HCA Healthcare reports higher Q2 revenue, EPS, admissions, and adjusted EBITDA despite profitability pressure.
Stock Earnings Results
July 24, 2026
Table of Contents
July 24, 2026
HCA Healthcare, Inc. (NYSE: HCA) reported second-quarter 2026 results with higher revenue, higher earnings per share, admissions growth, and increased adjusted EBITDA, while an unfavorable payer mix shift and weaker surgical volume pressured profitability.
HCA Healthcare is one of the largest hospital operators in the United States, providing inpatient care, emergency care, outpatient services, surgery, physician services, and related healthcare services across its hospital and care network.
Revenue increased 8.7% year-over-year to $20.23 billion.
Net income attributable to HCA Healthcare increased 2.8% to $1.70 billion.
Diluted EPS increased 11.6% to $7.62.
Adjusted diluted EPS increased 11.0% to $7.59.
Adjusted EBITDA increased 4.6% to $4.03 billion.
Cash flow from operating activities was $2.34 billion, down from $4.21 billion in the prior-year quarter.
Same facility admissions increased 2.5%.
Same facility equivalent admissions increased 2.7%.
Same facility emergency room visits increased 3.6%.
Same facility revenue per equivalent admission increased 6.4%.
The volume growth helped support revenue, even as the company dealt with weaker payer mix and softer surgery trends.
HCA said the second quarter was affected by a payer mix shift driven by higher uninsured volume.
The company said the increase was mainly tied to patients who lost coverage on health insurance exchanges.
HCA estimated the payer mix shift had an unfavorable impact of about $400 million on income before income taxes during the second quarter.
That amount included about $75 million tied to the company’s prior estimate of the first-quarter health insurance exchange impact.
The company also reported a service mix shift, mainly related to lower surgical volume.
HCA recognized about $400 million of incremental net benefit from Medicaid Supplemental Payment Programs during the quarter.
That benefit was mainly tied to the Florida program.
The quarter included incremental revenues of $1.37 billion and other operating expenses of $829 million related to the Florida directed payment program for the period from October 1, 2024 through June 30, 2026.
Of those amounts, about $980 million of incremental revenue and $557 million of other operating expenses related to periods before 2026.
Same facility inpatient surgeries declined 2.3%.
Same facility outpatient surgeries declined 3.4%.
That weaker surgical activity was a negative mix factor because surgical procedures are often higher-value services for hospital operators.
The decline in surgery volumes partly offset growth in admissions, ER visits, and revenue per equivalent admission.
HCA ended the quarter with $1.01 billion in cash and cash equivalents.
Total debt was $49.72 billion, while total assets were $63.25 billion.
Capital expenditures totaled $1.23 billion during the quarter, excluding acquisitions.
The company repurchased 4.75 million shares for $2.06 billion.
HCA had $7.21 billion remaining under its share repurchase authorization at quarter-end.
The board also declared a quarterly dividend of $0.78 per share, payable September 30, 2026, to shareholders of record as of September 16.
HCA revised its 2026 outlook.
The company now expects revenue of $77.00 billion to $79.50 billion, compared with the prior range of $76.50 billion to $80.00 billion.
Net income attributable to HCA Healthcare is now expected to range from $6.30 billion to $6.70 billion, down from the prior range of $6.50 billion to $7.04 billion.
Adjusted EBITDA is now expected to range from $15.40 billion to $16.10 billion, down from the prior range of $15.55 billion to $16.45 billion.
Diluted EPS is now expected to range from $28.70 to $30.50, down from the prior range of $29.10 to $31.50.
Capital expenditure guidance remained unchanged at $5.0 billion to $5.5 billion, excluding acquisitions.
HCA delivered revenue growth and higher EPS, but the quarter showed a clear mix problem.
Admissions and ER visits increased, revenue per equivalent admission improved, and Medicaid supplemental payments provided a major offset. At the same time, higher uninsured volume and lower surgery activity weighed on profitability, leading management to reduce its full-year earnings and adjusted EBITDA outlook.
The key question is whether HCA can stabilize payer mix and surgery volume while continuing to grow admissions and manage labor and operating costs.
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