HCA Healthcare Inc. (HCA): 2Q Recap: With Full-Year EBITDA Guidance Reset, Our Focus Shifts to Gauging 2H26 Utilization Seasonality

Research evidence excerpt

HCA Healthcare Inc. (HCA): 2Q Recap: With Full-Year EBITDA Guidance Reset, Our Focus Shifts to Gauging 2H26 Utilization Seasonality

Goldman Sachs HCA Healthcare Inc. (HCA)

2%-3% volume growth algorithm, supported by favorable demographic

growth trends across its core markets.

o Pricing (Revenue per Adjusted Admission): Pricing trends were significantly

stronger than expected, with same-facility revenue per equivalent admission

increasing 6.4% year-over-year versus GS/consensus expectations of

2.7%/3.7%. The upside was driven primarily by Florida directed payment

program approvals, including approximately $1.372 billion of incremental

gross revenue recognition and approximately $980 million related to periods

prior to 2026. Excluding the out-of-period Florida benefit, underlying RPAA

growth would have been approximately 2.6%, broadly consistent with our

prior modeling expectations and supported by contracted commercial rate

increases and governmental payment updates.

o HIX & Medicaid Volumes: Exchange equivalent admissions declined

approximately 15% year-over-year in 2Q26, consistent with trends observed

in 1Q26. HCA indicated that patients losing Exchange coverage migrated

almost one-for-one into uninsured admissions, rather than transitioning to

alternative coverage sources as the company originally anticipated. HCA

provided additional payer mix detail, noting that same-facility equivalent

admissions for insured patients, excluding those covered through the

Exchanges, increased 3.2% in 2Q26, including Medicare volume growth of

+3.6%, Medicaid growth of +2.7%, and Commercial market (excluding

Exchanges) growth of +2.4%, underscoring that underlying insured demand

trends remained intact across the major payer end markets outside of the

Exchanges.