Dive Brief:
- Hospital operator HCA Healthcare is continuing to lose money as patients formerly covered by plans on the Affordable Care Act exchanges become uninsured.
- HCA took a $400 million hit to its pretax earnings during the third quarter as uninsured admissions swelled to 10.5% of its overall volume, executives said on a call with investors Tuesday.
- Executives said losses could be slightly above the $1.2 billion that HCA previously predicted it could lose from the ACA headwind.
Dive Insight:
HCA has already lost about $950 million in pretax earnings this year as a result of more people going uninsured after being priced out of the ACA exchanges.
Millions of people dropped their ACA coverage this year following the expiration of more generous subsidies last year, which caused premiums to skyrocket for many enrollees. About 18% fewer individuals — or more than 4.6 million people — signed up for ACA coverage in June 2026 compared to June 2025.
Ahead of the expiry, hospital operators said they expected some people previously covered by ACA plans to become uninsured, but expected others to migrate into other forms of health coverage.
Instead, people began dropping their ACA coverage and going uninsured at almost a 1-to-1 rate, hospital operators said this year.
As a bellwether for for-profit hospitals, HCA — which operates 190 hospitals and 2,600 other care sites in the U.S. and United Kingdom — was the first operator to flag the rising uninsured trend earlier this year. Executives cut its guidance and said they expected to lose about $1 billion more than they had previously thought from uncompensated care and a reduced demand for elective procedures. Other for-profit hospital operators followed suit, notching millions of dollars in losses.
Uninsured patients saddle hospital operators with higher uncompensated care. They also tend to postpone or defer elective procedures, a lucrative service line for chains like HCA. During the third quarter, HCA said admissions across both inpatient and outpatient from ACA patients declined 19% year over year, a “little bit higher than we estimated,” CFO Mike Marks said on the call.
HCA was able to mitigate some of those headwinds as outpatient and inpatient admissions grew 3% in the third quarter compared to the year prior as more patients with commercial insurance sought care, according to Marks.
But the loss of exchange customers for surgeries hit HCA’s earnings. Elective volumes in its outpatient ambulatory unit declined 5.4%, with the loss of ACA volumes contributing to a “very large” percentage of the decrease, according to CEO Sam Hazen.
Still, HCA expects to land in the upper end of its earnings guidance range for the year, as add-on payments in Medicaid canceled out some of the worst effects from the exchanges.
The hospital operator expects to reap $77 billion to $79.5 billion in revenue this year, and between $15.4 billion and $16.1 billion in pretax earnings.
HCA did not amend the $1 billion to $1.2 billion it expects to lose due to ACA headwinds this year, although analysts noted that would leave only $250 million in losses for the fourth quarter.
In the third quarter, HCA netted $19.9 billion in revenue, a 3.6% increase from the prior year due to higher admissions and add-on payments from Medicaid. Net income fell about 4% to $1.6 billion.
