HCA Healthcare has issued revised 2026 guidance with revenue between $77 billion and $79.5 billion and diluted earnings per share between $28.70 and $30.50. The updated outlook reflects a larger-than-expected headwind from health insurance exchanges, now estimated at a negative $1 billion to $1.2 billion, as nearly all patients losing exchange coverage became uninsured rather than shifting to other plans. This payer mix shift had an unfavorable impact on adjusted EBITDA of approximately $400 million in the second quarter, partially offset by a $400 million incremental net benefit from Medicaid Supplemental Payment Programs, including $540 million related to a recently approved Florida program. Second-quarter admissions rose 2.5% and equivalent admissions increased 2.7%, while emergency room visits grew 3.6%, though inpatient and outpatient surgeries declined. The company also approved more than $7 billion in capital expenditures to come online over the next three years and repurchased $2.064 billion of shares during the quarter.
HCA Healthcare, Inc.Exchange headwind and payer mix shift (patients becoming uninsured) reduce revenue and EBITDA.