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HCA · Q2 2026
Archived report (Q2 2026). Latest deep dive →
The quarter in brief
A healthy top-line quarter (+8.7% revenue) masked underlying margin pressure from a ~$400M unfavorable ACA exchange payer-mix shift, offset almost entirely by a one-time ~$400M Medicaid supplemental payment benefit, leaving adjusted EBITDA growth (+4.6%) trailing revenue growth and net income to HCA shareholders up just 2.8%.
Net Income to HCA
$1,699M
up 2.8% y/y
Revenue
$20,230M
up 8.7% y/y
Operating Income
$3,093M
up 5.5% y/y
All figures in $M.
| Line item | Amount and change |
|---|---|
| Revenue | $20,230 · +8.7% |
| Salaries & Benefits | $8,290 · +1.9% |
| Supplies | $2,886 · +1.5% |
| Other Operating Expenses | $5,043 · +33% · incl. Florida DPP catch-up expense |
| Depreciation & Amortization | $944 · +9.4% |
| Equity in Earnings of Affiliates | $16 · -16% |
| Gains on Sales of Facilities | $10 |
| Operating Income | $3,093 · +5.5% |
| Interest Expense | $599 · +5.5% |
| Income Before Taxes | $2,494 · +3.3% |
| Provision for Income Taxes | $564 · +7.6% |
| Noncontrolling Interests | $231 · -3.0% |
| Net Income to HCA | $1,699 · +2.8% · $7.62 diluted EPS · +11.6% |
Verdict: a healthy top-line quarter (+8.7% revenue) masked underlying margin pressure from a ~$400M unfavorable ACA exchange payer-mix shift, offset almost entirely by a one-time ~$400M Medicaid supplemental payment benefit, leaving adjusted EBITDA growth (+4.6%) trailing revenue growth and net income to HCA shareholders up just 2.8%.
Operating cash flow $2,335M (vs $4,210M PY); $2,064M of buybacks in Q2 (4.752M shares); quarterly dividend $0.78/share; FY2026 revenue guidance narrowed to $77.0-79.5B, net income guidance cut to $6.3-6.7B from $6.495-7.035B.
Source and notation
* marks non-cash / ≈ estimated. Source: HCA Healthcare press release / 10-Q (SEC EDGAR).
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<figure> <a href="https://whoreportstoday.com/t/hca/q2-2026"><img src="https://whoreportstoday.com/t/hca/q2-2026/sankey.png" alt="HCA Q2 2026: where the revenue went" loading="lazy" style="max-width:100%;height:auto"></a> <figcaption>Source: <a href="https://whoreportstoday.com/t/hca/q2-2026">Who Reports Today</a>, licensed under <a href="https://creativecommons.org/licenses/by/4.0/">CC BY 4.0</a></figcaption> </figure>
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- Revenue includes $1,372M of incremental Florida directed payment program revenue (catch-up for Oct 2024–Jun 2026), of which ~$980M relates to prior periods, inflating the y/y comparison.
- Other operating expenses jumped to $5,043M (24.9% of revenue) from $3,793M (20.4%), partly the offsetting $829M Florida program expense recognition (~$557M of it prior-period catch-up).
- Company estimates a ~$400M unfavorable hit to pretax income from ACA exchange-related uninsured volume shift, partially offset by a ~$400M incremental net Medicaid Supplemental Payment Programs benefit — largely netting out but adding noise to margins.
- GAAP net income attributable to HCA rose only 2.8% to $1,699M despite revenue growth of 8.7%, showing margin compression (net margin 8.4% vs 8.9% prior year).
- Adjusted EBITDA margin fell to 19.9% from 20.7% y/y despite the EBITDA dollar increase, confirming underlying cost/mix pressure beneath the reported growth.
- Diluted EPS grew faster (+11.6%) than net income (+2.8%) due to aggressive buybacks that cut diluted share count from 241.9M to 222.8M.
What distorts the picture in this report and what to watch beyond the headlines.
HCA — HCA Healthcare is a leading healthcare provider operating hospitals, outpatient centers, and clinics across the United States.
The company focuses on patient care services and healthcare delivery through an extensive network of facilities.
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