Megabill implications for anesthesiologists

[ambiturner]

---

Members don't see this ad.

Putting aside what everyone thinks of the bill, I thought a thread about what to expect for taxes for w2 and 1099 anesthesiologists would be helpful. I haven’t been able to find too many details but maybe you guys have.

Specifically:
-SALT limit is now $40,000, but ‘starts to phase out at’ $500,000. Where does it finish phasing out? As in, what would the typical benefit amount be for someone making $750,000, $1,000,000, $10,000,000?

-1099 vs w2: does this tilt the math even more toward 1099, or just keep things as they were?

-other stuff to consider: AMT, child tax credits, anything else should the average physician qualify for them

 

[pgg]

I'm less concerned about a few % on next year's tax return, and more concerned about what the cuts to Medicaid will do to US hospitals and ultimately supply/demand for our services a few years hence.

 

[Status Sciaticus]

I'm less concerned about a few % on next year's tax return, and more concerned about what the cuts to Medicaid will do to US hospitals and ultimately supply/demand for our services a few years hence.

People are going to keep getting sicker and waiting until the last minute to show up. We will be even more in demand.

 

[ambiturner]

I'm less concerned about a few % on next year's tax return, and more concerned about what the cuts to Medicaid will do to US hospitals and ultimately supply/demand for our services a few years hence.

I agree with you and am confident that, between the NSA and now this, no president has ever f’ed over anesthesiologists harder than Trump.

However, the downstream effects of this are speculative and there’s already 2 other threads on them. I was more wondering if anyone knew what immediate changes occurred that may change their withholding patterns, reconsider their employment type, etc.

 

[TeslaCoil]

lets also remember the bill puts a pause on year-over-year cms cuts to physicians across the board. I wish they would burn the ACA already. Its ridiculous. You want to talk about what screwed over doctors the MOST? And anybody who actually pays for health insurance?? Its the ACA (that was obama).

 

[secretasianman]

While I agree with everything above that rural hospitals are screwed, will this shift the supply demand curve that much? Let’s also not forget that Medicaid (and Medicare) rates drastically lag behind private insurance for us anyways, and we are more reliant on insurance and hospital subsidies to keep the surgical industrial complex running.

If anything, there is more pressure for these big hospital conglomerates to keep the machine humming and lean more on it to make up the deficit. So I would like to think that demand for us will continue to be high, or maybe I’m just being Cramer.

 

[RTMD]

lets also remember the bill puts a pause on year-over-year cms cuts to physicians across the board. I wish they would burn the ACA already. Its ridiculous.

The initial House bill included inflation adjusted payments for Medicare. The Senate removed this text.

Neither the House nor Senate included a provision to mitigate a 2.83% cut to Medicare payments that are in effect for 2025. There is a one time payment adjustment for 2026 in the final version of the OBBBA.

However nothing permanent to fix CMS payments.

 

[aneftp]

I agree with you and am confident that, between the NSA and now this, no president has ever f’ed over anesthesiologists harder than Trump.

However, the downstream effects of this are speculative and there’s already 2 other threads on them. I was more wondering if anyone knew what immediate changes occurred that may change their withholding patterns, reconsider their employment type, etc.

You forgot Obama f’ing over the anesthesiologists also with the ACA. The mega mergers/buyouts and consolidation accelerated under Obama’s watch causing massive salary constrictions in 80% of the USA. Just ask any one who finished residency between 2012-2018 how the job market was in most cities. Pretty bad.

Physicians overall have been losing autonomy and control since the 1970s. It’s not getting any better with any president.

 

[Radar26]

Specifically:
-SALT limit is now $40,000, but ‘starts to phase out at’ $500,000. Where does it finish phasing out? As in, what would the typical benefit amount be for someone making $750,000, $1,000,000, $10,000,000?

