HCA Healthcare, Inc.

What they do

HCA operates general acute care, behavioral, and rehabilitation hospitals, plus freestanding ambulatory surgery and endoscopy centers. It provides a broad range of medical services including cardiology, oncology, orthopedics, and emergency care, and earns revenue primarily from patient care services reimbursed by government programs and private insurers.

Revenue drivers

• General acute care hospitals — 179 hospitals providing inpatient and outpatient services; primary revenue source, driven by admissions and revenue per equivalent admission.
• Outpatient and ancillary services — Includes ASCs, endoscopy centers, urgent care, and diagnostic centers; contributes to same facility revenue growth and volume.
• Medicaid supplemental and state directed payment programs — In Q2 2026, recognized $1.372 billion of incremental revenues, primarily from Florida's directed payment program, boosting revenue.

Recent performance

Q2 2026 revenues increased 8.7% to $20.230 billion, with net income of $1.699 billion ($7.62 per diluted share). Adjusted EBITDA rose 4.6% to $4.027 billion. Same facility equivalent admissions grew 2.7%, and same facility revenue per equivalent admission rose 6.4%. Cash flows from operations were $2.335 billion, down from $4.210 billion in Q2 2025.

Strategy

HCA aims to grow in existing markets, achieve industry-leading clinical and operational performance, recruit physicians, and leverage economies of scale. The company invests in digital and AI capabilities to advance clinical systems and transform care models. A disciplined development strategy focuses on expanding comprehensive networks and coordinating higher quality care.

Risks

• Payer mix shift from exchange coverage loss — Expiration of enhanced premium tax credits led to increased uninsured volume, unfavorably impacting income before taxes by ~$400 million in Q2 2026.
• Regulatory and legislative changes — Changes to Medicare, Medicaid, and the 2025 Federal Budget Act could reduce reimbursements or alter supplemental payment programs.
• Labor and supply cost inflation — Inflation and workforce shortages could increase salaries, benefits, and supply costs, pressuring margins.
• High debt levels and refinancing risk — Average debt of $49.228 billion in Q2 2026 may require refinancing at higher rates if access to capital tightens.

Outlook

Management expects continued revenue growth from volume increases and Medicaid supplemental payments, but faces headwinds from exchange coverage losses and administrative reforms. Inflationary pressures on operating expenses are expected to persist. The company updated guidance consistent with its July 14, 2026 preview.