HCA Preliminary Results Highlight Drag from Exchanges, Surgery Volumes under Some Pressure; HCIT Read-Throughs

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HCA Preliminary Results Highlight Drag from Exchanges, Surgery Volumes under Some Pressure; HCIT Read-Throughs

July 15, 2026 HCA Preliminary Results Highlight Drag

from Exchanges, Surgery Volumes under

Some Pressure; HCIT Read-Throughs David(212) 738-6161Larsen,dlarsen@btig.comCFAHEALTHCARE Jenny Shen

(212) 738-6136 jshen@btig.comIT WHAT YOU SHOULD KNOW: On Tuesday, 7/14/26 BMO, HCA Healthcare (HCA, Not

Rated) reported preliminary 2Q:26 results. 2Q:26 revenue of $20.2B +9% y/y (vs.

consensus of $19.6B), and adjusted EBITDA of $4B +5% y/y, a 19.9% margin, (vs.AND consensus of $4B) seemed fine, but HCA lowered full-year 2026E EBITDA guidance,

and guidance for other earnings metrics like net income and EPS were also reduced.

The main headwind continues to be the Big Beautiful Bill Act (BBBA) and Exchange

enrollment declines, with HCA highlighting "a payer mix shift driven by an increase in

uninsured volume, primarily due to patients who lost coverage on the health insuranceDIGITAL exchanges." The unfavorable payer mix shift drove a ~$400M earnings headwind in the

quarter, which was higher than initially expected and also included an unfavorable mix

shift in services as well, primarily from a decline in surgical volume. HCA now expects

the Exchange drag to be $1B-$1.2B for the year, which is far higher than the previousHEALTH expectation of $600M-$900M. Although same facility equivalent admissions increased

+2.7% y/y in 2Q:26 and ED visits increased +3.6% y/y, surgeries, which are often more

discretionary, declined. Volumes declined for both inpatient and outpatient surgeries,

declining -2.3% y/y and -3.4% y/y, respectively. We believe that some people may be

avoiding or delaying elective surgeries. Medicaid saw some relief, with HCA receiving