HCA Healthcare, Inc. (NYSE: HCA) today announced financial and operating results for the second quarter ended June 30, 2026.

The Company's financial and operating results, as well as its updated guidance and key assumptions, are consistent with its July 14, 2026 second quarter preview.

Key second quarter metrics (all percentage changes compare 2Q 2026 to 2Q 2025 unless otherwise noted):

• Revenues increased 8.7 percent to $20.230 billion
• Net income attributable to HCA Healthcare, Inc. increased 2.8 percent to $1.699 billion
• Diluted earnings per share increased 11.6 percent to $7.62 per diluted share, and diluted earnings per share, as adjusted, increased 11.0 percent to $7.59 per diluted share
• Adjusted EBITDA increased 4.6 percent to $4.027 billion
• Cash flows from operating activities totaled $2.335 billion, compared to $4.210 billion in the second quarter of 2025
• Same facility admissions increased 2.5 percent and same facility equivalent admissions increased 2.7 percent

Second Quarter Commentary

During the second quarter, the Company experienced a payer mix shift driven by an increase in uninsured volume, primarily due to patients who lost coverage on the health insurance exchanges. The Company estimates this payer mix shift had an unfavorable impact on income before income taxes of approximately $400 million during the second quarter. This amount includes an increase of approximately $75 million related to the Company’s previous estimate of the first quarter health insurance exchange impact. In addition, to a lesser degree the Company experienced a service mix shift primarily related to a decline in surgical volume.

The Company also experienced positive factors including increased benefit from Medicaid Supplemental Payment Programs, growth in admissions, equivalent admissions and ER visits, and improved expense results. During the second quarter, the Company recognized approximately $400 million of incremental net benefit from Medicaid Supplemental Payment Programs, primarily related to the state of Florida program, which is discussed further below.

Revenues in the second quarter of 2026 totaled $20.230 billion, compared to $18.605 billion in the second quarter of 2025. Net income attributable to HCA Healthcare, Inc. totaled $1.699 billion, or $7.62 per diluted share, compared to $1.653 billion, or $6.83 per diluted share, in the second quarter of 2025. Results for the second quarter of 2026 include gains on sales of facilities of $10 million, or $0.03 per diluted share, compared to losses on sales of facilities of $3 million, or $0.01 per diluted share, in the second quarter of 2025.

For the second quarter of 2026, Adjusted EBITDA totaled $4.027 billion, compared to $3.849 billion in the second quarter of 2025. Diluted earnings per share, as adjusted, and Adjusted EBITDA are non-GAAP financial measures. A table providing supplemental information on these non-GAAP financial measures and reconciling GAAP measures of financial performance to them is included in this release.

The second quarter of 2026 includes incremental revenues of $1.372 billion and other operating expenses of $829 million related to the Florida directed payment program for the time period October 1, 2024 through June 30, 2026, to reflect the impact of the state directed payment program approved during the quarter by the Centers for Medicare and Medicaid Services. Of those amounts, approximately $980 million of incremental revenues and $557 million of other operating expenses related to periods prior to 2026.

Same facility admissions increased 2.5 percent and same facility equivalent admissions increased 2.7 percent in the second quarter of 2026, compared to the prior year period. Same facility emergency room visits increased 3.6 percent in the second quarter of 2026, compared to the prior year period. Same facility inpatient surgeries declined 2.3 percent, and same facility outpatient surgeries declined 3.4 percent in the second quarter of 2026, compared to the same period of 2025. Same facility revenue per equivalent admission increased 6.4 percent in the second quarter of 2026, compared to the second quarter of 2025.

Six Months Ended June 30, 2026

Revenues for the six months ended June 30, 2026 totaled $39.339 billion, compared to $36.926 billion in the same period of 2025. Net income attributable to HCA Healthcare, Inc. was $3.319 billion, or $14.77 per diluted share, compared to $3.263 billion, or $13.28 per diluted share, for the first six months of 2025. Results for the six months ended June 30, 2026 include gains on sales of facilities of $9 million, or $0.03 per diluted share. Results for the six months ended June 30, 2025 included losses on sales of facilities of $2 million, or $0.01 per diluted share.

