HCA Healthcare, Inc. (NYSE:HCA) released preliminary second-quarter 2026 financial results while reducing its full-year earnings outlook, as a growing number of uninsured patients weighed on profitability following changes in health insurance exchange coverage.
The hospital operator said the shift in patient payer mix had a significant impact on second-quarter earnings despite higher revenue and continued growth in patient admissions.
Revenue and Profit Continue to Increase
For the quarter ended 30 June 2026, HCA expects revenue of approximately $20.23 billion, up from $18.61 billion in the corresponding period last year.
Net income attributable to shareholders is estimated at approximately $1.699 billion, or $7.62 per diluted share, compared with $1.653 billion, or $6.83 per diluted share, in the second quarter of 2025.
Adjusted EBITDA is projected to reach approximately $4.027 billion, compared with $3.849 billion a year earlier.
Payer Mix Shift Reduces Earnings
HCA said changes in its patient payer mix reduced pre-tax income by an estimated $400 million during the quarter.
The company attributed the impact to a rise in uninsured patients after more individuals lost health insurance coverage obtained through public insurance exchanges.
The negative effect was largely offset by approximately $400 million in additional benefits from Medicaid Supplemental Payment Programs, primarily in Florida, following approval of a state-directed payment programme by the Centers for Medicare and Medicaid Services.
Patient Activity Shows Mixed Performance
Same-facility admissions increased 2.5% compared with the prior-year period, while emergency room visits rose 3.6%.
However, inpatient surgeries declined 2.3%, and outpatient surgical procedures fell 3.4% on a same-facility basis.
Company Reduces Full-Year Guidance
HCA revised its financial outlook for fiscal 2026 to reflect the continuing impact of changes in insurance coverage.
The company now expects revenue between $77.0 billion and $79.5 billion, compared with previous guidance of $76.5 billion to $80.0 billion.
Net income guidance was lowered to a range of $6.3 billion to $6.7 billion from the previous forecast of $6.495 billion to $7.035 billion.
Diluted earnings per share are now expected to be between $28.70 and $30.50, down from earlier guidance of $29.10 to $31.50.
Adjusted EBITDA guidance was also reduced to $15.4 billion to $16.1 billion, compared with the previous range of $15.55 billion to $16.45 billion.
Higher Insurance Exchange Impact Expected
HCA now estimates that changes in health insurance exchange coverage will reduce full-year earnings by between $1.0 billion and $1.2 billion.
The company had previously forecast an impact of between $600 million and $900 million.
Its capital expenditure outlook remains unchanged at between $5.0 billion and $5.5 billion for fiscal 2026.
HCA noted that the figures remain preliminary and are subject to completion of its standard quarterly financial reporting procedures.