The One Big Beautiful Bill Act (OBBBA), signed into law in July 2025, has implemented numerous significant changes to the U.S. tax code. The law’s provisions impact organizations across a wide range of industries—including healthcare entities. Below are some of the key tax law changes under the OBBBA that could impact your health care organization this year.
Bonus Depreciation
The OBBBA has permanently restored 100% bonus depreciation for qualified property placed in service as of January 19, 2025. Healthcare entities can now immediately write off capital investments, such as new medical equipment, facility upgrades, expansions, and technology infrastructure.
Section 179 Deduction
The expensing limit for the Section 179 deduction, which allows businesses to deduct the full cost of qualifying equipment in the year it is placed into service, has been increased to $2.5 million.
SALT Cap
The OBBBA has temporarily increased the federal deduction limit for state and local taxes (SALT cap) from $10,000 to $40,000. This limit will be adjusted each year for inflation until 2029, after which the SALT cap will revert to $10,000. The deduction phases out for taxpayers with modified gross income (MAGI) greater than $500,000 in 2025, with the MAGI threshold adjusted for inflation until 2029. For high-income earners before 2030, the SALT deduction is reduced by 30% of their MAGI over the threshold amount, but the deduction will not be reduced below $10,000. Importantly for many businesses, the OBBBA imposes no limitations on Pass-Through Entity Taxes (PTET), which serve as workarounds for SALT.
R&D Deductions
Healthcare organizations investing in research and development activities—such as developing new medical techniques, testing new medical devices, or conducting clinical trials—can now deduct these costs immediately. Under the OBBBA, U.S. research and development (R&D) expenditures, previously required to be amortized over five years, can now be deducted in the year paid. Small businesses averaging $31 million or less in annual gross receipts may elect to apply the change retroactively for tax years beginning after December 31, 2021. All businesses that made domestic R&D expenditures between 2022 and 2024 may elect to accelerate the remaining deductions for those expenditures over one or two years. Unlike domestic expenditures, however, foreign R&D costs continue to require a 15‑year amortization under Section 174.
QBI Deduction
The OBBBA permanently extends the Qualified Business Income (QBI) deduction, which allows eligible taxpayers to deduct up to 20% of their qualified business income.
Limitation on Business Interest
The OBBBA reinstated the EBITDA (earnings before interest, taxes, depreciation, and amortization) limitation under Sec. 163(j), effective for tax years beginning after December 31, 2024. Adjusted taxable income (ATI) will now be computed without regard to the deduction for depreciation, amortization, or depletion. For health care entities financing new facilities or expansions through debt, this shift back to an EBITDA-based calculation may allow for greater deductibility and improved cash flow.
New Deduction for Qualified Overtime
For tax years 2025 through 2028, the OBBBA creates a temporary deduction up to $12,500 for individuals who receive qualified overtime compensation, with phaseouts for high earners. “Qualified overtime compensation” is defined as the premium (“half”) portion of overtime pay required under the Fair Labor Standards Act (FLSA). Qualified overtime pay must be separately reported on employee W-2s. Healthcare organizations that employ large numbers of hourly employees may need to update their payroll systems to track qualified overtime compensation.
Partner with RBT CPAs for Expert Guidance
RBT CPAs’ specialized healthcare accounting team is here to help you navigate the tax law changes under the One Big Beautiful Bill Act and to make the most of expanded tax incentives in 2026 and beyond. Our experienced team of professionals is available to support all of your organization’s accounting, tax, audit, and advisory needs. Give us a call today and find out how we can be Remarkably Better Together.





