This proposal would change tax rules so most abortions could not be paid for with pre-tax health accounts. It would block using health savings accounts (HSAs), Archer MSAs, flexible spending accounts (FSAs), health reimbursement arrangements (HRAs), and retiree health accounts for abortions, except in limited cases. The exceptions are when the pregnancy is from rape or incest, or when a doctor certifies the abortion is needed because of a physical disorder, injury, or illness that would put the woman’s life at risk if the pregnancy continues. These limits start with tax years after December 31, 2025 .

Key points

• Who is affected: People using HSAs, Archer MSAs, FSAs, HRAs, or retiree health accounts; employers and plan administrators for these benefits.
• What changes: Abortion costs would not count as “qualified medical expenses,” so they couldn’t be paid or reimbursed with pre-tax dollars through these accounts, except for the noted cases of rape, incest, or life-threatening conditions certified by a physician .
• When: Applies to amounts paid and reimbursements for tax years beginning after December 31, 2025.