Health systems closed the second quarter of 2026 with a wide spread in performance, but a substantial group of large systems stayed in the black — several of them by a comfortable margin — even as they brace for Medicaid and coverage changes under HR 1 that take hold in 2027.
For-profit operators again anchored the top of the list, with Tenet Healthcare, Community Health Systems, HCA Healthcare and Universal Health Services all clearing double-digit operating margins. On the nonprofit side, AdventHealth and ProMedica also posted double-digit margins, while Allegheny Health Network doubled its margin year over year and Adventist HealthCare and Yale New Haven Health swung back to operating gains. Supplemental Medicaid and state-directed payment programs in Arizona, Florida and Ohio lifted several systems’ results, and a handful of the gains rest on hospital divestitures rather than core operations.
Investment returns also did heavy lifting below the operating line. Mayo Clinic, Cleveland Clinic and AdventHealth each posted net income at least double their operating income, and Kaiser Permanente’s $5.3 billion net income was more than three times its operating result.
Here are 28 health systems that reported operating income in the second quarter of 2026, ranked by operating margin.
Editor’s note: This is not an exhaustive list. Unless otherwise noted, results reflect the three months ended June 30, 2026. Systems reporting on a non-calendar fiscal year or on a six-month basis are noted individually.
1. Dallas-based Tenet Healthcare reported operating income of $1.5 billion (26.7% operating margin) in the second quarter of 2026, up from $823 million (15.6% margin) during the same period last year. Total operating revenue rose 6.8% to $5.6 billion, while expenses were $4.4 billion. Net income was $826 million, up from $288 million. The system raised its full-year net income and EBITDA outlook, citing same-store revenue growth and expense management.
2. Franklin, Tenn.-based Community Health Systems posted operating income of $389 million (13.8% margin), down from $512 million (16.3% margin) a year earlier. Revenue was $2.8 billion and expenses were $2.4 billion. Net income fell 75% to $70 million (2.5% margin) from $282 million, though the bottom line was lifted by a $172 million net gain tied to hospital divestitures. CHS used about $600 million in divestiture proceeds to buy back senior notes and has trimmed its portfolio to 60 hospitals.
3. Altamonte Springs, Fla.-based AdventHealth recorded operating income of $916.2 million (13.4% operating margin), up from $657.4 million (11.7% margin) a year earlier. Revenue was $6.9 billion and operating expenses were $5.9 billion. CMS’ approval of an expanded Florida Medicaid state-directed payment program let AdventHealth book a $195.8 million net benefit attributable to prior periods. Net income was $1.5 billion, up from $784.1 million.
4. Nashville, Tenn.-based HCA Healthcare reported operating income of $2.5 billion (12.3% margin) on revenue of $20.2 billion — the largest revenue base of any system in the quarter. Expenses totaled $17.7 billion and net income was $1.7 billion, up from $1.65 billion. The for-profit chain cut its full-year profit outlook, citing an ACA-related headwind of $1 billion to $1.2 billion.
5. King of Prussia, Pa.-based Universal Health Services recorded operating income of $516.7 million (11.1% operating margin), compared with $500.3 million (11.7% margin) a year earlier. Net operating revenue was $4.6 billion and expenses were $4.1 billion. Results included a net favorable pretax impact of about $72 million, driven by a $100 million benefit tied to the Florida Medicaid program. UHS’ behavioral health division carried the quarter with $411.1 million in operating income (20.3% margin), while its acute care business posted $228 million (8.7% margin). Net income was $364.6 million, up from $362.6 million. The system trimmed its full-year forecast.
6. Toledo, Ohio-based ProMedica posted $83.3 million in operating income (10.3% margin) on revenue of $809.7 million in the second quarter of 2026. This was up from an operating income of $48.7 million (6.6% margin) on revenues of $738 million in the second quarter of 2025. Net income was $93.6 million, up from $73.6 million.
7. Pittsburgh-based Allegheny Health Network doubled its operating margin, reporting $150.9 million in operating income (9.1% margin), up from $64 million (4.5% margin) a year earlier. Total revenue rose 15.7% to $1.7 billion, with net patient service revenue up 8.4% to $1.4 billion and other operating revenue up 65% to $303.7 million on federal grant funds. Expenses rose 10.1% to $1.5 billion. AHN’s parent Highmark Health posted $2 billion in net income for the six months ended June 30, including $911 million in non-cash gains tied to completed affiliations.
