Jump in Uninsured Patients Stings HCA
The number of uninsured patients who sought care at HCA Healthcare Inc. hospitals during the second quarter surprised the company’s executives and has led them to lower their profit forecasts for the year by about $265 million.
Sam Hazen, CEO of Nashville-based HCA, and his team said on July 14 that the company saw a shift in its mix of payers that was primarily caused by a rise in patients who have lost coverage on the health insurance exchanges. That, they said, cost HCA about $400 million in pre-tax profits during the three months that ended June 30, with that figure including about $75 million added to what the HCA team had estimated uninsured care cost it in the first quarter.
“Our colleagues continue to manage well through the positive and negative factors that have impacted our business in the first half of the year,” Hazen said in a statement that detailed his team’s new earnings guidance and noted that surgical volumes dropped off during the second quarter. “We remain confident in our ability to navigate through this dynamic environment, maintain our focus and investments on improving patient care, and execute on our strategic plan to digitize and grow our healthcare networks.”
The impact of fewer insurance exchange patients is the main driver of that less optimistic outlook: Hazen and his lieutenants have hiked their full-year estimate of the financial impact from seeing fewer exchange patients to between $1 billion and $1.2 billion in EBITDA; they had earlier expected that range to be $600 million to $900 million.
Still, it’s not a shock that the complex picture around coverage options, the exchanges and uninsured patients has evolved quickly. HCA executives this spring raised the possibility that the situation on the ground could evolve from what they had seen in the first three months of 2026. On the company’s first-quarter earnings conference call, CFO Mike Marks said the market had evolved roughly along the lines of HCA leaders’ expectations that 15 percent to 20 percent of exchange patient volume would disappear—while adding that “it’s early.”
“Patients migrating to uninsured are just a little bit less than expected as we are seeing some individuals converting to Medicare or Medicaid due to the age or to changes in life circumstances,” Marks said April 24. “But I would note that this is a slight improvement and was not significant. And overall, […] the payer mix deterioration from the exchanges is generally in line with our expectations for the quarter. It's early, and obviously, this is going to continue to mature.”
Shares of HCA (Ticker: HCA) fell 7 percent on the lowered guidance and closed at $363.60 July 14. Year to date, they’ve lost 22 percent of their value, a slide that has trimmed the company’s market capitalization to about $81 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.