It’s a 30% reduction of the amount of income over the phase out amount (500k). The phase out stops at 600k becuase it hits the minimum SALT deduction (0.3 x 100k =30k) and 40k-30k =10 K SALT deduction. Anyone over 600k will get a 10k deduction regardless of how much over 600k you are

 

[TheLoneWolf]

I'm less concerned about a few % on next year's tax return, and more concerned about what the cuts to Medicaid will do to US hospitals and ultimately supply/demand for our services a few years hence.

Hence hospital employment is looking more and more reasonable...job security. That or ASC work for the privately insured.

 

[aneftp]

It’s a 30% reduction of the amount of income over the phase out amount (500k). The phase out stops at 600k becuase it hits the minimum SALT deduction (0.3 x 100k =30k) and 40k-30k =10 K SALT deduction. Anyone over 600k will get a 10k deduction regardless of how much over 600k you are

These republican tax bills rarely benefit the Henry (high earner not rich yet) basically white color working professionals making 200-500k. Auto loan interest deduction phased out at 100k income/200k for example in the bill

Besides the Medicaid stuff , it doesn’t really hurt the poor. That’s all fluff anyways because hospitals will write off bad debt from indigent non paid care.

It’s the rich will get richer bill.

I see zero revenue neutral savings from this bill. And lots of what ifs. Meaning if there is grass roots no movement to meet all the Medicaid paperwork. And people remain enrolled in Medicaid. There will be no savings.

 

[UscGhost]

You forgot Obama f’ing over the anesthesiologists also with the ACA. The mega mergers/buyouts and consolidation accelerated under Obama’s watch causing massive salary constrictions in 80% of the USA. Just ask any one who finished residency between 2012-2018 how the job market was in most cities. Pretty bad.

Physicians overall have been losing autonomy and control since the 1970s. It’s not getting any better with any president.

Hardly.

Buyouts and consolidations were due to greedy docs cashing in combined with cheap debt and the ability for private equity to bill OON.

Labor supply and demand were mich different. The job market improved for us due to the supply/demand changes after covid. ACA didn't change

Private practice has been dying for decades, as you said. ACA didn't change that

 

[aneftp]

Hardly.

Buyouts and consolidations were due to greedy docs cashing in combined with cheap debt and the ability for private equity to bill OON.

Labor supply and demand were mich different. The job market improved for us due to the supply/demand changes after covid. ACA didn't change

Private practice has been dying for decades, as you said. ACA didn't change that

ACA encouraged mega mergers. In case you didn’t realize. Hospitals figured this out quickly. The little hospitals got gobbled up by the bigger hospital.

To put tons of pressure on insurers. Same way usap formed from mergers and buyouts to put tremendous pressure on insurers as well.

Except the hospitals have much larger lobbying power than physicians with the out of network surprise billing act.

All the mergers happened in the the name of efficiency and bs metrics. We all know the game. All the Medicare crap boxes we have to check like did the patient smoke the day of surgery (shockingly if you answer honestly the patient smoked day of surgery) you actually get dinged on metrics by answering the truth! I’m not kidding. It’s actually better to lie and say the patient didn’t smoke and pad your stats for Medicare reimbursements due to the ACA. This is how absurd our healthcare system measures how well we are doing.

“One of the strongest catalysts for these vertical acquisitions came in the form of the 2010 Affordable Care Act (the “ACA”), which mandated payment and delivery system reforms and sought to transform of the U.S. healthcare system from one that incentivizes volume of care to one that rewards value-based care”

Hospital Mergers: The Value and Pitfalls

Hospital mergers have been an increasing trend in the healthcare markets over the past decade, with many proponents of these mergers believing that the

www.corporatesecuritieslawblog.com

 

[allantois]

People are going to keep getting sicker and waiting until the last minute to show up. We will be even more in demand.

Who is going to pay for their care if they are uninsured?

 

[UscGhost]

ACA encouraged mega mergers. In case you didn’t realize. Hospitals figured this out quickly. The little hospitals got gobbled up by the bigger hospital.

