Income Taxes (Tables)

12 Months Ended

Dec. 31, 2023

Income Tax Disclosure [Abstract]

Schedule of Provision for Income Taxes

The provision for income taxes consists of the following (dollars in millions):

	2023		2022		2021
Current:
Federal	$	1,118	$	1,222	$	1,769
State		213		206		311
Foreign		3		18		15
Deferred:
Federal		241		261		24
State		21		27		(18	)
Foreign		19		12		11
	$	1,615	$	1,746	$	2,112

Schedule of Reconciliation of Federal Statutory Rate to Effective Income Tax Rate

A reconciliation of the federal statutory rate to the effective income tax rate follows:

	2023			2022			2021
Federal statutory rate		21.0	%		21.0	%		21.0	%
State income taxes, net of federal tax benefit		2.6			2.3			2.0
Change in liability for uncertain tax positions		0.4			0.7			0.7
Tax benefit from settlements of employee equity awards		(1.2	)		(0.9	)		(1.2	)
Other items, net		0.8			0.5			0.8
Effective income tax rate on income attributable to HCA Healthcare, Inc.		23.6			23.6			23.3
Income attributable to noncontrolling interests from consolidated partnerships		(2.6	)		(3.3	)		(1.8	)
Effective income tax rate on income before income taxes		21.0	%		20.3	%		21.5	%

Schedule of Deferred Tax Assets and Liabilities

A summary of the items comprising our deferred tax assets and liabilities at December 31 follows (dollars in millions):

	2023				2022
	Assets		Liabilities		Assets		Liabilities
Depreciation and fixed asset basis differences	$	—	$	1,048	$	—	$	938
Allowances for professional liability and other risks		452		—		430		—
Accounts receivable		363		—		368		—
Compensation		308		—		402		—
Right-of-use lease assets and obligations		506		492		451		438
Other		592		860		536		698
	$	2,221	$	2,400	$	2,187	$	2,074

Schedule of Activity Related to our Gross Unrecognized Tax Benefits

The following table summarizes the activity related to our gross unrecognized tax benefits, excluding accrued interest of $177 million and $129 million as of December 31, 2023 and 2022, respectively (dollars in millions):

	2023			2022
Balance at January 1	$	639		$	576
Additions based on tax positions related to the current year		30			25
Additions for tax positions of prior years		4			50
Reductions for tax positions of prior years		(10	)		(4	)
Settlements		—			(1	)
Lapse of applicable statutes of limitations		(24	)		(7	)
Balance at December 31	$	639		$	639