HCA Healthcare (HCA) Q2 2026 earnings summary

Executive summary

• Diluted EPS grew 11.6% year-over-year in Q2 2026 to $7.62 per share, with net income up 2.8% to $1.699 billion, despite significant headwinds from payer mix shifts and increased uninsured volumes, which pressured margins.

• Strong demand persisted, with insured volume growth (excluding exchanges), particularly in ER visits, cardiac procedures, and rehab, though elective and outpatient surgeries declined.

• Negative payer mix shift from exchange attrition led to a $400 million pre-tax income impact, partially offset by a $400 million net benefit from Medicaid Supplemental Payment Programs.

• Cash flows from operations dropped to $2.335 billion, down 45% year-over-year, mainly due to Medicaid payment timing and prior year tax deferrals.

Financial highlights

• Q2 2026 revenues rose 8.7% to $20.230 billion, with net income at $1.699 billion and diluted EPS at $7.62.

• Adjusted EBITDA was $4.027 billion, with a margin of 19.9%, and was negatively impacted by exchange-related payer mix shift but offset by Medicaid program benefits.

• Admissions increased 2.5%, equivalent admissions up 2.7%, ER visits up 3.6%, while inpatient surgeries fell 2.3% and outpatient surgeries dropped 3.4% year-over-year.

• Net revenue per equivalent admission grew 6.4% in Q2.

• Cash and equivalents at June 30, 2026, were $1.013 billion; total debt was $49.718 billion.

Outlook and guidance

• 2026 revenue guidance: $77–$79.5 billion; Adjusted EBITDA: $15.4–$16.1 billion; Net income: $6.3–$6.7 billion; Diluted EPS: $28.70–$30.50.

• Expected unfavorable Adjusted EBITDA impact from exchanges: negative $1–$1.2 billion; Medicaid supplemental payment net benefit: $300–$500 million.

• CapEx guidance maintained at $5–$5.5 billion; most of the authorized share repurchase program expected to be completed, subject to market conditions.

• Fourth quarter Adjusted EBITDA growth rate expected to be higher than third quarter due to timing of exchange and Medicaid program effects.