Trump’s “Big Beautiful Bill”: What It Means for Nurses in 2025

Nurses are used to dealing with pressure, long shifts, and unpredictable patients. But what about unpredictable tax laws?

If you’ve been hearing about Trump’s “Big Beautiful Bill” and wondering, “How will this affect me as a nurse?”—you’re in the right place.

Let’s break it down nurse-to-nurse, so you can understand what this bill could mean for your paycheck, your taxes, and your long-term financial goals.

What Is the “Big Beautiful Bill”?

The One Big Beautiful Bill (OBBBA for short) is a sweeping tax and economic proposal backed by former President Trump and Republican lawmakers. It’s essentially a sequel to the 2017 Tax Cuts and Jobs Act (TCJA)—but bigger.

Here’s what the bill proposes:

✅ Permanent extension of 2017 Trump tax cuts
✅ Increased standard deduction (an extra $2,000 for married couples)
✅ Higher cap on state and local tax (SALT) deductions—from $10K up to $30K+
✅ Enhanced child tax credits and the creation of “Trump Accounts”
✅ New deductions for tip income and overtime
❌ Cuts to Medicaid, ACA subsidies, and other safety-net programs
❌ Estimated $2.4–3.3 trillion added to the national deficit

How This Affects Nurses (Especially High-Income Nurses)

If you’re a nurse earning over six figures—especially in high-tax states like California or New York—you’re in the group that stands to benefit the most from certain parts of this bill.

Let’s say your household income is around $300K–$400K (like many dual-income families of NPs, CRNAs, and travel nurses). Here’s what to pay attention to:

1. Lower Taxes and Bigger Deductions

If the bill passes, your federal income tax rate may stay low thanks to the extended 2017 tax brackets. You’ll also get a larger standard deduction—meaning less taxable income overall.

This puts more money back in your pocket every pay period.

2. SALT Cap Raised = Big Savings for California Nurses

Right now, there’s a cap of $10,000 on how much you can deduct for state and local taxes—but many California nurses pay way more than that.

This bill could raise the cap to $30,000+, meaning:

You get to deduct more of what you already pay in taxes
Your taxable income goes down
You keep more of your money

For high-income earners in high-tax states, this is a huge win.

3. Extra Perks for Families With Kids

If you have children under 8:

You’ll get an extra $1,000/year in a new “Trump Account”
The child tax credit will increase to $2,200 per child

These are modest, but meaningful savings—especially when paired with other deductions.

4. New Deductions for Nurses Working Overtime or Per Diem

If you earn overtime, holiday pay, or shift differentials, the bill proposes deducting some of that income—potentially reducing your overall tax burden.

That means your long shifts could stretch further toward your wealth goals.

But Be Cautious: Not All Nurses Win Equally

Here’s the truth:
While higher-earning nurses may benefit from this bill, the biggest tax breaks go to the top 1% and big corporations—not everyday workers.

And the bill plans to cut programs like Medicaid, food assistance, and ACA health coverage, which may: