HCA Healthcare Beats Q3 Estimates but Flags Flat 2027 Earnings on Medicaid Pressure, Shares Fall 5%

HCA Healthcare reported third-quarter 2026 revenue of $19.85 billion, up 3.6% year over year and ahead of the $19.33 billion consensus estimate, while adjusted earnings per share of $7.27 beat expectations of $6.66 by roughly 7%. Net income, however, slipped to $1.58 billion from $1.64 billion a year earlier, a 3.9% decline, as the company absorbed an approximately $400 million unfavorable pretax impact from higher uninsured patient volumes driven by federal policy changes affecting Medicaid coverage.

Operational metrics showed genuine demand growth, with equivalent admissions rising 3.0% and same-facility emergency room visits climbing 5.1% year over year. Adjusted EBITDA reached $3.92 billion, up 1.2%, and operating cash flow came in at $4.46 billion. CEO Samuel Hazen acknowledged the federal policy headwinds, saying colleagues had continued to deliver high-quality care despite those challenges.

For full-year 2026, HCA maintained guidance with revenue of $77.0 billion to $79.5 billion, EPS of $28.70 to $30.50, adjusted EBITDA of $15.4 billion to $16.1 billion, and net income of $6.3 billion to $6.7 billion, with management signaling results are tracking toward the upper half of that range. Those ranges straddle the prior consensus of $78.52 billion in revenue and $29.48 in EPS, leaving the guidance reading as roughly in line.

The sharper market reaction came from HCA signaling flat earnings for 2027, citing continued pressure from lower Medicaid reimbursement rates and an ongoing rise in uninsured patients. Shares fell more than 5% on the news, dragging hospital peers Tenet Healthcare and Universal Health Services lower as well. HCA also declared a quarterly dividend of $0.78 per share.