Proposed HEALTH Act Offers Doctors Tax Deduction for Charity Care, Starting 2026, But Excludes Gender-Affirming Services

The proposed Helping Everyone Access Long Term Healthcare Act of 2025 (HEALTH Act) aims to boost the amount of free medical care available to low-income patients by giving physicians a new financial incentive. Starting in 2026, the bill creates a federal tax deduction for doctors who provide charity care to individuals enrolled in Medicaid or the Children’s Health Insurance Program (CHIP). The deduction is based on the “unreimbursed Medicare-based value” of the services provided, meaning doctors can deduct the amount Medicare would have paid for that service, even if they don't itemize their taxes (Section 2).

The Trade-Off: Tax Breaks and Liability Shields

This isn't just about tax relief; it’s also about legal protection. The bill establishes a federal liability shield for physicians and their medical staff when they provide this qualified charity care (Section 3). Essentially, if a doctor provides free care, they cannot be sued in a civil court for harm unless their actions were determined to be intentional, knowing, reckless, or grossly negligent. This federal protection overrides inconsistent state laws, unless the state law offers even stronger protection. For a doctor in a high-risk specialty, this significantly reduces the personal risk of providing uncompensated care, potentially encouraging them to take on more pro bono work for families who really need it.

The Fine Print: What Counts as 'Qualified Care'

Here’s where the bill gets specific about who benefits and who doesn't. While the overall goal is to increase access for Medicaid and CHIP patients, the definition of “qualified charity care” explicitly excludes two categories of services: sex reassignment surgeries and hormone treatments for the gender alteration of a transgender individual (Section 2). This means a doctor could provide a free appendectomy or a free annual physical to a low-income patient and claim the tax deduction and liability protection, but if they provide free gender-affirming care, they receive neither benefit under this program. For patients seeking gender-affirming care and the doctors who provide it, this provision effectively walls off that area of medicine from the incentives and protections offered by the HEALTH Act.

Real-World Impact: Access vs. Exclusion

For a single parent relying on Medicaid, this bill could mean greater access to specialist care if doctors, motivated by the tax deduction, open up more slots for charity work. Instead of waiting months for an appointment, they might get seen sooner. The fact that the deduction is based on the Medicare rate provides a standard, measurable value for the care provided. However, the explicit exclusion of gender-affirming care means that while the bill attempts to broaden access generally, it simultaneously creates a clear disincentive for physicians to provide that specific type of specialized care free of charge. This sends a clear signal about which types of medical services the federal government is willing to subsidize and protect under this new program.