To put tons of pressure on insurers. Same way usap formed from mergers and buyouts to put tremendous pressure on insurers as well.

Except the hospitals have much larger lobbying power than physicians with the out of network surprise billing act.

All the mergers happened in the the name of efficiency and bs metrics. We all know the game. All the Medicare crap boxes we have to check like did the patient smoke the day of surgery (shockingly if you answer honestly the patient smoked day of surgery) you actually get dinged on metrics by answering the truth! I’m not kidding. It’s actually better to lie and say the patient didn’t smoke and pad your stats for Medicare reimbursements due to the ACA. This is how absurd our healthcare system measures how well we are doing.

“One of the strongest catalysts for these vertical acquisitions came in the form of the 2010 Affordable Care Act (the “ACA”), which mandated payment and delivery system reforms and sought to transform of the U.S. healthcare system from one that incentivizes volume of care to one that rewards value-based care”

Hospital Mergers: The Value and Pitfalls

Hospital mergers have been an increasing trend in the healthcare markets over the past decade, with many proponents of these mergers believing that the

www.corporatesecuritieslawblog.com

What does that have to do with anesthesia salaries?
The hospitals didnt suddenly un-merge in 2018 or 2020 resulting in the increase in anes salaries that we experienced.

If anything, more insured patients via the ACA led to an increase demand for our services and increased our salaries (via subsidy from the hospitals, since medicare and insurers are now allowed to **** us via the NSA)

Now you see the threads that discuss whether medicaid cuts (reduce surgical volume) will reduce anes demand.

 

[amyl]

I’m just curious- anyone who voted for Trump this last time regretting their vote? Anyone organizing an exodus from the US? A few of my friends talk but idk anyone who will actually do it….

 

[amyl]

Hardly.

Buyouts and consolidations were due to greedy docs cashing in combined with cheap debt and the ability for private equity to bill OON.

Labor supply and demand were mich different. The job market improved for us due to the supply/demand changes after covid. ACA didn't change

Private practice has been dying for decades, as you said. ACA didn't change that

This. Mitt Romney and Bain capital were the first to make medicine into a business…. Although had they not done so probably someone else would have…. But technically that’s who started it with HCA.
The generation before us sold out to private equity (and crnas) - interest rates were down and amcs used market share and Oon billing to drive up rates… these are the reasons…. I mean the FTC lawsuit details the business plan… that worked…. For awhile. Now that trumps in office it seems like those lawsuits will just stall permanently.

 

[chessknt]

I’m just curious- anyone who voted for Trump this last time regretting their vote? Anyone organizing an exodus from the US? A few of my friends talk but idk anyone who will actually do it….

Has anyone who voted for him ever regretted it? It is a fascist cult at this point. The formal creation of a massive federal police force to disappear people is a feature. Eating the poor and targeting higher education written in to the bill. The Republicans love this stuff, it is Project 2025 memorialized in to law. The timing gimmicks for all the tax and debt bombs to cheat it through the system were spaced to punish Democrats.

If it were legal to take the Democrats out back and shoot them they would have out it in this bill too. They have more work to do in suppressing the media before that can become a reality but they have been angling for absolute war and extermination of their domestic enemies for a decade and they are going to win. The American system has failed, we are collectively too stupid and gullible to run a Republic and voted it away.

 

[caligas]

What about implications for pass through corporations?

Will my 199a deduction change? Will the income phase out increase?

What about SALT cap workaround, does that go away?

Will my my slice get better? Will BC have a good powder year?

 

[aneftp]

What about implications for pass through corporations?

Will my 199a deduction change? Will the income phase out increase?

What about SALT cap workaround, does that go away?

Will my my slice get better? Will BC have a good powder year?

Salt cap workaround stays for those in state income tax states

 

[anonperson]

I’m just curious- anyone who voted for Trump this last time regretting their vote? Anyone organizing an exodus from the US? A few of my friends talk but idk anyone who will actually do it….

