Overview

The Abortion Is Not Health Care Act of 2025 fundamentally restructures the federal tax treatment of abortion expenses by categorically excluding them from the medical expense deduction available under the Internal Revenue Code. The bill operates through a targeted amendment to IRC Section 213, which currently allows taxpayers who itemize deductions to claim qualifying medical expenses exceeding 7.5% of their adjusted gross income. By creating a new subsection that explicitly removes abortion-related payments from the calculation of deductible medical expenses, the legislation embeds a policy declaration in the tax code that abortion does not constitute healthcare for federal tax purposes. The bill establishes a general prohibition on deducting abortion expenses while carving out narrow exceptions for life-threatening medical conditions certified by a physician and for pregnancies resulting from rape or incest. This approach represents an indirect economic restriction on abortion access through tax policy rather than direct prohibition, increasing the after-tax cost of abortion procedures for taxpayers who itemize deductions. The legislation reflects a federal policy alignment with existing abortion funding restrictions like the Hyde Amendment, extending the principle that federal tax benefits should not subsidize abortion services except in limited circumstances.

Legal References

• Internal Revenue Code of 1986, Section 213
• Hyde Amendment

Core Provisions

The bill amends Section 213 of the Internal Revenue Code of 1986 by adding a new subsection (f) titled 'Amounts paid for abortion not taken into account.' The general rule established in subsection (f)(1) provides that any amount paid during the taxable year for an abortion shall not be taken into account under subsection (a) when calculating the medical expense deduction. This categorical exclusion removes abortion expenses from the pool of potentially deductible medical costs regardless of medical necessity or other circumstances. The legislation creates two mandatory exceptions under subsection (f)(2) that preserve deductibility in specific situations. Exception (A) applies when a woman suffers from a physical disorder, physical injury, or physical illness, including specifically a life-endangering physical condition caused by or arising from the pregnancy itself, that would place the woman in danger of death unless an abortion is performed. This exception requires certification by a physician documenting the life-threatening nature of the condition. Exception (B) applies when the pregnancy results from an act of rape or incest, allowing abortion expenses in these circumstances to remain deductible. The amendment applies to taxable years beginning after the date of enactment, creating immediate application once the bill becomes law without any phase-in period or transition provisions.

Key Points

• New IRC Section 213(f)(1): General prohibition on deducting abortion expenses
• Exception 213(f)(2)(A): Life-endangering conditions with physician certification
• Exception 213(f)(2)(B): Pregnancies resulting from rape or incest
• Effective date: Taxable years beginning after enactment

Legal References

• 26 U.S.C. § 213 (Internal Revenue Code Section 213)
• 26 U.S.C. § 213(a) (medical expense deduction base provision)
• 26 U.S.C. § 213(f) (new subsection created by this bill)

Implementation

The Internal Revenue Service bears primary responsibility for implementing and enforcing this tax code amendment through its standard tax return processing, examination, and audit procedures. The IRS will need to develop guidance on documentation requirements for taxpayers claiming the life-endangerment exception, including specifications for physician certifications that must demonstrate danger of death. The agency faces the challenge of creating verification mechanisms for the rape and incest exception without established documentation standards in the legislation. Physicians assume a new gatekeeping role as certifying authorities for the medical necessity exception, creating potential liability concerns and requiring clear standards for what constitutes a life-endangering condition. Taxpayers claiming exceptions must obtain and maintain appropriate documentation, including physician certifications for medical necessity claims and substantiation of rape or incest circumstances. The IRS will need to balance enforcement of the exclusion with medical privacy protections under HIPAA and constitutional privacy concerns. Tax preparers and tax software companies must update their systems to identify and exclude abortion expenses from medical deduction calculations while properly applying the exceptions. The lack of specified regulatory authority in the bill text suggests the Treasury Department may issue implementing regulations under its general rulemaking authority to clarify ambiguous terms and establish uniform procedures.

Key Points

• IRS: Primary enforcement through tax return processing and audits
• Physicians: Certification of life-endangering conditions
• Taxpayers: Documentation and recordkeeping for exceptions
• Treasury Department: Potential regulatory guidance under general authority
• Tax preparers: System updates for expense segregation and exception application

Legal References

• 26 U.S.C. § 7805 (Treasury regulatory authority)
• Health Insurance Portability and Accountability Act (HIPAA)

Impact

The legislation directly affects all U.S. taxpayers who itemize deductions and incur abortion-related expenses, increasing their effective tax burden by eliminating a previously available deduction. The financial impact falls most heavily on middle and upper-income taxpayers who itemize deductions and whose medical expenses exceed the 7.5% adjusted gross income threshold required for deductibility. Lower-income taxpayers who take the standard deduction experience no direct tax impact since they do not claim itemized medical expense deductions. Healthcare providers performing abortions face indirect effects as patients lose tax benefits that partially offset procedure costs, potentially affecting demand and payment capacity. Women with life-threatening pregnancy complications retain access to the tax benefit through the medical necessity exception, preserving deductibility for the most severe health circumstances. Rape and incest survivors similarly maintain deduction eligibility, though they face potential privacy concerns and documentation burdens. The administrative burden increases for all stakeholders, including taxpayers who must segregate abortion expenses from other medical costs, physicians who must provide certifications, and the IRS which must verify exception claims without established medical expertise. The bill contains no sunset provision, making the exclusion permanent absent future legislative action. Revenue estimates and the number of affected taxpayers are not specified in the legislation, though the impact likely affects thousands of taxpayers annually who currently claim medical expense deductions.

