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Income Taxes (Tables) | 12 Months Ended
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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 |

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