Sponsor
Roger Wayne Marshall
Senator · R-KS
Senator · R-KS
The bill improves clarity and narrows ambiguous HSA/HDHP rules while expanding some allowable HSA uses and permitting deductions for health-care-sharing payments—trading clearer administration and targeted access improvements for reduced HSA eligibility, shifted tax benefits toward higher‑income filers, potential revenue loss, and added administrative burdens.
Taxpayers, employers, and the IRS: HSA and HDHP rules are clarified and simplified (monthly HSA eligibility, clearer cross‑references, and a streamlined HDHP statutory test), reducing confusion and IRS disputes.
Patients with chronic conditions and HSA holders: HSA funds may be used for periodic physician access fees and prepaid preventive/diagnostic services, increasing affordable access to certain care and reducing tax risk when paying for those services.
Members of health care sharing ministries who itemize: Payments to health care sharing ministries can be deducted as medical expenses beginning in 2027, lowering taxable income for eligible filers.
People covered by Medicare, Medicaid, CHIP, federal employee health plans, or health care sharing ministries: Barred from contributing to HSAs and thus lose access to tax-advantaged medical savings, raising after-tax costs for many who relied on HSAs.
Taxpayers in some employer plans: Narrowing the HDHP statutory scope may disqualify certain plans from HDHP status, making HSA contributions ineligible and reducing tax-advantaged savings for affected enrollees.
Low-income people and patients with chronic conditions: Restricting HSA/MSA reimbursement for OTC items to prescription-only will raise out-of-pocket costs or force extra doctor visits to obtain prescriptions.
Based on analysis of 7 sections of legislative text.
Narrows HSA/HDHP rules, excludes health care sharing ministries from qualifying plans while allowing HCSM payments as itemized medical deductions, and limits HSA/MSA OTC drug reimbursements to prescribed drugs or insulin.
Introduced April 21, 2026 by Roger Wayne Marshall · Last progress April 21, 2026
Makes multiple changes to tax rules for Health Savings Accounts (HSAs), Archer MSAs, and the medical expense deduction starting in taxable years after Dec 31, 2026. It narrows which health plans count as qualifying high-deductible health plans, adds new disqualifying coverage categories for HSA eligibility (including many government plans and participation in health care sharing ministries), restricts HSA/MSA reimbursement of over-the-counter medicines to prescribed drugs or insulin, and explicitly allows payments to health care sharing ministries to be treated as deductible medical expenses under the itemized medical deduction.