Balance Sheet and Cash Flows from Operations

As of June 30, 2026, HCA Healthcare, Inc.’s balance sheet reflected cash and cash equivalents of $1.013 billion, total debt of $49.718 billion, and total assets of $63.250 billion. During the second quarter of 2026, capital expenditures totaled $1.231 billion, excluding acquisitions. Cash flows provided by operating activities in the second quarter of 2026 totaled $2.335 billion, compared to $4.210 billion in the second quarter of 2025.

During the second quarter of 2026, the Company repurchased 4.752 million shares of its common stock at a cost of $2.064 billion. The Company had $7.210 billion remaining under its repurchase authorization as of June 30, 2026. As of June 30, 2026, the Company had $3.086 billion of availability under its credit facility (after giving effect to letters of credit and amounts reserved to backstop our commercial paper program).

Dividend

HCA today announced that its Board of Directors declared a quarterly cash dividend of $0.78 per share on the Company’s common stock. The dividend will be paid on September 30, 2026 to stockholders of record at the close of business on September 16, 2026.

The declaration and payment of any future dividend will be subject to the discretion of the Board of Directors and will depend on a variety of factors, including the Company’s financial condition and results of operations. Future dividends are expected to be funded by cash balances and future cash flows from operations.

2026 Updated Guidance and Key Assumptions

Based on results through the first half of the year, the Company has revised its 2026 guidance as follows:

The Company revised its 2026 key assumptions related to the unfavorable impact on income before income taxes from payer mix shifts due to the health insurance exchanges, as well as the incremental net benefit from Medicaid Supplemental Payment Programs, as follows:

The Company's 2026 estimate for capital expenditures of $5.0 billion to $5.5 billion, excluding acquisitions, remains unchanged.

The Company’s guidance contains a number of assumptions, including, among others, the Company’s current expectations regarding volume growth coupled with an anticipated mostly stable operating environment, payer mix, service mix, the impact of current and future health care public policy developments, including the estimated impact on health insurance exchanges from administrative reforms and the expiration of the enhanced premium tax credits, anticipated results from resiliency initiatives, as well as general business or economic conditions, including inflation and the impact of trade policies, including tariffs, and excludes the impact of items such as, but not limited to, gains or losses on sales of facilities, losses on retirement of debt, legal claims costs and impairment of long-lived assets. In addition, the Company’s guidance excludes the impact of future approvals that could impact reimbursement under certain state Medicaid directed and supplemental payments.

Adjusted EBITDA is a non-GAAP financial measure. A table reconciling forecasted net income attributable to HCA Healthcare, Inc. to forecasted Adjusted EBITDA is included in this release.

The Company’s updated guidance is based on current plans and expectations and is subject to a number of known and unknown uncertainties and risks, including those set forth below in the Company’s “Forward-Looking Statements.”

Earnings Conference Call

HCA Healthcare will host a conference call for investors at 9:00 a.m. Central Time today. All interested investors are invited to access a live audio broadcast of the call via webcast. The broadcast also will be available on a replay basis beginning this afternoon. The webcast can be accessed through the Company’s Investor Relations web page at

https://investor.hcahealthcare.com/events-and-presentations/default.aspx.

About the Company

As of June 30, 2026, HCA operated 190 hospitals and approximately 2,600 ambulatory sites of care, including surgery centers, freestanding emergency rooms, urgent care centers and physician clinics, in 19 states and the United Kingdom.