Key Points

• Primary beneficiaries: None identified; bill restricts rather than expands benefits
• Affected taxpayers: Those who itemize deductions and incur abortion expenses
• Financial impact: Increased after-tax cost of abortion procedures
• Administrative burden: Documentation, certification, and verification requirements
• No sunset provision: Permanent change to tax code

Legal Framework

The bill operates under Congress's constitutional authority to levy and collect taxes under Article I, Section 8 of the U.S. Constitution, which grants broad power to structure the federal tax system and define what constitutes deductible expenses. The legislation amends the Internal Revenue Code of 1986, the comprehensive statutory framework governing federal taxation, specifically targeting Section 213 which establishes the medical expense deduction. The amendment creates a statutory exclusion rather than a regulatory restriction, requiring full legislative process for any future modifications. The bill does not explicitly address preemption of state tax laws, leaving states free to maintain different tax treatment of abortion expenses in their own tax codes. States that automatically conform to federal tax definitions may need to affirmatively decouple from this provision if they wish to maintain deductibility of abortion expenses under state law. The legislation contains no explicit judicial review provisions, but taxpayers may challenge IRS determinations through the standard tax court procedures and federal court system. Constitutional challenges could arise under multiple theories, including equal protection arguments regarding differential treatment of medical procedures, due process claims concerning reproductive rights, and potential establishment clause issues if the policy is viewed as reflecting religious doctrine. The physician certification requirement creates a delegation of authority to medical professionals to make determinations that affect tax liability, raising questions about appropriate standards and potential liability for certification decisions.

Key Points

• Constitutional basis: Article I, Section 8 (taxing power)
• Statutory framework: Internal Revenue Code of 1986
• State law interaction: No explicit preemption; states may decouple
• Judicial review: Standard tax court and federal court procedures
• Delegation: Physician certification authority for exception determinations

Legal References

• U.S. Constitution, Article I, Section 8
• Internal Revenue Code of 1986
• 26 U.S.C. § 213
• 26 U.S.C. § 6213 (tax court jurisdiction)
• 28 U.S.C. § 1346 (federal court jurisdiction over tax refund suits)

Critical Issues

The legislation faces substantial constitutional challenges under multiple legal theories. Equal protection arguments contend that singling out abortion for exclusion from medical expense deductions constitutes discriminatory treatment of a medical procedure used exclusively by women, potentially violating the Fifth Amendment's equal protection component. Due process challenges may assert that increasing the economic burden of abortion through tax policy creates an undue burden on reproductive rights, though the post-Dobbs constitutional landscape significantly weakens such claims. Privacy concerns arise from requiring taxpayers to disclose abortion-related expenses and rape or incest circumstances on tax returns or during IRS audits, potentially chilling exercise of constitutional rights. The bill's definitional ambiguities create significant implementation challenges, as it fails to define critical terms including 'abortion,' 'physical disorder,' 'physical injury,' 'physical illness,' and 'life-endangering condition.' This lack of clarity invites inconsistent application and litigation over what procedures qualify as abortion versus other gynecological care, particularly for medication abortion, emergency contraception, miscarriage management, and treatment of ectopic pregnancies. The physician certification requirement lacks specified standards for timing, format, physician qualifications, degree of certainty required, and liability protections, creating potential reluctance among physicians to provide certifications. The rape and incest exception contains no documentation requirements, evidentiary standards, or time limitations, raising questions about verification procedures and privacy protections. The IRS lacks medical expertise to evaluate physician certifications or make determinations about life-endangering conditions, yet must enforce these provisions through its audit function. Cost implications remain unspecified, with no revenue estimates or analysis of how many taxpayers currently claim deductions for abortion expenses. The legislation may create unintended consequences including reduced access to abortion services due to increased costs, potential discrimination in physician certification decisions, and conflicts with state laws protecting abortion access or mandating insurance coverage.

Key Points

• Constitutional concerns: Equal protection, due process, privacy rights, establishment clause
• Definitional gaps: No definitions for abortion, life-endangering condition, or qualifying circumstances
• Physician certification: Lack of standards, timing requirements, and liability protections
• Documentation ambiguity: No specified requirements for rape/incest exception
• IRS expertise: Agency lacks medical knowledge to evaluate certifications
• Privacy risks: Disclosure of sensitive medical and criminal information on tax returns
• State conflicts: Potential tension with state abortion protection laws
• Revenue impact: No cost estimates or affected taxpayer analysis provided

Legal References

• U.S. Constitution, Fifth Amendment (due process and equal protection)
• Dobbs v. Jackson Women's Health Organization, 597 U.S. ___ (2022)