HCA raises 2026 outlook to upper half despite $400 million impact from uninsured patients
Key Facts
HCA Healthcare reported on October 27 results for the third quarter ended September 30, 2026, showing growth in revenue and admissions alongside a decline in net income under pressure from a rise in uninsured patients. The company said a change in payer mix reduced pretax income by about $400 million during the quarter. Adjusted earnings per share, meanwhile, came to $7.22, above the analyst average estimate of $6.66, according to data compiled by LSEG and reported by Reuters. The company also raised its full-year operating outlook to the upper half of its previous ranges. The results put growth in clinical activity alongside the effect of insurance coverage on financial returns.
Adjusted earnings per share rose 3.7% year over year to $7.22, while adjusted earnings before interest, taxes, depreciation and amortization increased 1.2% to $3.918 billion, according to the company’s statement. Cash flows from operations totaled $4.461 billion, compared with $4.416 billion in the third quarter of 2025. But the improvement in these adjusted metrics did not prevent net income from falling, according to the results announced by HCA. Revenue came to $19.849 billion, versus analyst expectations of $19.33 billion, according to Investing.com. Second-quarter revenue was $20.23 billion, putting the third-quarter result in the context of a sequential decline that does not erase the beat against the estimate preceding the results.
At the operating level, same-facility admissions rose 2.7%, and equivalent admissions increased 3.0% from the year-earlier quarter. Emergency room visits also rose 5.1%. In the opposite direction, same-facility inpatient surgeries fell 1.4% and outpatient surgeries declined 3.7%. Reuters, citing an assessment by Bernstein, said insurance coverage losses are selectively weighing on elective surgery volumes. The indicators therefore show a divergence between growth in some hospital services and a contraction in surgical procedures, alongside a shift of some patients into the uninsured category.
HCA attributed the impact on pretax income to an increase in uninsured patients, particularly those who lost coverage through health insurance marketplaces. The company estimated the impact at about $400 million in the third quarter, amid a change in payer mix. Barclays, meanwhile, estimated that state-administered supplemental Medicaid programs provided an unexpected benefit of about $250 million during the quarter, helping offset part of the impact, according to a Reuters report. Chief Executive Sam Hazen said the company faced “challenges stemming from federal policy changes this year.” He added that HCA expects to finish the year positively, while the company said its full-year operating results would come in the upper half of the guidance range issued on July 14.
Salaries and benefits accounted for 43.2% of revenue in the third quarter, compared with 43.6% a year earlier, according to a Reuters report, a relative decline in labor costs’ share of revenue. Morningstar estimated that pressures in the health insurance market were only beginning, and that Medicaid work requirements and lower state payments could limit earnings growth through 2028. On liquidity and financing, company data showed cash and cash equivalents of $908 million, against total debt of $50.493 billion as of September 30. HCA also repurchased 7.230 million shares for $2.970 billion during the quarter, leaving $4.240 billion under its buyback authorization. These figures provide financial context for assessing the raised outlook amid the challenges cited by the company and analysts.
The stock moved higher in early trading, contrary to the decline described in the initial draft. Investing.com reported a 3.2% rise in premarket trading, while a StockStory report said it climbed 5.7% to $491.76 immediately after the results were announced. Reuters said the stock was up more than 1% in early trading on the day the results were announced. These readings differ in timing, but all point to an upward move following the published results. They do not establish the stock’s direction for the remainder of the October 27 session.
For upcoming dates, HCA scheduled its investor call for October 27 at 9:00 a.m. Central time and said a recording would be available afterward. It also announced a quarterly cash dividend of $0.78 per share. The dividend is payable on December 29 to shareholders of record on December 15, 2026. The company raised its full-year operating outlook to the upper half of the guidance range issued on July 14. These outlook and dividend details remain the key dates and announcements the company cited after reporting its quarterly results.