And go where? Regardless of anyone's voting pattern, the United States is the greatest country.

I was on vacation in Europe and Asia recently. Fine to visit. Made me appreciate the United States even more.

 

[aneftp]

Has anyone who voted for him ever regretted it? It is a fascist cult at this point. The formal creation of a massive federal police force to disappear people is a feature. Eating the poor and targeting higher education written in to the bill. The Republicans love this stuff, it is Project 2025 memorialized in to law. The timing gimmicks for all the tax and debt bombs to cheat it through the system were spaced to punish Democrats.

If it were legal to take the Democrats out back and shoot them they would have out it in this bill too. They have more work to do in suppressing the media before that can become a reality but they have been angling for absolute war and extermination of their domestic enemies for a decade and they are going to win. The American system has failed, we are collectively too stupid and gullible to run a Republic and voted it away.

I don’t regret voting for trump 3x.

The Dems need to bring viable candidates to the the table. As much as people are in denial. The only reason Biden even won in 2020 was because of a once in a 100 years virus. That’s the simple truth. Biden been trying to become president since the late 1980s and failed. Almost a participation trophy Biden was awarded in 2020 due to the virus.

I think trump is a con artist. But that’s what Americans loves. It’s like a woman going out with bad boys in her 20s and loving it even though she knows it’s all wrong.

It’s a phase in life. Trump and the bad boy will be gone in 3.5 years and the new generation will come.

 

[calvnandhobbs68]

This is a good purely financial overview with a lot of the actual detail for many of the deductions including income phase outs.

Tax provisions in the One Big Beautiful Bill Act

The bill extends portions of the Tax Cuts and Jobs Act, provides deductions to eliminate income taxes on certain tips and overtime pay, and addresses other tax priorities of the Trump administration.

www.journalofaccountancy.com

 

[UscGhost]

I don’t regret voting for trump 3x.

The Dems need to bring viable candidates to the the table. As much as people are in denial. The only reason Biden even won in 2020 was because of a once in a 100 years virus. That’s the simple truth. Biden been trying to become president since the late 1980s and failed. Almost a participation trophy Biden was awarded in 2020 due to the virus.

I think trump is a con artist. But that’s what Americans loves. It’s like a woman going out with bad boys in her 20s and loving it even though she knows it’s all wrong.

It’s a phase in life. Trump and the bad boy will be gone in 3.5 years and the new generation will come.

I thought you said you vote anti-incumbent to keep the pressure on the candidates to serve the people. Now you say you voted Trump 3 times...

 

[aneftp]

I thought you said you vote anti-incumbent to keep the pressure on the candidates to serve the people. Now you say you voted Trump 3 times...

Biden was incumbent

I don’t like Hillary and trump was not Hilary.
And Kamela was a fraud

I didn’t vote Rick Scott

I’d vote democrat if AOC or a socialist is running. I really despise how politics are going with our country. We need to move towards a more socialist state in terms of taxes if we are to get our spending under control.

My voting records are all over the place

 

[CopaceticOne]

I think trump is a con artist. But that’s what Americans aneftp loves.

Fixed that for ya

 

[UscGhost]

Biden was incumbent

I don’t like Hillary and trump was not Hilary.
And Kamela was a fraud

I didn’t vote Rick Scott

I’d vote democrat if AOC or a socialist is running. I really despise how politics are going with our country. We need to move towards a more socialist state in terms of taxes if we are to get our spending under control.

My voting records are all over the place

Hillary v Trump
Trump (incumbent) v Biden
Harris vs Trump

You said you dont vote incumbent. Am i missing something?

You voted for the same guy 3 times. Your votes arent all over the place

 

[aneftp]

Hillary v Trump
Trump (incumbent) v Biden
Harris vs Trump

You said you dont vote incumbent. Am i missing something?

