The four largest publicly traded hospital operators reported second-quarter 2026 results within days of each other in late July, and each revised its full-year guidance in a different direction: Tenet Healthcare raised its outlook, HCA Healthcare and UHS trimmed theirs modestly, and Community Health Systems cut its guidance sharply.
Here’s a look at how each system’s outlook changed after reporting their second quarter results:
HCA Healthcare (Nashville, Tenn.)
HCA narrowed its revenue guidance to $77 billion to $79.5 billion, from $76.5 billion to $80 billion. The system also trimmed its adjusted EBITDA guidance to $15.4 billion to $16.1 billion, from $15.55 billion to $16.45 billion. The system now expects a bigger hit from exchange-related payer mix (a negative impact of $1 billion to $1.2 billion, up from $600 million to $900 million) after concluding that nearly all patients losing exchange coverage are becoming uninsured, versus an original assumption of between 80% to 85%. That’s mostly offset by a swing to a Medicaid supplemental payment benefit of $300 million to $500 million, reversing an earlier assumption of a net cost. CFO Mike Marks called the revised outlook a return to HCA’s long-term growth trend rather than a sign of a weaker base business.
Tenet Healthcare (Dallas)
Tenet raised its revenue guidance to $21.9 billion to $22.5 billion, a $300 million increase at the midpoint, and its adjusted EBITDA outlook to $4.83 billion to $5.03 billion, a $295 million increase at the midpoint, on stronger-than-planned cost management and ambulatory growth. Chairman and CEO Saum Sutaria, MD, said the raise reflects the underlying business rather than one-time items; management said exchange-related pressure — exchange revenue fell 17% in the quarter — came in within Tenet’s original expectations.
Community Health Systems (Franklin, Tenn.)
CHS cut its revenue guidance to $11.4 billion to $11.6 billion, down from $11.6 billion to $12 billion. It also cut its adjusted EBITDA guidance to $1.3 billion to $1.375 billion, down from $1.3 billion to $1.5 billion. CFO Jason Johnson said the system had assumed patients losing exchange coverage would largely stop seeking care; instead they’ve kept coming, mostly through the emergency room, now as uninsured or self-pay patients. CHS also raised its estimated full-year hit from ACA disenrollment to $50 million to $75 million, from $20 million to $30 million, and cited continued softness in commercial elective surgery.
Universal Health Services (King of Prussia, Pa.)
UHS’ revenue guidance of $18.501 billion to $18.762 billion is essentially unchanged from its original forecast of $18.417 billion to $18.789 billion, up 0.2% at the midpoint. UHS trimmed its adjusted EBITDA guidance to $2.61 billion to $2.717 billion, a 1.9% cut at the midpoint. CFO Steve Filton said about $150 million in added Medicaid supplemental payment benefit was more than offset by roughly $200 million in adverse items: costs tied to recertifying a Texas behavioral health hospital, a slower ramp at its Cedar Hill, Washington, D.C., de novo hospital, higher professional and general liability reserves, and trimmed same-facility volume assumptions.
