HCA still expects up to $900M hit from ACA headwinds

 Nashville, Tenn.-based HCA Healthcare said it still expects a $600 million to $900 million EBITDA headwind in 2026 tied to changes in the ACA exchange environment, including the expiration of enhanced subsidies. 

The outlook is unchanged from guidance the system shared in January, when CFO Mike Marks outlined the expected financial impact tied to exchange-related shifts.

During HCA’s April 24 earnings call, executives said first-quarter trends were largely in line with expectations built into that forecast.

HCA recorded an approximately $150 million EBITDA headwind related to exchange dynamics in the first quarter. Same-facility exchange equivalent admissions declined about 15% year over year for the three months ended March 31, in line with the lower end of the system’s expected 15% to 20% decline.

At the same time, same-facility uninsured equivalent admissions increased about 16% year over year. More than half of that increase was driven by patients shifting out of exchange coverage, and normal uninsured growth. 

Mr. Marks said it is too early to determine whether the full-year impact will fall at the lower end of the projected range.

“Based on the data that we’ve seen to date, we do believe that our assumption of a 15% to 20% volume decline continues to be reasonable,” he said.

HCA reaffirmed its 2026 estimated guidance ranges that were issued in January. For the year, HCA is projecting a net income between $6.5 billion and $7 billion and an adjusted EBITDA between $15.6 and $16.5 billion. Revenue is projected to be between $76.5 billion and $80 billion.

The system reported an operating income of $2.29 billion (12% operating margin) in the first quarter of 2026, down from $2.33 billion (12.7% margin) during the same period last year. 

https://www.beckershospitalreview.com/finance/hca-still-expects-up-to-900m-hit-from-aca-headwinds/