You voted for the same guy 3 times. Your votes arent all over the place

They are with Congress and us senate and judges.

 

[aneftp]

Fixed that for ya

I don’t love trump. I like people who do extreme things and against the norm.

Give him some credit. He stuck to most of his agenda. Some of it works. Some of it doesn’t work.

We will have a new Congress sworn in 18 months and trump is done.

 

[TeslaCoil]

The initial House bill included inflation adjusted payments for Medicare. The Senate removed this text.

Neither the House nor Senate included a provision to mitigate a 2.83% cut to Medicare payments that are in effect for 2025. There is a one time payment adjustment for 2026 in the final version of the OBBBA.

However nothing permanent to fix CMS payments.

I was told this is a temporary fix while an actual doc fix is in the works. My understanding is that there is some relief on the way.

 

[CopaceticOne]

I don’t love trump. I like people who do extreme things and against the norm.

Give him some credit. He stuck to most of his agenda. Some of it works. Some of it doesn’t work.

We will have a new Congress sworn in 18 months and trump is done.

I was implying you love con artists.

 

[CopaceticOne]

I was told this is a temporary fix while an actual doc fix is in the works. My understanding is that there is some relief on the way.

I will only believe it when I see it.

 

[RTMD]

I was told this is a temporary fix while an actual doc fix is in the works. My understanding is that there is some relief on the way.

Would this go against the idea of having one big, beautiful bill?

 

[aneftp]

I was implying you love con artists.

I love things that are different. Including cons

Most who voted for Biden are also love con artists as well! The freaking irony. He fooled 80 plus million who voted for him

 

[Chrish]

It’s a phase in life. Trump and the bad boy will be gone in 3.5 years and the new generation will come.

Yeah… About that.

 

[nimbus]

This. Mitt Romney and Bain capital were the first to make medicine into a business…. Although had they not done so probably someone else would have…. But technically that’s who started it with HCA.
The generation before us sold out to private equity (and crnas) - interest rates were down and amcs used market share and Oon billing to drive up rates… these are the reasons…. I mean the FTC lawsuit details the business plan… that worked…. For awhile. Now that trumps in office it seems like those lawsuits will just stall permanently.

Tom Frist (father of Senator Bill) started HCA in the 1960s. Bain and KKR took it private in the early 2000s and IPO’d it (again) a few years later. HCA has been around longer than most of us.

 

[amyl]

Tom Frist (father of Senator Bill) started HCA in the 1960s. Bain and KKR took it private in the early 2000s and IPO’d it (again) a few years later. HCA has been around longer than most of us.

I guess I meant it was Romney and Bain who were first to make medicine into”big business,” not that he started hca. Didn’t Mean to imply that… I like the guy but he seems like the first of the robber barons in medicine to me. But this was before my time so very possible idk the whole story

 

[TeslaCoil]

I will only believe it when I see it.

You and me both.

 

[aneftp]

Tom Frist (father of Senator Bill) started HCA in the 1960s. Bain and KKR took it private in the early 2000s and IPO’d it (again) a few years later. HCA has been around longer than most of us.

The republican bill the son/us senator sneakingly favored the ACA/patient protection act in 2009 wine Obama Becuase he’s a greedy mother f’ lol. He had side business gigs aligned and ready to go to take advantage of the the ACA business side of thing.

The funny side gigs the guys decided to setup shop for breast feeding lessons due to the ACA. These are guys. Who are trying to tell women (new Hispanics mothers) how to breast feed and make money off the ACA in south Florida.

Bill frist knew there was lots of money to be made with the ACA.

 

[UscGhost]

I love things that are different. Including cons

Most who voted for Biden are also love con artists as well! The freaking irony. He fooled 80 plus million who voted for him

You voted for the same guy 3 times. Thats not different

 

[Lab Lover]

I love things that are different. Including cons

Most who voted for Biden are also love con artists as well! The freaking irony. He fooled 80 plus million who voted for him

Better the Devil you know. Same reason people stay in below average jobs.

