King of Prussia, Pa.-based Universal Health Services is projecting ACA exchange volumes will decline by 25% to 30% in 2026 with the expiration of the enhanced premium tax credits, resulting in a $75 million headwind.
The exchange headwinds will be concentrated in the system’s acute care segment, UHS Executive Vice President and CFO Steve Filton said on the system’s Feb. 26 earnings call. In 2025, the exchange represented about 6% of acute care adjusted admissions and slightly less than 5% of the segment’s revenue.
Mr. Filton said UHS’ estimates are based on the Congressional Budget Office and other public projections.
“We’ve already seen a decline in exchange volumes in the first couple of months of the year,” he said.
Another publicly traded for-profit system, Dallas-based Tenet Healthcare, is projecting a 20% reduction in ACA exchange enrollment.
“All of us — meaning all the hospital companies — have made estimates about what’s going to happen with the exchanges, etc.,” Mr. Filton said. “The truth is we’re going to need a few more months to really see how this sorts out. What the real loss in volume is, how many of these people who lose their exchange coverage can get other coverage, etc.”
Mr. Filton said UHS leaders feel comfortable with the estimates they’ve made, but “we’re all going to be able to be more precise over the next few months as we get more and more accurate data.”
UHS is projecting adjusted earnings before interest, taxes, depreciation and amortization between $2.6 billion and $2.8 billion in 2026. It is projecting net revenue between $18.4 billion and $18.8 billion. In 2025, UHS recorded adjusted EBITDA of $2.6 billion, up from $2.2 billion in 2024. The system’s net revenue was $17.4 billion in 2025, up from $15.8 billion in 2024.
The system operates 29 inpatient acute care hospitals, 346 behavioral health facilities, 168 outpatient facilities, an insurance offering, and a physician network in 40 states, Washington, D.C., the United Kingdom and Puerto Rico.
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