By Nate Goodman, CEO of Goodman CPA
(Adapted from our October webinar for Direct Care & Healthcare leaders.)
The One Big Beautiful Bill Act (OBBBA / H.R. 1) enacted July 4, reshapes a wide span of individual and business tax rules that matter to Direct Primary Care (DPC) and other direct-care practices. Some provisions are permanent, others sunset, and several await IRS/Treasury guidance. This post distills what changed, why it matters to clinicians and practice owners, and the practical steps to take next, without letting “the tax tail wag the dog.”
The New Landscape at a Glance
OBBBA’s theme is stability plus targeted incentives:
- Permanent individual rate “lock-ins.” The 10% and 37% brackets from 2017 remain in place, preventing automatic hikes that were slated to return. This isn’t a windfall; it’s protection against increases.
- Higher standard deduction, plus a temporary boost. For married filing jointly, the standard deduction is $31,500, with an extra $2,000 for the next four years. Many households will itemize less often.
- Child Tax Credit secured and improved. $2,200 per child, with $1,400 refundable even if your deductions wipe out tax.
- Senior deduction boost (time-boxed). Ages 65+ may receive an additional $6,000 on the standard deduction for four years, phasing down at higher incomes.
- Targeted wage relief through 2028. “No tax on tips” (up to $25k) and “no tax on overtime premium” (up to $12.5k single / $25k married) offer meaningful relief, but only with the right payroll setup and subject to income caps.
- New personal deduction for car loan interest. Up to $10,000/year for new, U.S.-assembled vehicles, with income limitations.
- “Trump Accounts” for kids. For children born after 1/1/2025, a new after-tax savings vehicle launches July 2026with a $1,000 Treasury seed and $5,000 annual contribution limit, converting to a traditional IRA at 18 with special early-use allowances.
- SALT cap relief. The state and local tax deduction cap rises to $40,000 (phasing out for very high earners). Even so, pass-through entity (PTE) elections may still create a “double benefit” (explained below).
What This Means for DPC Practices
1) Pass-Through Relief (QBI) That Sticks
The 20% Qualified Business Income (QBI) deduction is now permanent, with improved thresholds and a $400 minimum deduction for active owners. Professional service limits still apply, but many DPCs, especially in startup or lower-income years can capture real savings. Example: $100,000 of ordinary S-Corp income can yield a $20,000 QBI deduction on your personal return (subject to SSTB limits/phase-outs).
2) First-Year Write-Offs on Equipment & Build-Outs
Two powerful tools work together:
- Bonus depreciation returns to 100% for eligible assets placed in service after Jan 19, 2025 (think furniture, fixtures, IT, certain leasehold improvements).
- Section 179 expensing remains essential where bonus doesn’t apply (e.g., HVAC, roofing, sprinklers, certain built-in security systems) and in non-conforming states.
Strategy: Mix and match bonus and $179 to maximize federal + state outcomes. If you’re already planning an expansion or refresh, aligning the placed-in-service date can materially lower your current-year tax.
3) Credits You Might Be Overlooking
- Employer childcare support now earns up to a 40% credit (and up to 50% for small businesses under ~$29M revenue) with higher phase-out thresholds. If you directly help staff pay for childcare, a slice of that cost can come back as a dollar-for-dollar credit, not just a deduction.
- R&D incentives expand for domestic work (immediate expensing) while foreign R&D amortizes over 15 years. DPC qualifies more often than owners realize: creating new clinical workflows, tech-enabled processes, or software/AI that advances care can unlock R&D credits plus deductions.
4) Estate Tax Peace of Mind
The estate exemption climbs to $15M per person / $30M per married couple, indexed for inflation and without the 2026 cliff. Most single-site practices won’t hit this, but multi-site groups and valuable brands should revisit succession and gifting strategies now that the ceiling is stable.
Health & Medical Savings: Big Win for HSAs (and Soon, for DPC)
- HSA limits rise to $4,300 (individual) and $8,550 (family), with a $2,000 catch-up at age 55+. Spousal allocations are more flexible.
- Medicare Part A enrollees can now contribute to HSAs, a significant change for older clinicians and staff.
- Roll-ins from certain FSA/HRA/HSA funds are permitted when moving to an HDHP (caps apply).
- DPC + HSA usage: Patients may use HSA funds to pay DPC membership fees starting Jan 1, 2026.
- To keep HSA payments clean, separate non-medical amenities/admin fees from clinical access in your billing.
(Note: FSAs are not currently supported for DPC membership fees under our understanding.)
Home & Energy: Still Worth Running the Numbers
- Efficiency upgrades (insulation, windows, heat pumps, etc.) can earn up to a $1,200 credit if installed by year-end.
- Residential solar remains attractive with a 30% credit on qualified costs.
For EV credits and other energy cut-offs, verify purchase/install dates and confirm which provisions still apply to your situation.
Payroll & Configuration: Don’t Leave Money in the IRS’s Hands
The “no tax on tips/overtime premium” provisions aren’t automatic. If you have hourly team members who occasionally work overtime, ensure your payroll system is updated with the correct earnings codes so eligible wages aren’t taxed up-front. Otherwise, your staff will be over-withheld and waiting for refunds, effectively lending the IRS money.
Frequently Asked (from the Webinar)
- Can patients use HSA funds for DPC memberships? Yes, starting Jan 1, 2026.
- Can FSAs pay for DPC memberships? Not under current rules as we understand them.
- Does the new car-loan interest deduction apply to my practice vehicle? The new personal deduction targets personal loans on new U.S.-assembled cars (income limits apply). Business-owned vehicle interest remains a business deduction under existing rules.
- I’m on a health-sharing plan, can I contribute to an HSA? No. HSAs require enrollment in a high-deductible health plan (HDHP).
Bottom Line
OBBBA creates real cash-flow opportunities for DPC owners, if you configure payroll, sequence equipment/build-outs, revisit benefits, and tidy billing in advance of 2026. Some moves are “set it and forget it” (rates, higher standard deduction); others require deliberate action (payroll codes, placed-in-service timing, HSA/DPC billing updates, PTE vs. SALT). The payoff is fewer surprises in April and more predictable economics year-round.
If you want a free personalized assessment, our team will model your QBI, $179 vs. bonus by asset, state conformity, PTE election potential, R&D, and HSA/DPC readiness, so you can act with confidence. Book a free consultation with us: Book Here
Disclosure: This post reflects our understanding as of 10/1/2025. Some provisions await IRS/Treasury guidance and may change. Always coordinate with your CPA regarding your facts, state rules, and deadlines.
Disclosure: This post reflects our understanding as of 10/1/2025. Some provisions await IRS/Treasury guidance and may change. Always coordinate with your CPA regarding your facts, state rules, and deadlines.