HCA Healthcare Inc Q&A Our Way: ACA Exchange Trends More Unfavorable than Anticipated; Guidance Implies Core Growth Closer to Historical Trends

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HCA Healthcare Inc Q&A Our Way: ACA Exchange Trends More Unfavorable than Anticipated; Guidance Implies Core Growth Closer to Historical Trends

FigureSource:Company1: 2026Data,CoreUBSGrowthEstimates Calculation2026

Exchanges the Major Story; Some Elective Softness Due to Other Factors

The headwind from ACA exchange disenrollment has been higher than HCA's original

expectations, driven by close to zero conversion to other types of insurance (vs. original

expectations that 15-20% would transition to employer sponsored insurance) and

essentially zero decline in utilization among the newly uninsured (vs. original

expectations for a ~30% utilization decrease). The impact is particularly concentrated in

three of HCA's divisions in the southeast U.S., which have experienced around two times

the level of exchange volume loss compared to the company as a whole. Management

highlighted that the ACA exchange dynamics cut across multiple components of the

business and are a primary factor contributing to both the rise in uninsured volumes

(~80% due to ACA disenrollment, ~20% due to lower Medicaid conversions) and the

softness ins surgical volumes. However, management noted that at least a piece of the

softness in demand for elective surgeries appears related to a general reticence among

patients to scheduled elective procedures, meaning the impact is not entirely explained

by the exchanges. Emergent inpatient surgery volumes (ie. non-elective) were still up

2% over the prior year and overall admissions were up 2.5%, indicating that the

demand environment for non-elective procedures and medical visits remains solid.

Resiliency Plan Modestly Ahead of Schedule; Don't Expect Quarterly Numbers

Management was positive on the progress of the company's resiliency plan and noted