The call came in somewhere around the forty-minute mark of a Saturday morning program on Omaha’s KFAB. The host had been taking questions about government benefits for the self-employed, and a woman named Carmen came on the line, voice steady but with an edge to it — the kind of edge that comes from carrying a financial problem for too long. She said she owned an auto shop, had no employer health insurance, and had just finished paying off a credit card she’d maxed out after an emergency appendectomy in 2023. “I just want to know,” she said, “if there was ever anything out there I was supposed to get and didn’t.”
I wrote her name on a notepad and tracked her down the following week. When I finally sat down with Carmen Ramos in late February 2026 at her shop on the south side of Omaha — oil-stained concrete, three bays, a whiteboard covered in job orders — she was already onto her second side hustle of the day. She had flipped a truck engine before 9 a.m. and was researching wholesale auto parts pricing on her phone between sentences. She is forty-three years old and she does not stop moving.
A Medical Emergency With No Safety Net
Carmen has run her shop, Ramos Auto, for eleven years. She nets roughly $78,000 a year after expenses — enough to be comfortable by most measures, but not enough to absorb what happened on October 7, 2023. She woke up with abdominal pain that she initially chalked up to stress. By that evening she was in the emergency room at Nebraska Medicine with a ruptured appendix.
The surgery went well. The bill did not. Carmen had been uninsured for nearly three years at that point — she’d let her previous ACA marketplace plan lapse in 2021 after a premium increase and hadn’t re-enrolled. The final statement from the hospital came to $14,200. After a brief negotiation with the billing department, she got it reduced to $12,600. She put $11,000 of that on two credit cards, both carrying interest rates close to 20 percent.
“I just ground it down,” Carmen told me, leaning against a work bench. “Threw every extra dollar at it for about fourteen months. No vacations. Sold some equipment I didn’t strictly need. I figured that was just the price of being self-employed and stupid about insurance.”
By early 2025, the balance was gone. But the resentment had not fully left. She felt — correctly, it turns out — that she had paid a penalty that a W-2 employee with employer-sponsored insurance never would have faced. What she didn’t know yet was that the tax code had tools she had never used.
Getting Back on the Marketplace — and Discovering the Deduction
In January 2024, three months after her surgery, Carmen enrolled in an ACA marketplace plan through HealthCare.gov. Her monthly premium came to $487 for a silver-tier plan. She chose it because it had a hospital network that included Nebraska Medicine, and because she was not going through another uninsured medical event. Over the course of 2024, she paid $5,844 in premiums.
When she sat down to file her 2024 taxes in late January 2026, she used a tax software program she’d relied on for years. This time, she answered a question she had previously clicked past: whether she had paid for health insurance as a self-employed individual not eligible for employer coverage. The software flagged the Self-Employed Health Insurance Deduction under IRS Publication 535.
The deduction allowed Carmen to reduce her taxable income by the full $5,844 she’d paid in 2024 premiums. But that was only the beginning. The software also surfaced the self-employment tax deduction — the provision that allows self-employed workers to deduct half of their self-employment tax liability from gross income. Based on her net earnings, that added another $5,540 to her deductions.
What the Numbers Actually Looked Like
Carmen’s net profit from Ramos Auto in 2024 was approximately $79,400. Before these deductions, a significant portion of that income fell into the 22 percent federal bracket. The combined deductions from the SEHI deduction and the SE tax deduction reduced her adjusted gross income by roughly $11,384. Combined with her standard deduction, her final tax liability dropped by approximately $3,800 compared to what she had initially projected when she started filing.
Carmen also qualified for the Qualified Business Income (QBI) deduction — a provision under the 2017 Tax Cuts and Jobs Act that allows eligible self-employed individuals and pass-through business owners to deduct up to 20 percent of qualified business income. According to the IRS, the QBI deduction is subject to income limits and business type restrictions, but for a sole proprietor like Carmen with income below the threshold, it applied in full.
The Regret That Stayed Behind
The $3,800 in savings from her 2024 return was not the end of Carmen’s accounting. As she told me, once she understood how the SEHI deduction worked, she started thinking backward — to the years before her emergency when she had no insurance at all, and to 2022 and 2021, when she had briefly carried a plan but never claimed the deduction on her returns.
“I probably left three, four thousand dollars on the table over those years,” she said, not with anger exactly, but with the particular tiredness of someone calculating what they could have done differently. “Nobody ever explained this to me. Not my tax software, not anyone.”
She looked into filing amended returns for prior years — the IRS generally allows amended returns within three years of the original filing deadline — but after reviewing her records, she determined that in the years she had a marketplace plan, she had not actually paid the premiums consistently enough to make the paperwork worthwhile. It was a door that was technically open but practically closed.
Where Carmen Stands Now
When her 2024 refund of approximately $4,100 landed in her checking account in early March 2026, Carmen split it deliberately. She put $2,800 toward a remaining personal loan she had taken out during the lean months of 2023. The rest went into a small equipment fund for the shop — she has her eye on a used alignment rack she found through a dealer in Kansas City.
She is still carrying her ACA plan — the same silver-tier coverage, now with a premium of $511 per month for 2026 after a rate adjustment. She said she views it differently now: not as a cost but as something she can partially recover through her return each year, which changes the psychological weight of it. “It’s not gone,” she told me. “It’s delayed. That’s a different thing.”
When I asked Carmen what she would tell another self-employed person sitting across from her right now, she thought about it for longer than I expected. She was quiet for a moment, watching one of her mechanics roll a tire across the bay. Then she said: “Just answer the questions. All of them. The ones in the software you skip because you assume they don’t apply to you. Because I assumed that for about four years and it cost me.”
I left Ramos Auto with grease on my notebook from resting it on the wrong shelf and a text from Carmen twenty minutes later: she’d found an alignment rack listing in Iowa for $200 less than the Kansas City one. She was already working the side angle. She always is.
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