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HCA cuts 2026 guidance after payer mix worsens
The company said Medicaid redeterminations and health insurance exchange coverage lapses removed about $400 million in Q2 pre-tax income and widened its full-year exchange drag to $1.0 billion to $1.2 billion.
HCA Healthcare reported second-quarter 2026 results, with revenue rising 8.7% year over year to $20.23 billion and diluted EPS increasing 11.6% to $7.62, while adjusted EBITDA climbed 4.6% to $4.027 billion, according to Yahoo Finance. The company also reported positive operational volume, including same-facility admissions up 2.5%, equivalent admissions up 2.7%, and emergency room visits rising 3.6%.
Despite the topline gains, HCA said payer mix deteriorated and it revised its full-year profitability guidance downward, prompting Wall Street target cuts. In its Q2 details, same-facility inpatient surgeries declined 2.3% and outpatient surgeries fell 3.4%, alongside the shift in mix.
HCA attributed the outlook change to a policy-driven payer mix shift, including an increase in uninsured volume after Medicaid redeterminations and the lapse of health insurance exchange coverage. The company estimated the move wiped out roughly $400 million from Q2 pre-tax income and now expects exchange-related drag of $1.00 billion to $1.20 billion for 2026, partly offset by $300 million to $500 million in net Medicaid Supplemental Payment Program benefits.
For 2026, HCA lowered guidance for diluted EPS to $28.70 to $30.50 and adjusted EBITDA to $15.40 billion to $16.10 billion, and narrowed revenue guidance to $77.00 billion to $79.50 billion. After the release, Mizuho cut its price target to $475 from $525, and Morgan Stanley reduced its price target to $380 from $425, according to Yahoo Finance.