HCA Healthcare Inc

EPS momentum despite headwinds (good): - HCA reported solid diluted EPS growth of ~11% in Q2 and ~11% YTD. - The company emphasized continued high-quality care while managing through policy-driven utilization and coverage changes.

Primary driver of pressure: Exchange coverage loss → payer mix deterioration (bad/surprising): - Exchange volumes declined ~15% in the first half; admissions for people formerly covered by exchanges were down ~15%. - Key surprise vs prior assumptions: instead of a partial shift away from hospital use, those losing exchange coverage migrated ~1-for-1 to uninsured (management states this explains ~80% of uninsured volume growth). - This payer mix shift created an ~$400M unfavorable impact to adjusted EBITDA in Q2 (includes +$75M related to updated Q1 estimate).

Guidance updated for exchange headwinds + Medicaid supplemental benefits (forecast/outlook): - 2026 guidance (revised): - Revenue: $77.0B to $79.5B - Adjusted EBITDA: $15.4B to $16.1B - Net income attributable to HCA: $6.3B to $6.7B - Diluted EPS: $28.70 to $30.50 - Exchange impact on adjusted EBITDA (updated): negative ~$1.0B to ~$1.2B (worsened because migration is closer to 1-for-1 to uninsured vs earlier ~80–85% assumption). - Medicaid supplemental payments (Florida-focused) net benefit: +$300M to +$500M; mgmt’s updated view implies back-half headwind of ~$100M to $300M due to timing/retro payment patterns exceeding incremental benefit later in 2026.