HCA Healthcare cuts 2026 profit outlook on insurance exchange losses

HCA Healthcare, Inc. (NYSE: HCA) released preliminary second-quarter 2026 results and lowered its full-year earnings guidance, citing a shift in patient payer mix driven by an increase in uninsured volume linked to patients who lost coverage on health insurance exchanges.

For the quarter ended June 30, 2026, the Nashville-based hospital operator reported estimated revenue of $20.23 billion, up from $18.61 billion in the same period of 2025. Net income attributable to HCA Healthcare is expected to reach approximately $1.699 billion, or $7.62 per diluted share, compared with $1.653 billion, or $6.83 per diluted share, a year earlier. Adjusted EBITDA is expected to approximate $4.027 billion, versus $3.849 billion in the prior-year quarter.

The company said the payer mix shift had an estimated unfavorable impact of approximately $400 million on income before income taxes during the quarter. Partially offsetting that impact, the company recognized approximately $400 million of incremental net benefit from Medicaid Supplemental Payment Programs, primarily related to Florida for the period October 1, 2024 through June 30, 2026, following approval of a state directed payment program by the Centers for Medicare and Medicaid Services.

Same-facility admissions rose 2.5% and emergency room visits increased 3.6% compared with the prior-year period, while same-facility inpatient surgeries declined 2.3% and outpatient surgeries fell 3.4%.

HCA revised its full-year 2026 guidance. The company now expects revenue of $77.0 billion to $79.5 billion, narrowed from a prior range of $76.5 billion to $80.0 billion. Net income guidance was lowered to $6.3 billion to $6.7 billion from $6.495 billion to $7.035 billion. Diluted earnings per share guidance was reduced to $28.70 to $30.50 from $29.10 to $31.50. Adjusted EBITDA guidance was revised to $15.4 billion to $16.1 billion from $15.55 billion to $16.45 billion.

The estimated unfavorable impact from health insurance exchange payer mix shifts was raised to $1.0 billion to $1.2 billion for the full year, up from a prior estimate of $600 million to $900 million. The company's capital expenditure forecast of $5.0 billion to $5.5 billion remains unchanged. The preliminary results are subject to completion of the company's quarterly financial closing procedures.

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