What You Need to Know from HCA‘s 2Q Earnings & Follow-Up with Management

Research evidence excerpt

What You Need to Know from HCA‘s 2Q Earnings & Follow-Up with Management

ikely more modest anyway, with our

analysis of quarterly data finding that s-f total surgeries have grown on average +0.3%

y/y since 2005.

• With HCA’s 2H26 outlook not anticipating a material decline in ACA Exchange

enrollment, we flag the potential for continued declines as the year progresses given

historical effectuation patterns.

• With HCA’s updated 2026 guidance now expecting -$350M in additional impact

from ACA Exchange changes following a material step-down in ACA Exchange

enrollment between 1Q/2Q, we flag the potential for additional enrollment declines.

• Based on our analysis of market-level trends across hospital footprints historically

showing a larger decline during 4Q and payer commentary discussing material (~5%-

15%) incremental attrition as the year progresses, we would expect historical trends

to continue here (particularly without any offsetting SEP benefits), which would lead

to additional disenrollment during 2H26. Given HCA’s sizable footprint in states that

grew above the national average in recent years, we would be surprised to see their

markets avoid similar attrition.

• That said, with implementation of several of the provisions in CMS’s Marketplace

Integrity Rule (2027 NBPP) stayed by the District Court of MD as part of the City of

Columbus v. Kennedy II, we note that there are some potential mitigating effects on

this cycle’s expected enrollment declines that serve as an offset to previous estimates.

• HCA’s payer mix commentary underscored that ACA Exchange volumes are down

and uninsured volumes are up, with evidence pointing to near 1:1 migration from

ACA Exchange to uninsured, which served as a meaningful profitability headwind