OBBBA and the Future of Healthcare Infrastructure: What Permanent Bonus Depreciation Means for Healthcare Providers

On July 4, 2025, the One Big Beautiful Bill Act (OBBBA) was signed into law, ushering in a wave of tax reforms aimed at boosting investment and operational flexibility across industries. Among its most impactful provisions is the permanent reinstatement of 100% bonus depreciation. This change holds significant promise for healthcare organizations navigating rising costs, aging infrastructure, and evolving patient care demands.

Immediate Expensing for Healthcare Capital Investments

Under the new law, healthcare providers can now fully expense qualified capital assets in the year they’re placed in service. This includes medical equipment, diagnostic technology, facility upgrades, and even administrative infrastructure. Rather than depreciating these assets over several years, organizations can deduct the full cost upfront, dramatically improving cash flow and freeing up capital for reinvestment.

For hospitals, skilled nursing facilities, outpatient centers, and physician groups, this change offers a strategic advantage. Whether upgrading imaging systems, expanding surgical suites, or modernizing patient rooms, the ability to immediately expense these investments can accelerate growth and improve financial agility.

Strategic Planning Without the Year-End Rush

Previously, bonus depreciation was subject to a phase-out schedule, often prompting year-end spending sprees to capture tax benefits before they diminished. With permanence now in place, healthcare CFOs and finance teams can plan capital expenditures based on operational needs rather than tax deadlines. This allows for smarter purchasing decisions, better vendor negotiations, and more thoughtful alignment with clinical priorities.

State-Level Considerations Still Apply

While the federal treatment of bonus depreciation is now permanent, many states do not conform to this provision. Healthcare organizations operating in nonconforming states must continue to add back bonus depreciation for state tax purposes and apply regular depreciation instead. This is not a new challenge, but it remains a critical planning point to avoid unexpected liabilities and ensure accurate forecasting.

Additional Tax Provisions That Matter

OBBBA also made permanent the 20% Qualified Business Income (QBI) deduction, which benefits many pass-through healthcare entities such as physician practices and management companies. Additionally, the law restores the interest expense limitation under IRC Section 163(j) to an EBITDA-based calculation, allowing greater deductibility for organizations financing capital improvements. However, the requirement to add back certain capitalized interest for deduction calculations may affect the net benefit, especially for debt-heavy projects.

What This Means for Healthcare Leaders

The permanent return of 100% bonus depreciation is more than a tax perk, it’s a strategic tool for healthcare organizations seeking to modernize, expand, and remain competitive in a rapidly changing landscape. With improved liquidity and simplified planning, providers can reinvest in patient care, workforce development, and operational resilience.

As with any financial decision, proper forecasting and tax planning are essential. Healthcare leaders should work closely with advisors to assess the impact of these changes, model investment scenarios, and ensure compliance across jurisdictions.

Citrin Cooperman’s Healthcare Industry Practice is here to help you navigate these updates and optimize your capital strategy. Contact Blake Spina or another member of Citrin Cooperman’s Healthcare Industry Practice for more or more information or to explore how bonus depreciation can support your organization’s goals