HCA Healthcare (HCA) TD Cowen 46th Annual Health Care Conference summary

Strategic initiatives and resiliency planning

• Four focus areas drive the resiliency program: revenue integrity, asset optimization, fixed cost, and variable cost, targeting a $400 million benefit by 2026 to offset ACA-related headwinds.

• Hundreds of work streams are underway, with only those far enough along included in the 2026 guidance.

• The program is positioned as a multi-year, enterprise-wide effort, continuing through the decade.

Financial modeling and headwinds

• ACA APTC expiration is modeled as a $600–$900 million headwind for 2026, with key assumptions around attrition rates, metal tier shifts, and coverage transitions.

• 15–20% of those leaving exchanges are expected to move to employer-sponsored insurance, with the rest becoming uninsured.

• Updates on these assumptions will be provided in quarterly calls as data matures.

Operational trends and capacity management

• Outpatient revenue growth outpaced inpatient in Q4, with declines in lower acuity surgeries and Medicaid volumes offset by growth in other payer mixes.

• Inpatient occupancy averages 73%, managed through adding 600–700 beds annually and reducing length of stay.

• No immediate capacity constraints are expected, with planning focused on maintaining occupancy in the 70–75% range.