Congress quietly expands tax breaks for unregulated health ministries

What it does

This bill expands Health Savings Accounts (HSAs) by allowing people covered by government health plans (Medicare, Medicaid, CHIP) and health care sharing ministries to open HSAs, loosens the definition of qualifying high-deductible health plans, permits HSA funds to pay for health insurance premiums directly, and expands what counts as a medical expense to include direct-pay physician arrangements and over-the-counter drugs. The primary beneficiaries are higher-income individuals who can use HSAs as tax-advantaged savings vehicles and the health care sharing ministry sector.

Why we flagged it

The bill's core function is to expand HSA eligibility and tax benefits for higher-income savers, but it also creates a significant regulatory carve-out for health care sharing ministries by exempting them from insurance regulations while allowing their fees to be treated as medical expenses. This dual mechanism—tax expansion plus regulatory exemption—is the bill's true character.

• Sections 5–6 treat health care sharing ministries as non-insurance entities eligible for HSA funding, effectively exempting them from insurance regulation while subsidizing them via tax code.

What the text implies

• Health care sharing ministries are unregulated entities that do not guarantee coverage or payment of claims; allowing HSA funds to pay their fees shifts financial risk from regulated insurers to individuals, particularly lower-income savers who may not understand the difference.
• Expanding HSA eligibility to Medicare and Medicaid beneficiaries may incentivize higher-income seniors and dual-eligible individuals to shift to HSA-compatible plans, potentially destabilizing traditional Medicare and Medicaid risk pools by removing healthier, wealthier enrollees.
• Allowing HSA funds to pay health insurance premiums directly (Section 4) creates a tax arbitrage opportunity: individuals can accumulate HSA balances tax-free and use them to pay premiums, effectively converting ordinary income into tax-free savings.
• The inclusion of direct-pay physician arrangements and prepaid wellness services as qualified medical expenses may incentivize concierge medicine and boutique health services, further stratifying access by income.
• Treating health care sharing ministry fees as medical expenses under Section 213 creates a permanent tax subsidy for an unregulated sector with no consumer protection requirements, audit standards, or solvency guarantees.

Who it affects

While HSA expansion may benefit some individuals with higher incomes and stable employment, it primarily shifts tax revenue away from the general fund (reducing funding for public health, education, and infrastructure) and creates a two-tiered health system where wealthier people can accumulate tax-free savings while lower-income individuals remain dependent on traditional insurance. The inclusion of health care sharing ministries—which lack regulatory oversight and consumer protections—exposes

Who stands to gain

• health care sharing ministries
• high-income individuals and families
• concierge medicine providers
• direct-pay physician practices
• financial services firms managing HSAs

Named in the bill

Internal Revenue Code Section 223, Internal Revenue Code Section 213, Internal Revenue Code Section 5000A, Medicare (Title XVIII, Social Security Act), Medicaid (Title XIX, Social Security Act), CHIP (Title XXI, Social Security Act), Federal Employees Health Benefits Program (Chapter 89, Title 5 USC), Health Care Sharing Ministries, High-Deductible Health Plans (HDHPs)

Where it stands

• Apr 21, 2026 — Introduced · Congress.gov: “Introduced in Senate”
• Apr 21, 2026 — Referred to Senate Committee on Finance · Congress.gov: “Read twice and referred to the Committee on Finance”

Dates and quoted wording are Congress.gov's action record; the timeline shows status changes, not every procedural step.

Money around this bill

1 lobbying clients named this bill on 1 disclosure filings across 1 quarter, Jun 2026 to Jun 2026. Those filings disclosed $30,000 in lobbying spend. A filing names 15 bills on average, so that figure is what each filing reported, not a share belonging to this bill.

More lobbying clients named this bill than 0% of bills with at least one filing.

Roger Marshall, the sponsor, reported $1,777,391 in PAC receipts in the 2026 cycle.

• Ascensus, Inc. — $30,000 on 1 filing

Lobbying Disclosure Act filings through Jul 18, 2026. A filing shows who paid to lobby on a bill it names, not what changed.