Income Taxes (Tables)

12 Months Ended

Dec. 31, 2024

Income Tax Disclosure [Abstract]

Schedule of Provision for Income Taxes

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

	2024		2023		2022
Current:
Federal	$	1,202	$	1,118	$	1,222
State		212		213		206
Foreign		20		3		18
Deferred:
Federal		394		241		261
State		31		21		27
Foreign		7		19		12
	$	1,866	$	1,615	$	1,746

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:

	2024			2023			2022
Federal statutory rate		21.0	%		21.0	%		21.0	%
State income taxes, net of federal tax benefit		2.7			2.6			2.3
Change in liability for uncertain tax positions		(2.3	)		0.4			0.7
Tax benefit from settlements of employee equity awards		(1.2	)		(1.2	)		(0.9	)
Internal restructuring of affiliates		3.5			—			—
Other items, net		0.8			0.8			0.5
Effective income tax rate on income attributable to HCA Healthcare, Inc.		24.5			23.6			23.6
Income attributable to noncontrolling interests from consolidated partnerships		(2.6	)		(2.6	)		(3.3	)
Effective income tax rate on income before income taxes		21.9	%		21.0	%		20.3	%

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):

	2024				2023
	Assets		Liabilities		Assets		Liabilities
Depreciation and fixed asset basis differences	$	—	$	1,139	$	—	$	1,048
Allowances for professional liability and other risks		395		—		452		—
Accounts receivable		418		—		363		—
Compensation		285		—		308		—
Right-of-use lease assets and obligations		478		462		506		492
Other		297		932		592		860
	$	1,873	$	2,533	$	2,221	$	2,400

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 and penalties of $115 million and $177 million as of December 31, 2024 and 2023, respectively (dollars in millions):

	2024			2023
Balance at January 1	$	639		$	639
Additions based on tax positions related to the current year		40			30
Additions for tax positions of prior years		63			4
Reductions for tax positions of prior years		(206	)		(10	)
Settlements		(17	)		—
Lapse of applicable statutes of limitations		(15	)		(24	)
Balance at December 31	$	504		$	639