8. Fort Wayne, Ind.-based Parkview Health recorded $90.5 million in operating income (9.1% margin) on revenue of $997.4 million, up from $81.8 million in operating income a year earlier, though its margin narrowed from 9.8% as expenses grew faster than revenue. Total expenses were $906.9 million, up from $754.6 million. Net income was $433.8 million, up from $169.6 million.
9. Coral Gables, Fla.-based Baptist Health South Florida posted $176 million in operating income (9% margin) on $2 billion in revenue, down from $185.3 million (10.2% margin) during the same period last year. Total expenses were $1.8 billion, up from $1.6 billion. Revenue recognized from Florida supplemental payment programs, including the Medicaid Directed Payment Program and Low Income Pool, fell to $40.5 million from $98.3 million a year earlier. Net income was $700.6 million, up from $484.5 million, on $538.6 million in investment income.
10. Rochester, Minn.-based Mayo Clinic recorded operating income of $501 million (8.6% operating margin), up from $394 million (7.4% margin) a year earlier. Revenue rose 9.5% to $5.9 billion while expenses rose 8.1% to $5.4 billion. Mayo had 409 days cash on hand as of June 30. Net income was $1.5 billion, up from $921 million.
11. San Diego-based Scripps Health reported $101.5 million in operating income (6.6% margin) on $1.5 billion in revenue, up sharply from $24.4 million (2.1% margin) a year earlier. Revenue climbed 30.3% and expenses 24.3% to $1.4 billion, with both swings driven largely by timing: CMS approved California’s calendar 2025 provider fee program in June, letting Scripps book $209.8 million in provider fee revenue against $168.7 million in provider fee expense in a single quarter. Net income was $487.5 million, up from $287.3 million. The system had 427 days cash on hand and estimates HR 1 could reduce its net revenue by as much as $100 million once fully implemented.
12. Phoenix-based Banner Health reported operating income of $431.2 million (5.1% operating margin) for the first half of 2026, up from $251.2 million (3.2% margin) during the same period last year. Total operating revenue was $8.4 billion for the six months ended June 30, up from $7.9 billion; the system attributed $236 million of that growth to increases in Arizona’s Medicaid state-directed payment program. Expenses were $7.9 billion. Banner|Aetna, the system’s commercial insurance joint venture, posted a $25 million operating gain after exiting the individual ACA marketplace, compared with a $32 million loss a year earlier. Net income was $966.6 million, up from $694.7 million.
13. Cleveland Clinic posted $245.6 million in operating income (5% margin), down from $255.3 million (5.6% margin) a year earlier, as 9.5% expense growth outpaced an 8.7% rise in revenue. Revenue was $4.9 billion and expenses were $4.5 billion. A new Ohio physician state-directed payment program and expanded Ohio and Florida hospital programs lifted net patient service revenue. The system had 337 days cash on hand as of June 30. Net income was $1 billion, up from $763.2 million.
14. Oakland, Calif.-based Kaiser Permanente recorded operating income of $1.7 billion (4.6% operating margin), up from $1 billion (3.2% margin) a year earlier. Total operating revenue was $35.6 billion, up from $32.1 billion, and expenses were $34 billion. Health plan membership across Kaiser and Risant Health affiliates reached nearly 13.4 million. Kaiser cautioned that operating income is typically stronger in the first half of the year because of enrollment cycles. Net income was $5.3 billion, up from $3.3 billion.
15. Chicago-based Northwestern Medicine recorded operating income of $126.3 million (4.2% operating margin) in the third quarter of fiscal 2026, up from $111 million (4.1% margin) during the same period last year. Total operating revenue was $3 billion for the three months ended May 31, up from $2.7 billion, while expenses rose to $2.9 billion from $2.6 billion. Net income was $577.8 million, up from $220.3 million. Results reflect the three months ended May 31, 2026.
16. NewYork-Presbyterian reported operating income of $124.2 million (4% operating margin) in the second quarter. Revenue was $3.1 billion and expenses were $3 billion. NewYork-Presbyterian reported a net income of $1.1 billion, up from $611.6 million during the same period last year.
17. Charlotte, N.C.-based Advocate Health recorded operating income of $775.3 million (3.8% operating margin) in the first half of 2026, down from $824.4 million (4.4% margin) during the same period last year. Total revenue rose 8.6% to $20.5 billion while expenses grew 9.3% to $19.7 billion. The system’s commercial payer mix fell to 45% from 50%, and its Medicaid mix rose to 20% from 18%. Advocate had 288 days cash on hand as of June 30. Net income was $2.7 billion, up from $2 billion, driven largely by a 50.9% jump in investment income.
