- Company name
- HCA Healthcare
- Sector
- Hospitals
- About
- HCA Healthcare runs hospitals and outpatient sites in the United States and the United Kingdom. At September 30, 2026, it operated 189 hospitals and about 2,600 ambulatory sites, such as surgery centers, freestanding emergency rooms, urgent care centers and physician clinics, in 19 states and the United Kingdom. Texas and Florida had 103 of its hospitals and gave 51% of revenue in the third quarter of 2026. Revenue was $75.6 billion in 2025. HCA is based in Nashville, Tennessee, and its shares trade on the New York Stock Exchange.
- Thesis
- HCA trades at a premium because investors pay for its scale and its record of steady growth and large buybacks. Same facility admissions rose 2.7% in Q3 2026, and HCA bought back $6.6 billion of shares in the first nine months of 2026. But 2026 brought new pressure. Enhanced premium tax credits for health insurance exchange plans expired at the end of 2025, and same facility uninsured admissions rose 27.4% in Q3. HCA estimates that this payer mix shift lowered income before taxes by about $400 million in each of Q2 and Q3. In July 2026 it lowered its 2026 guidance for net income to $6.3 billion to $6.7 billion. For the premium to be earned, three things must be true. Results must land in the upper half of the 2026 guidance, as HCA now expects. The rise in uninsured patients must slow in 2027, so that adjusted EBITDA grows again. Medicaid supplemental payments must hold under the 2025 Federal Budget Act. The Q4 2026 report with 2027 guidance, expected in late January 2027, gives the next test. If 2027 guidance shows flat adjusted EBITDA or more losses from the exchanges, the premium can shrink within one or two quarters.
- Risks
- Enhanced premium tax credits for exchange plans expired at the end of 2025. Same facility uninsured admissions rose 27.4% in Q3 2026. More uninsured patients lower revenue per patient and raise bad debt.
The 2025 Federal Budget Act and changes to Medicaid programs can cut payments to hospitals. HCA's 2026 guidance includes $300 million to $500 million of net benefit from Medicaid supplemental payment programs, which states and the federal government must approve.
Total debt was $50.493 billion at September 30, 2026, and HCA has a stockholders' deficit because of large buybacks. Higher interest rates raise the cost to refinance this debt.
Texas and Florida gave 51% of revenue and 73% of uninsured admissions in Q3 2026. Policy changes or hurricanes in these states have a large effect.
Hospitals need many nurses and doctors. A shortage of staff or higher wages can lower margins.
- Balance sheet
- Cash: $908M
Debt: $50.5B
Net debt: $49.6B
EBITDA, last 12 months: $15.9B
Net debt / EBITDA: 3.1× (medium)
Undrawn credit line: $2.2B
Debt due within 12 months: $8.1B
Last debt due: 2056
HCA uses much debt and buys back shares, so it has a stockholders' deficit of $8.077 billion attributable to HCA at September 30, 2026. Total debt was $50.493 billion and cash was $908 million at that date. Adjusted EBITDA was $15.861 billion for the four quarters to September 30, 2026 (a sum of the quarterly releases), so debt was about 3.2 times adjusted EBITDA. Of the debt, $8.093 billion was short-term borrowings or due within one year. HCA had $2.226 billion of availability under its credit facility at September 30, 2026, and it raised its commercial paper program to $8.0 billion in July 2026. On November 5, 2026, it issued $6.5 billion of senior notes due from 2028 to 2056. Cash from operations was $8.810 billion in the first nine months of 2026, and capital spending was $3.707 billion.
As of 2026-09-30.
- Checkpoints
- Oct 27, 2026: Q3 2026 results: exchange losses. Passed. Watch: Higher adjusted EBITDA and kept guidance pass; another guidance cut or larger losses from the exchanges fail. Outcome: Adjusted EBITDA rose 1.2% to $3.918 billion and HCA said 2026 results will be in the upper half of its guidance, although the payer mix shift cost about $400 million.
Jan 27, 2027 (estimate): Q4 2026 results and 2027 guidance. Pending. Watch: 2026 results in the upper half of guidance and 2027 guidance for higher adjusted EBITDA pass; flat 2027 EBITDA guidance or more exchange losses fail.
- Recent events
- 2026-11-05: HCA completed an offering of $6.5 billion of senior notes in seven series, due from 2028 to 2056, with fixed coupons from 5.200% to 6.500% and one floating rate series.
2026-10-27: HCA reported Q3 2026 results. Revenue rose 3.6% to $19.849 billion, and diluted EPS rose 4.5% to $7.27. Adjusted EBITDA rose 1.2% to $3.918 billion. Same facility admissions rose 2.7%, but uninsured admissions rose 27.4%. HCA estimates that the payer mix shift lowered income before taxes by about $400 million. It bought back 7.230 million shares for $2.970 billion and said that 2026 results will be in the upper half of its guidance ranges.
2026-07-29: HCA raised the maximum size of its commercial paper program from $4.0 billion to $8.0 billion.
2026-07-24: HCA reported Q2 2026 results. Revenue rose 8.7% to $20.230 billion, and diluted EPS rose 11.6% to $7.62. It bought back 4.752 million shares for $2.064 billion.
2026-07-14: HCA gave preliminary Q2 2026 results and lowered its 2026 guidance. It now expects revenue of $77.0 billion to $79.5 billion, net income of $6.3 billion to $6.7 billion, adjusted EBITDA of $15.4 billion to $16.1 billion and diluted EPS of $28.70 to $30.50. It raised its estimate of the loss from the health insurance exchanges to $1.0 billion to $1.2 billion of income before taxes, partly offset by higher Medicaid supplemental payments.
2026-06-18: HCA said that Dr. Michael Cuffe will step down as Executive Vice President and Chief Clinical Officer on August 31, 2026 and stay in a transition role until February 2027.
2026-04-24: HCA reported Q1 2026 results. Revenue rose 4.3% to $19.109 billion, and diluted EPS rose 10.9% to $7.15. It kept its 2026 guidance.
2026-01-27: HCA reported 2025 results. Revenue was $75.600 billion, and diluted EPS was $28.33. It gave 2026 guidance for diluted EPS of $29.10 to $31.50, and its board approved an additional $10 billion share buyback program.