HCA Says Insurance Exchanges Reset Will Cut up to $900M From ’26 EBITDA
Hospital giant HCA Healthcare Inc. will lose up to $900 million in earnings before interest, depreciation and amortization this year because of an expected double-digit drop in volumes from patients with health insurance exchange coverage.
Speaking to analysts and investors after reporting Nashville-based HCA’s fourth-quarter profits of $2.16 billion, an increase from roughly $1.7 billion in late 2024, CEO Sam Hazen and CFO Mike Marks said they are closely watching exchange enrollment trends. At this point, HCA teams are forecasting that volumes of patients covered by exchanges—who accounted for 8 percent of the company’s admissions and 10 percent of its revenues in 2025—will fall by 15 percent to 20 percent this year because of rules passed as part of the One Big Beautiful Bill Act and the year-end expiration of a series of tax credits.
That fall in volumes will slice between $600 million and $900 million from HCA’s adjusted EBITDA, executives said. The company last year produced adjusted EBITDA of more than $15.5 billion, an increase of 12 percent from 2024.
On a conference call, Marks said the range of $600 million to $900 million is as wide as it is because several factors can swing the financial impact over the course of 2026.
“First, how many people lose exchange coverage. And what form of coverage, if any, do those lives migrate to?” Marks said, adding that HCA thinks up to 20 percent of people who have had insurance coverage will move to employer-sponsored plans. “And for those retaining coverage, is there a change in medal tier or utilization? As you can imagine, assumptions around the variables are informed through our own data and experience as well as incorporating external studies and analysis. These variables are difficult to predict and require significant judgments.”
On the flip side, Hazen and Marks called out their expectation that HCA teams will this year generate another $400 million of cost cuts and efficiencies, continuing a multi-year program Hazen said has become “cultural within HCA.”
“We have tools […] that are in front of us as opportunities to create even more consistency, efficiencies and transparency in the company’s overall cost,” Hazen told analysts.
Executives are forecasting that revenues will climb from last year’s $75.6 billion to somewhere between $76.5 billion and $80 billion and their forecast for equivalent admissions growth is 2 percent to 3 percent. Capital spending for the year is expected to be between $5 billion and $5.5 billion compared to $4.9 billion in 2025. Investments in outpatient facilities—a longer-term priority—will be a significant part of that plan, Hazen said, adding that HCA’s pipeline for acquisitions of outpatient sites also is better than it has been in recent years.
Shares of HCA (Ticker: HCA) rose 7 percent to nearly $506 apiece on the heels of executives’ report and conference call but gave up some of those gains on the two ensuing days. On the afternoon of Feb. 2, they were changing hands around $492, adding slightly to six-months gains of nearly 40 percent that have grown the company’s market value to more than $115 billion.
About the Author
Geert De Lombaerde
A native of Belgium, Geert De Lombaerde has more than two decades of business journalism experience and writes about markets and economic trends for Endeavor Business Media publications Healthcare Innovation, IndustryWeek, FleetOwner, Oil & Gas Journal and T&D World. With a degree in journalism from the University of Missouri, he began his reporting career at the Business Courier in Cincinnati and later was managing editor and editor of the Nashville Business Journal. Most recently, he oversaw the online and print products of the Nashville Post for more than a decade and reported primarily on Middle Tennessee’s finance sector as well as many of its publicly traded companies.