18. St. Louis-based SSM Health posted $130.2 million in operating income (3.6% margin) on revenue of $3.6 billion in the second quarter, up from a $1.3 million gain (0% margin) on revenues of $3.1 billion. Expenses were $3.5 billion, up from $3.1 billion. Net income for the quarter was $339 million, up from $147 million.
19. Gaithersburg, Md.-based Adventist HealthCare returned to the black with $18.2 million in operating income (3% margin) through the first six months of 2026, reversing a $205,000 operating loss (-0.1% margin) during the same period last year. Operating revenue was $616.7 million, up from $555.7 million, and expenses were $598.5 million. Net income was $28.9 million, up from $7.3 million.
20. Orlando (Fla.) Health recorded operating income of $81.5 million (3% operating margin) in the third quarter of fiscal 2026 — the three months ending June 30, 2026 — up from an operating gain of $56.3 million (2.2% margin). Net income for the quarter was $405.6 million, up from $300.5 million.
21. Brentwood, Tenn.-based Ardent Health recorded $43.2 million in operating income (2.7% margin) on $1.6 billion in revenue, down from $122 million a year earlier. Revenue slipped 1.4% year over year, largely because the prior-year quarter booked two quarters of New Mexico state-directed payment program benefit. Net income fell to $17 million from $73 million, and adjusted EBITDA dropped 32.3% to $115 million.
22. New York City-based NYU Langone Health recorded operating income of $107.1 million (2.6% operating margin) in the second quarter of fiscal 2026 — the three months ended Feb. 28, 2026 — up from $55 million (1.5% margin) during the same period last year. Total operating revenue was $4.1 billion for the three months ended Feb. 28, up from $3.7 billion, while expenses rose to $4 billion from $3.7 billion.
23. Cincinnati-based Bon Secours Mercy Health posted operating income of $95.3 million (2.5% margin) in the second quarter, up from $75.6 million (2.2% margin) a year earlier. Revenue rose 8.2% to $3.75 billion, while expenses increased to $3.65 billion. Net income climbed to $613.8 million (16.4% margin) from $464 million (13.4%), driven in part by $544.8 million in investment gains. The system said higher patient volumes and increased reimbursement from supplemental state Medicaid programs helped fuel revenue growth, while cost-management initiatives supported improved operating performance.
24. Indianapolis-based Indiana University Health posted $51.2 million in operating income (1.9% margin), down from $132.7 million (5.4% margin) a year earlier. Operating revenue was $2.7 billion, up from $2.5 billion, while expenses rose to $2.7 billion from $2.3 billion. Total surgery cases fell 13.6% and ambulatory surgery volume dropped 51%, which the system tied to the sale of membership interests in partly owned ambulatory surgery center subsidiaries. IU Health had 321 days cash on hand as of June 30. Net income was $616.2 million, down slightly from $623.7 million.
25. Somerville, Mass.-based Mass General Brigham recorded $80.5 million in operating income on $6.3 billion in revenue, up from $74.4 million a year earlier, with the operating margin flat at 1.3%. Revenue rose 7% to $3.9 billion while operating expenses also rose 7% to $6.2 billion. The system’s health plan remained a drag, with medical claims up 17% to $545.6 million, a medical loss ratio of 97.2% — up from 96.4% — and an administrative expense ratio of 7.5%, up from 6.3%. Net income was $1.7 billion, up from $1 billion, on a $1.6 billion nonoperating gain.
26. Renton, Wash.-based Providence reported $64 million in operating income (0.8% margin), up from $24 million (0.3% margin) a year earlier. Revenue was $7.6 billion and expenses were $7.6 billion. Agency contract labor fell 48% year over year, while supply expenses rose 8% on a 12% increase in pharmaceutical costs. Through the first six months, Providence posted $175 million in operating income, reversing a $225 million operating loss.
27. New Orleans-based Ochsner Health recorded operating income of $32.5 million (0.8% operating margin) in the first half of 2026, up from the same period last year. The system reported a net income of $114.9 million, up from a net loss of $2.2 million during the same period last year.
28. Duluth, Minn.-based Essentia Health posted operating income of $4.3 million (0.5% margin) in the quarter ended June 30, down from $13.5 million (1.6% margin) a year earlier. Revenue increased 4.5% to $885.7 million, while expenses rose 5.7% to $881.4 million. Net income climbed to $172.1 million (16.3% margin) from $122 million (12.8%).
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