 

[aneftp]

You voted for the same guy 3 times. Thats not different

I won’t vote for him 4x than. I’m sure he’s trying to get on the ballot again in 2028.

 

[mathezar]

Has anyone who voted for him ever regretted it? It is a fascist cult at this point. The formal creation of a massive federal police force to disappear people is a feature. Eating the poor and targeting higher education written in to the bill. The Republicans love this stuff, it is Project 2025 memorialized in to law. The timing gimmicks for all the tax and debt bombs to cheat it through the system were spaced to punish Democrats.

If it were legal to take the Democrats out back and shoot them they would have out it in this bill too. They have more work to do in suppressing the media before that can become a reality but they have been angling for absolute war and extermination of their domestic enemies for a decade and they are going to win. The American system has failed, we are collectively too stupid and gullible to run a Republic and voted it away.

Geeze dude, MSNBC must be the only thing you watch.

 

[chessknt]

Geeze dude, MSNBC must be the only thing you watch.

I primarily just read whitehouse.gov releases. Absolutely horrifying but I guess it must be refreshing to see your vision of America come true so quickly especially since you aren't the one who is having their rights stripped away.

 

[Splenda88]

I don’t regret voting for trump 3x.

The Dems need to bring viable candidates to the the table. As much as people are in denial. The only reason Biden even won in 2020 was because of a once in a 100 years virus. That’s the simple truth. Biden been trying to become president since the late 1980s and failed. Almost a participation trophy Biden was awarded in 2020 due to the virus.

I think trump is a con artist. But that’s what Americans loves. It’s like a woman going out with bad boys in her 20s and loving it even though she knows it’s all wrong.

It’s a phase in life. Trump and the bad boy will be gone in 3.5 years and the new generation will come.

Lol for the woman analogy

A deficit/debt bomb will be left for someone to fix.

 

[Splenda88]

Hillary v Trump
Trump (incumbent) v Biden
Harris vs Trump

You said you dont vote incumbent. Am i missing something?

You voted for the same guy 3 times. Your votes arent all over the place

He is a republican MAGA. Unlike other MAGA, he at least recognizes that Trump is not God.

 

[centdoc]

What about implications for pass through corporations?

Will my 199a deduction change? Will the income phase out increase?

What about SALT cap workaround, does that go away?

Will my my slice get better? Will BC have a good powder year?

Unfortunately the 199a did not change. For those of us with medical S corps, the same old rules still apply. No one new was removed from the SSTB.

 

[Splenda88]

And go where? Regardless of anyone's voting pattern, the United States is the greatest country.

I was on vacation in Europe and Asia recently. Fine to visit. Made me appreciate the United States even more.

It is GREAT mostly for the top 10%. We have the feds giving us money all the time...in term printing the $$$ and lowering interest rate.

The BBB will likely inflate assets and the stock market.

I am not complaining. I LOVE the US.

 

[aneftp]

It is GREAT mostly for the top 10%. We have the feds giving us money all the time...in term printing the $$$ and lowering interest rate.

The BBB will likely inflate assets and the stock market.

I am not complaining. I LOVE the US.

It’s the top 1% of wealth that really benefits from these tax laws.

By wealth I mean those with stock and assets over 13-14 million.

 

[anonperson]

It is GREAT mostly for the top 10%. We have the feds giving us money all the time...in term printing the $$$ and lowering interest rate.

The BBB will likely inflate assets and the stock market.

I am not complaining. I LOVE the US.

Nah. It's great for nearly everyone. People in the United States are truly insulated from the misery that most experience in third world and second world countries.

It's truly comical at times.

I work at an FQHC. My patients have nice phones, the younger ones are wearing Jordan 1s, manicures, fake eyelashes, and all look like they get more then enough to eat. Sure they may not be rolling around in a cyber truck or BMW but their quality of life is reasonably good.