HCA FY2026 Q2 LOWERED

HCA Healthcare, Inc. earnings call

Jul 24, 2026 · 05:00 ET Frank MorganMike MarksSam Hazen

Buzzberg read

Exchange headwind increased to $1B-$1.2B

HCA reported Q2 2026 results with diluted EPS growth of 11%, but faced significant headwinds from health insurance exchange disenrollment (15% decline in exchange admissions) that largely migrated to uninsured, leading to a $400M EBITDA hit. Management lowered full-year 2026 guidance to reflect higher exchange impact and slower elective surgery volumes, while noting continued demand growth in insured populations and progress on cost resiliency programs. Exchange volume declined 15% with nearly all patients becoming uninsured, causing a $400M EBITDA impact in Q2 (including $75M upward revision from Q1).

Buzzberg read Exchange headwind increased to $1B-$1.2B HCA reported Q2 2026 results with diluted EPS growth of 11%, but faced significant headwinds from health insurance exchange disenrollment (15% decline in exchange admissions) that largely migrated to uninsured, leading to a $400M EBITDA hit. Management lowered full-year 2026 guidance to reflect higher exchange impact and slower elective surgery volumes, while noting continued demand growth in insured populations and progress on cost resiliency programs. Exchange volume declined 15% with nearly all patients becoming uninsured, causing a $400M EBITDA impact in Q2 (including $75M upward revision from Q1). Read full analysisCollapse analysis

Elective inpatient surgeries fell 6% year-over-year (vs. 2% last year), attributed to exchange losses and general affordability pressures.
Medicaid supplemental payment programs provided $400M net benefit in Q2, largely from Florida, but back-half tailwind expected to wane.
Full-year 2026 guidance lowered: revenue $77-79.5B, adjusted EBITDA $15.4-16.1B (vs. long-term 4-6% growth target).

Revenue $20.23B +6% QoQ

EPS $7.59 +6% QoQ

Gross margin 15.16% reported

Op margin 15.16% reported

What changed this quarter

Guidance

Exchange headwind increased to $1B-$1.2B

Guidance · revenue to $78.25B

Guidance

Revised guidance: EBITDA $15.4B-$16.1B

Guidance · revenue to $78.25B

Capex

$7 billion in capex over three years

Management maintained their stated CapEx range of $5 billion to $5.5 billion for 2026, and noted they have approved more than $7 billion in capital expenditures coming online over the next three years, including new inpatient beds and outpatient facilities to meet expected…

Demand

Three divisions account for 50% of exchange impact

Management's tone was cautious as they revised full-year guidance downward due to a larger-than-expected impact from the expiration of enhanced premium tax credits, though they expressed confidence in demand trends and their resiliency program.

Demand & capex

Demand

Bookings & conversion

Three divisions account for 50% of exchange impact. Management's tone was cautious as they revised full-year guidance downward due to a larger-than-expected impact from the expiration of enhanced premium tax credits, though they expressed confidence in demand trends and their resiliency program.

Capex

Investment and capacity

Tone · cautious

Forward guidance

LoweredGuidance · revenue to $78.25B · was IN LINE last Q

Forward guidance
Metric	Period	Range	Midpoint	Status
Capex	FY2026	$5B–$5.5B	$5.25B	MAINTAINED
EPS	FY2026	$28.70–$30.50	$29.60	LOWERED
Op margin	FY2026	$15.4B–$16.1B	$15.75B	LOWERED
Revenue	FY2026	$77B–$79.5B	$78.25B	LOWERED

Guidance credibility

1 / 1met or beat

Guidance credibility
Issued	Metric	Target	Guide	Actual	Outcome
FY2025 Q3	Capex	FY2025	$5B	$4.9B	Met / beat