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Income Taxes
 12 Months Ended
Dec. 31, 2022
Income Tax Disclosure [Abstract]  
Income Taxes
NOTE 4 — INCOME TAXES
The provision for income taxes consists of the following (dollars in millions):
 
    
    2022    
     
    2021    
     
    2020    
  
Current:
                           
Federal
   
$
1,222
 
    $ 1,769      $ 1,021  
State
   
 
206
 
      311        126  
Foreign
   
 
18
 
      15        5  
Deferred:
                           
Federal
   
 
261
 
      24        (73 ) 
State
   
 
27
 
      (18 )       (39 ) 
Foreign
   
 
12
 
      11        3  
    
 
 
     
 
 
     
 
 
  
    
$
1,746
 
    $ 2,112      $ 1,043  
    
 
 
     
 
 
     
 
 
  
Our provision for income taxes for the years ended December 31, 2022, 2021 and 2020 included tax benefits of $77 million, $119 million and $92 million, respectively, related to the settlement of employee equity awards. Our foreign pretax income was $66 million, $64 million and $9 million for the years ended December 31, 2022, 2021 and 2020, respectively.
A reconciliation of the federal statutory rate to the effective income tax rate follows:
 
    
    2022    
    
    2021    
    
    2020    
  
Federal statutory rate
   
 
21.0
% 
     21.0 %      21.0 % 
State income taxes, net of federal tax benefit
   
 
2.3
 
     2.0       1.9  
Change in liability for uncertain tax positions
   
 
0.7
 
     0.7       (0.2 ) 
Tax benefit from settlements of employee equity awards
   
 
(0.9
) 
     (1.2 )      (1.8 ) 
Other items, net
   
 
0.5
 
     0.8       0.8  
    
 
 
    
 
 
    
 
 
  
Effective income tax rate on income attributable to HCA Healthcare, Inc.
   
 
23.6
 
     23.3       21.7  
Income attributable to noncontrolling interests from consolidated partnerships
   
 
(3.3
) 
     (1.8 )      (2.5 ) 
    
 
 
    
 
 
    
 
 
  
Effective income tax rate on income before income taxes
   
 
20.3
% 
     21.5 %      19.2 % 
    
 
 
    
 
 
    
 
 
  
 
 
A summary of the items comprising our deferred tax assets and liabilities at December 31 follows (dollars in millions):
 
    
2022
     
2021
  
    
    Assets    
     
 Liabilities 
     
  Assets  
     
  Liabilities  
  
Depreciation and fixed asset basis differences
   
$
—
 
   
$
938
 
    $ —      $ 737  
Allowances for professional liability and other risks
   
 
430
 
               426        —  
Accounts receivable
   
 
368
 
               348        —  
Compensation
   
 
402
 
               502        —  
Right-of-use
lease assets and obligations
   
 
451
 
   
 
438
 
      428        419  
Other
   
 
536
 
   
 
698
 
      499        652  
    
 
 
     
 
 
     
 
 
     
 
 
  
    
$
2,187
 
   
$
2,074
 
    $ 2,203      $ 1,808  
    
 
 
     
 
 
     
 
 
     
 
 
  
At December 31, 2022, federal and state net operating loss carryforwards (expiring in years 2025 through 2039) available to offset future taxable income approximated $28 million and $193 million, respectively. Utilization of net operating loss carryforwards in any one year may be limited.
The following table summarizes the activity related to our gross unrecognized tax benefits, excluding accrued interest of $129 million and $99 million as of December 31, 2022 and 2021, respectively (dollars in millions):
 
    
    2022    
     
    2021    
  
Balance at January 1
   
$
576
 
    $ 469  
Additions based on tax positions related to the current year
   
 
25
 
      57  
Additions for tax positions of prior years
   
 
50
 
      66  
Reductions for tax positions of prior years
   
 
(4
) 
      (6 ) 
Settlements
   
 
(1
) 
      (3 ) 
Lapse of applicable statutes of limitations
   
 
(7
) 
      (7 ) 
    
 
 
     
 
 
  
Balance at December 31
   
$
639
 
    $ 576  
    
 
 
     
 
 
  
Unrecognized tax benefits of $278 million as of December 31, 2022 ($217 million as of December 31, 2021) would affect the effective rate, if recognized.
The Internal Revenue Service (“IRS”) was conducting an examination of the Company’s 2016, 2017 and 2018 federal income tax returns and the 2019 return for one affiliated partnership at December 31, 2022. We are also subject to examination by state and foreign taxing authorities. Depending on the resolution of any federal, state and foreign tax disputes, the completion of examinations by federal, state or foreign taxing authorities, or the expiration of statutes of limitation for specific taxing jurisdictions, we believe it is reasonably possible that our liability for unrecognized tax benefits may significantly increase or decrease within the next 12 months. However, we are currently unable to estimate the range of any possible change.