HCA Healthcare (HCA) Q2 2026 earnings summary

Executive summary

• Revenues rose 8.7% year-over-year to $20.230 billion in Q2 2026, with net income up 2.8% to $1.699 billion and diluted EPS up 11.6% to $7.62 per share.

• Diluted EPS grew 11% year-over-year in Q2 and year-to-date, despite significant headwinds from payer mix shifts due to the expiration of enhanced premium tax credits, leading to a rise in uninsured patients and financial pressure.

• Medicaid state directed and supplemental payment programs, especially in Florida, contributed $1.372 billion in incremental revenues, partially offsetting a $400 million negative impact from payer mix shift.

• Uninsured admissions surged 23.3% due to the expiration of enhanced premium tax credits and administrative reforms.

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

Financial highlights

• Q2 2026 revenues: $20.230 billion (up from $18.605 billion in Q2 2025); net income: $1.699 billion (Q2 2025: $1.653 billion); diluted EPS: $7.62 (Q2 2025: $6.83).

• Adjusted EBITDA: $4.027 billion (Q2 2025: $3.849 billion); margin: 19.9%.

• Q2 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, aided by Medicaid supplemental payment programs and contracted rate increases.

• Cash flow from operations was $2.335 billion in Q2, down from $4.210 billion year-over-year, mainly due to timing of Medicaid payments and prior year tax deferrals.

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.

• Management expects continued inflationary pressures on operating expenses and ongoing impacts from policy changes affecting Medicaid and insurance exchanges.