HCA Healthcare Inc. (HCA): First Take: 2026 Guide Reset on Shifting Payer Mix and Surgical Softness; Key Themes from GS Hospital Diligence

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HCA Healthcare Inc. (HCA): First Take: 2026 Guide Reset on Shifting Payer Mix and Surgical Softness; Key Themes from GS Hospital Diligence

Equity Research

14 July 2026 | 9:31AM EDT

HCA Healthcare Inc. (HCA): First Take: 2026 Guide Reset on Shifting

Payer Mix and Surgical Softness; Key Themes from GS Hospital Diligence

On 7/14/26, HCA announced preliminary 2Q26 results with adjusted EBITDA of Scott Fidel

+1(212)902-7304 | scott.fidel@gs.com

approximately $4.027 billion, ahead of GS/Visible Alpha consensus estimates of Goldman Sachs & Co. LLC

$3.976 billion/$3.965 billion by 1.3%/1.6%, respectively. Revenue of $20.230 billion Sarah Conrad

exceeded GS/Street estimates of $19.451 billion/$19.362 billion by 4.0%/4.5%, +1(212)357-2448sarah.conrad@gs.com|

driven by stronger-than-expected overall volume growth and incremental Medicaid Goldman Sachs & Co. LLC

Valentine Vlasovsupplemental payment revenue. At the same time, the company lowered its full year +1(212)934-0210 |

2026 guidance to reflect a larger-than-expected negative impact from health valentine.vlasov@gs.comGoldman Sachs & Co. LLC

insurance exchange market membership losses and payer mix deterioration.

During the second quarter, HCA experienced an unfavorable payer mix shift driven

by increased uninsured volumes following coverage losses on the exchanges, which

the company estimates reduced pre-tax earnings by approximately $400 million,

including $75 million related to a refinement of its prior estimate of the 1Q26

impact. HCA also experienced a service mix shift related to a decline in surgical

volumes, similar to trends flagged by ARDT and from the panelists at our Hospital

Diligence Day, who also discussed similar changing payer mix dynamics, including

rising self-pay / uninsured volume trends.