So, you’ve heard about the “One Big Beautiful Bill” making its way through Congress.
And yes, that’s actually what they’re calling it—because apparently, our great nation has embraced the art of branding.
But beneath the name lies something that could significantly impact your bottom line as a private practice physician.
Let’s cut through the political pageantry and examine what this ‘beautiful’ piece of legislation actually means for your practice.
The Good, The Bad, and The Medicare
Medicare’s Crystal Ball: The MEI Connection
Starting in 2026, your Medicare payments will be tied to the Medicare Economic Index (MEI).
Sounds promising, right?
Well, here’s where it gets interesting. While being indexed to MEI is certainly better than the current system of random congressional mood swings, the catch is that you’ll only receive 10% of the MEI increase.
Think of it this way: If inflation is a speeding train, your payment increases are riding a bicycle alongside it.
Sure, you’re moving in the same direction, but good luck keeping up.
The American Academy of Family Physicians has already raised the alarm that this won’t cover your rising practice costs.
Shocking, I know.
Direct Primary Care: A Dose of Common Sense
The bill allows patients with high-deductible health plans (HDHPs) to use their Health Savings Accounts (HSAs) for direct primary care arrangements.
This is actually good news.
It means your patients can pay you directly without jumping through insurance hoops, fostering those old-fashioned doctor-patient relationships that insurance companies have been trying to complicate since the dawn of managed care.
Tax Breaks That Actually Break Your Way
Section 199A: The Gift That Keeps on Giving
Remember that qualified business income deduction (QBID) you’ve been enjoying?
It’s getting a makeover. The deduction jumps from 20% to 23% and—here’s the kicker—it becomes permanent.
For those keeping score at home, this drops your effective tax rate on pass-through income to approximately 28.49%.
And before you ask: yes, specified service trades or businesses (SSTBs) like medical practices appear to remain unchanged in their treatment.
Where the thresholds end up remains to be seen as the Senate debates the details.
SALT in the Wound? Not This Time
The state and local tax (SALT) deduction cap is quadrupling from $10,000 to $40,000 for those earning up to $500,000.
Finally, those of you in high-tax states can stop feeling like you’re being punished for geographic loyalty.
It’s about time Congress recognized that $10,000 doesn’t go very far when you’re paying property taxes on your home as well as your other annoying local taxes.
Equipment and Estate Planning: Double Win
Bonus Depreciation: Back to 100%
That MRI machine you’ve been eyeing? The bill brings back 100% bonus depreciation from 2025 through 2029.
You can write off the entire cost in year one.
It’s like Christmas morning for your accountant—and your cash flow.
Estate Planning for the Optimistic
The estate tax exemption is jumping from $10 million to $15 million per individual.
Because apparently, Congress believes you’ll all become fabulously wealthy despite those MEI-indexed Medicare payments.
Hey, at least you can tell yourself they’re optimistic about your financial future.
The Student Loan Squeeze
Here’s where things get less beautiful.
The bill includes new caps and restrictions on student loan programs, including changes to Public Service Loan Forgiveness (PSLF).
This could make it harder for new physicians to afford practicing in underserved areas—exactly where they’re needed most.
It’s a bit like offering someone a ladder to climb out of a hole, then sawing off the bottom rungs.
Young physicians already facing six-figure debt loads may find their options for loan forgiveness significantly limited.
The Bottom Line
The “One Big Beautiful Bill” is a mixed bag for private practice physicians.
While some tax benefits are genuinely helpful, the Medicare payment formula remains a concern.
And those student loan changes?
They might make it harder to recruit the next generation to your practice.
Your action item? Talk to your accountant about maximizing these tax benefits while they last.
And maybe start budgeting for those Medicare payment increases that won’t quite keep pace with your rising costs.
After all, “beautiful” is in the eye of the beholder.
Or in this case, the private practitioner.
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