Josh Hawley wants to cut taxes on health care. Wait until you hear what it includes | Opinion
Missouri Republican Sen. Josh Hawley is a font of interesting ideas. His latest is to add health care to the Trump administration’s tax mantra of “no tax on tips” and “no tax on overtime.” Hawley reports that Trump is intrigued by the idea proposed as a fallback position if Democrats and Republicans are unable to come to agreement on making the Biden administration’s temporary Obamacare subsidies more permanent.
Hawley’s “no tax on health care” proposal is to add up to $25,000 of medical expenses (including your premiums!) to the standard deduction so that you wouldn’t pay any income taxes on those expenses.
Sounds great. It is especially attractive to me in that I am sick of guessing how much my out-of-pocket medical expenses are every year in order to use my employer’s standard medical expense account that must be used up by the new year. Hawley’s plan would cover them all, unlike the tax system we have now that lets you deduct medical expenses only if they are over 7.5% of your adjusted gross income.
But there are a few caveats. For one thing, most of the people on the lower half of the income scale already pay zero income tax after things like the child tax credit and the earned income tax credit are figured in. So who benefits from this break that Hawley pitches as for the “working class”? Generally, it will go to people who make more than average income.
That’s fine with me, but it is not what Hawley is saying.
In any case, that’s not the big problem with the idea though. The big problem is deciding what is health care. At first glance, it would seem easy, but then I read the 15,000 word IRS rulebook for deducting health care expenses that only an accountant could love, or maybe a creative tax cheat.
To begin with, Republicans are going to have a hard time swallowing the fact that the IRS says abortion is health care. If Joe Biden had suggested a tax break for abortion, the Republican screams would have been heard past Jupiter. But it looks like that is what Josh Hawley proposed. Tell me again how these MAGA-types are the real conservatives.
Anyway, it was just weeks ago that Hawley was railing against medical abortions and Food and Drug Administration rules. Wait til he reads the Internal Revenue Service rules, which incidentally cover transgender surgeries, puberty blockers and hormones — even for minors, something else Hawley doesn’t like. Hawley’s office did not respond when I raised these issues in an email, but accountants I talked to who work with these rules say such things are covered under the general categories of surgery and medicine, since they are approved as standard care by medical governing bodies such as the American Academy of Pediatrics.
Dental implants, pet medical care, Ozempic
Some of the IRS rules are easy to understand — breast implants are medical care when they are used for reconstruction after breast cancer or other medical conditions, but not when they are used for, well, improving the scenery. But dental implants are covered, I am told, whether their primary reason is cosmetic or not.
There are rules for when an animal’s medical expenses are covered, when improvements to your house make the grade, when your trips and what expenses on your trips are covered, as well as baby milk accoutrements (breast pump yes, storage bottles no). There are even rules covering medical care for dead people.
Oh, then there is the Ozempic clause. It turns out that most things your doctor does to help you lose weight are included, except joining a gym. That means that our local Missouri senator has just proposed to make Ozempic tax-deductible for all Americans. I think maybe we should have a debate about that.
But just wait until the tax cheats get a hold of this thing. Is the IRS going to check whether you were actually driving to the doctor or flying to a medical conference when you deduct your family plane tickets or fill-up receipts? Who is going to be the IRS guardian of the line between legitimate seeing eye dogs and standard-issue pets with bogus emotional support animal credentials? Are you going to have to prove you had cancer before you deduct breast implants?
And what about plain old people just trying to do the right thing? Adding another 15,000-word set of rules for regular people with the simplest taxes doesn’t sound like an improvement to me. We already spend an average of 13 hours on these darned things, and if Hawley’s proposal goes through it will only get longer.
I don’t know Sen. Hawley, maybe we should reconsider. Let me go check the rules and see if that is deductible.
David Mastio is a national columnist for The Kansas City Star and McClatchy.
This story was originally published December 5, 2025 at 5:07 AM.
