Dive Brief:
- HCA Healthcare is facing ongoing financial losses as more patients who were covered by Affordable Care Act plans become uninsured.
- In the third quarter, the company reported a $400 million decrease in pretax earnings, with uninsured patient admissions rising to 10.5% of total volume, as noted by executives during an investor call.
- These losses might exceed the previous estimate of $1.2 billion that HCA anticipated from the challenges associated with the ACA.
Dive Insight:
This year, HCA has incurred around $950 million in pretax losses due to an increase in uninsured individuals who have been priced out of ACA exchanges.
After the expiration of more favorable subsidies last year, millions opted out of ACA coverage, leading to steep premium increases for many enrollees. In June 2026, around 18% fewer individuals—over 4.6 million—enrolled in ACA plans compared to June 2025.
Prior to the subsidy expiration, hospital operators anticipated that some individuals would lose their ACA coverage, although they expected many to transition to different health plans.
However, it turned out that a significant number of those previously covered went uninsured instead, at nearly a 1-to-1 ratio, according to hospital operators this year.
As a leading indicator for for-profit hospitals, HCA—operating 190 hospitals and 2,600 other care facilities in the U.S. and the U.K.—was the first to highlight the growing trend of uninsured patients early this year. Executives revised their guidance, anticipating $1 billion more in losses from uncompensated care and a lack of demand for elective procedures. Other for-profit hospitals soon reported similar financial difficulties.
Uninsured patients create a burden on hospitals due to increased uncompensated care costs, plus they often delay or avoid elective procedures, which are typically profitable for chains like HCA. For the third quarter, HCA noted a 19% year-over-year decline in admissions from ACA patients, which was “a bit more than we had estimated,” as mentioned by CFO Mike Marks during the call.
Some losses were somewhat offset as both outpatient and inpatient admissions grew by 3% in the third quarter from the previous year, driven by an increase in patients with commercial insurance, according to Marks.
Nonetheless, the reduction in exchange customers for surgeries impacted HCA’s earnings. Elective volumes in their outpatient ambulatory units dropped by 5.4%, largely due to the decrease in ACA patient volumes, CEO Sam Hazen noted.
In spite of these challenges, HCA still expects to stay within the higher end of its earnings guidance for the year, as additional payments from Medicaid helped mitigate some of the negative impacts from losing exchange customers.
The hospital chain is projecting revenues of between $77 billion and $79.5 billion this year, alongside pretax earnings in the range of $15.4 billion to $16.1 billion.
HCA has maintained its prediction of a $1 billion to $1.2 billion loss due to ACA-related issues, though analysts pointed out that this would leave just $250 million in losses for the fourth quarter.
During the third quarter, HCA achieved $19.9 billion in revenue, representing a 3.6% increase from the previous year, attributed to higher admissions and Medicaid payments. However, net income saw a 4% decline, dropping to $1.6 billion.
