available only to taxpayers who itemize and only for expenses above 7.5% of adjusted gross income.
His plan would move that deduction “above the line,” so that any taxpayer could claim up to $25,000 per person in out‑of‑pocket medical spending, including premiums they pay directly for coverage.
The proposal, announced in early December, is framed as “no taxes on healthcare,” echoing recent GOP slogans like “no tax on tips” and “no tax on overtime.”
What about ACA tax credits?
ACA premium tax credits lower marketplace premiums up front based on income and plan cost, and “enhanced” subsidies created by pandemic‑era legislation are set to expire at the end of 2025 unless Congress acts.
- Hawley’s bill doesn’t extend those ACA subsidies and doesn’t create a new, ACA‑style credit.
- Instead, his proposal offers a separate federal tax deduction that would come into play at filing time, not at the time you purchase a health care plan.
Because deductions reduce taxable income rather than premiums directly, they generally deliver less relief than a dollar‑for‑dollar subsidy, particularly for lower‑income households with little tax liability.
If enhanced ACA credits lapse, many marketplace enrollees could see substantial premium increases in 2026, regardless of Hawley’s idea. Non‑itemizers would still likely be left weighing higher monthly bills against a possible year‑end tax break
Who might benefit?
Generally speaking, an above‑the‑line health deduction would skew toward taxpayers with enough income and out‑of‑pocket costs to fully use it. Think middle‑ and upper‑middle‑income households buying their own coverage without employer help.
Lower‑income consumers who currently rely on ACA subsidies, Medicaid, or employer plans with modest worker premiums might see little or no direct gain from a health care tax deduction like Hawley’s. That’s because they often don’t pay enough income tax to fully benefit from a large deduction.
And…a tax deduction wouldn’t prevent coverage loss for people who can’t afford the higher gross premiums that will come if enhanced ACA credits expire.
Health care premiums: Bottom line
Key mechanics of the Hawley plan remain vague, including a major fiscal issue: how the government would offset the revenue loss from such a significant, broadly available health care tax deduction.
For now, the long and short of it is that Hawley’s bill is just a proposal.
Senate Democrats, meanwhile, continue to push for an extension of ACA subsidies rather than a deduction‑based alternative. So the health care tax debate rages on.
