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HCA Healthcare’s $400 Million Payer-Mix Hit Meets A $400 Million Medicaid Offset!

HCA Healthcare’s financial results for the second quarter of 2026 demonstrate a 11% growth in diluted earnings per share both quarterly and year-to-date, despite notable headwinds primarily stemming from unfavorable shifts in payer mix. The expiration of enhanced premium tax credits led to a significant decline—approximately 15%—in admissions covered through health insurance exchanges, with a majority of those patients becoming uninsured rather than transitioning to alternative coverage. This shift created an estimated $400 million adverse impact on adjusted EBITDA in the quarter, with certain divisions disproportionately affected. On the positive side, Medicaid Supplemental Payment Programs, especially in Florida, provided a net benefit of approximately $400 million during the quarter, partially offsetting payer mix challenges. These programs are vital as hospitals increasingly deliver uncompensated care to uninsured individuals. HCA Healthcare’s adjusted EBITDA guidance for 2026 has been revised downward to a range of $15.4 billion to $16.