HCA Healthcare Inc.’s (NYSE:HCA) stock is trading lower on Tuesday after cutting its fiscal 2026 earnings guidance from $29.10-$31.50 to $28.70-$30.50.
The company also narrowed its 2026 sales guidance from $76.5 billion-$80 billion to $77 billion-$79.5 billion, versus the consensus of $78.643 billion.
After the update, the stock fell around 10% during the premarket session.
The hospital operator reported preliminary second-quarter revenue of approximately $20.23 billion, up from $18.61 billion in the same period last year, compared to the consensus of $19.39 billion.
Net income is projected to reach about $1.70 billion, or $7.62 per diluted share, compared with $1.65 billion, or $6.83 per diluted share, a year earlier.
Admissions Growth Offsets Some Operational Weakness
HCA expects adjusted EBITDA of roughly $4.027 billion, compared with $3.85 billion in the prior-year quarter.
Operationally, same-facility admissions increased 2.5%, while equivalent admissions rose 2.7% year over year. Same-facility emergency room visits also increased 3.6%.
However, surgical volumes weakened during the quarter. Same-facility inpatient surgeries declined 2.3%, while outpatient surgeries fell 3.4% compared with the second quarter of 2025.
Medicaid Payments Help Counter Payer Mix Pressure
The company said the biggest challenge during the quarter came from a shift in payer mix as more patients became uninsured after losing health insurance exchange coverage.
The estimated $400 million unfavorable impact on pretax income includes approximately $75 million related to an updated estimate of the first-quarter health insurance exchange impact.
HCA also noted a less significant service mix shift tied primarily to lower surgical volumes.
Partially offsetting those pressures were higher admissions, increased emergency room visits, improved expense trends, and additional benefits from Medicaid Supplemental Payment Programs.
During the quarter, the company recognized approximately $400 million in incremental net benefits from Medicaid Supplemental Payment Programs, largely related to Florida, covering the period from Oct. 1, 2024, through June 30, 2026.
The benefit reflects the impact of a state-directed payment program approved during the quarter by the Centers for Medicare and Medicaid Services.
“Our colleagues continue to manage well through the positive and negative factors that have impacted our business in the first half of the year…As we look to the balance of the year, we have adjusted our guidance to reflect these factors. Moreover, we remain confident in our ability to navigate through this dynamic environment, maintain our focus and investments on improving patient care, and execute on our strategic plan to digitize and grow our healthcare networks,” said Sam Hazen, CEO of HCA Healthcare.
HCA Stock Price Activity: HCA Healthcare shares were down 6.25% at $366.33 during premarket trading on Tuesday, according to Benzinga Pro data.
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