Forward-Looking Statements

This press release contains forward-looking statements within the meaning of the federal securities laws, which involve risks and uncertainties. Forward-looking statements include the Company’s financial guidance for the year ending December 31, 2026, as well as other statements that do not relate solely to historical or current facts. Forward-looking statements can be identified by the use of words like “may,” “believe,” “will,” “expect,” “project,” “estimate,” “anticipate,” “plan,” “initiative” or “continue.” These forward-looking statements are based on our current plans and expectations and are subject to a number of known and unknown uncertainties and risks, many of which are beyond our control, which could significantly affect current plans and expectations and our future financial position and results of operations. These factors include, but are not limited to, (1) changes in or related to general economic or business conditions nationally and regionally in our markets, including inflation, and the impact of trade policies, including changes in, or the imposition of, tariffs and/or trade barriers; changes in revenues resulting from declining patient volumes; changes in payer mix (including increases in uninsured and underinsured patients); potential increased expenses related to labor, pharmaceuticals, supply chain or other expenditures; workforce disruptions; supply and pharmaceutical shortages and disruptions (including as a result of tariffs or geopolitical disruptions); and the impact of federal government shutdowns, holds on or cancellations of congressionally authorized spending and interruptions in the distribution of governmental funds, (2) the impact of current and future health care public policy developments and the implementation of new, and possible changes to existing, federal, state or local laws and regulations affecting health care spending or the health care industry, including the expiration at the end of 2025 of enhanced premium tax credits (“EPTCs”) for eligible individuals purchasing insurance coverage through federal and state-based health insurance exchanges, changes in the structure and administration of, and funding for, federal and state agencies and programs, effects of the 2025 Federal Budget Act (the “FBA”) and efforts to address health care affordability, (3) the impact of our significant indebtedness and the ability to refinance such indebtedness on acceptable terms, (4) the effects related to the implementation of sequestration spending reductions required under the Budget Control Act of 2011, related legislation extending these reductions, and the potential for future deficit or other spending reduction legislation that may alter current spending reductions, which include cuts to Medicare payments, or impose additional spending reductions, (5) the ability to achieve operating and financial targets, develop and execute resiliency plans to offset to the extent possible impacts from the FBA, the expiration of EPTCs and tariffs, attain expected levels of patient volumes and revenues and service mix, and control the costs of providing services, (6) the impact of reductions or other changes in Medicare, Medicaid and other state programs, including Medicaid supplemental payment programs, Medicaid waiver programs and state directed payment arrangements, any of which may negatively impact reimbursements to health care providers and insurers and the size of the uninsured or underinsured population, (7) the results of our efforts to use technology and resilience initiatives, including artificial intelligence and machine learning, to drive efficiencies, better outcomes and an enhanced patient experience, (8) increases in the amount and risk of collectability of uninsured accounts and deductibles and copayment amounts for insured accounts, (9) personnel-related capacity constraints, increases in wages and the ability to attract, utilize and retain qualified management and other personnel, including affiliated physicians, nurses and medical and technical support personnel, (10) the highly competitive nature of the health care business, (11) changes in service mix, revenue mix and service volumes, including potential declines in the population covered under third-party payer agreements, the ability to enter into and renew third-party payer provider agreements on acceptable terms and the impact of consumer-driven health plans and physician utilization trends and practices, (12) the efforts of health insurers, health care providers, large employer groups and others to contain health care costs, (13) the outcome of our continuing efforts to monitor, maintain and comply with appropriate laws, regulations, policies and procedures, (14) the availability and terms of capital to fund the expansion of our business and improvements to our existing facilities, (15) changes in accounting practices, (16) the emergence of and effects related to pandemics, epidemics and outbreaks of infectious diseases or other public health crises, (17) future divestitures which may result in charges and possible impairments of long-lived assets, (18) changes in business strategy or development plans, (19) delays in receiving or failure to receive payments for services provided, (20) the outcome of pending and any future tax audits, disputes and litigation associated with our tax positions, (21) the impact of known and unknown government investigations, litigation and other claims that may be made against us, (22) the impact of actual and potential cybersecurity incidents or security breaches involving us or our vendors and other third parties, (23) our ongoing ability to demonstrate meaningful use of certified electronic health record technology and the impact of interoperability requirements, (24) the impact of natural disasters, such as hurricanes and floods, including Hurricanes Milton and Helene, physical risks from changing global weather patterns or similar events beyond our control on our assets and activities and the communities we serve, (25) changes in U.S. federal, state, or foreign tax laws, interpretations of tax laws by taxing authorities, other standard setting bodies or judicial decisions, (26) changes to, and the timing and amount of future approvals (if any) of, state Medicaid directed and supplemental payments and (27) other risk factors described in our annual report on Form 10-K for the year ended December 31, 2025 and our other filings with the Securities and Exchange Commission. Many of the factors that will determine our future results are beyond our ability to control or predict. In light of the significant uncertainties inherent in the forward-looking statements contained herein, readers should not place undue reliance on forward-looking statements, which reflect management’s views only as of the date hereof. We undertake no obligation to revise or update any forward-looking statements, or to make any other forward-looking statements, whether as a result of new information, future events or otherwise. All references to “Company,” “HCA” and “HCA Healthcare” as used throughout this release refer to HCA Healthcare, Inc. and its affiliates.

The Company's forecasted guidance is based on current plans and expectations and is subject to a number of known and unknown uncertainties and risks.

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