Nashville, Tenn.-based HCA Healthcare could face up to a $1.4 billion financial impact from policy reforms and uncertainty in 2026.
HCA CFO Mike Marks said on the company’s Jan. 27 earnings call that HCA expects an earnings before interest, taxes, depreciation and amortization reduction of $600 million to $900 million from the expiration of enhanced ACA tax credits and reforms included in the One Big Beautiful Bill Act.
He added that HCA also expects a $250 million to $450 million decline in net benefits tied to Medicaid supplemental payment program changes in Tennessee, a pause in a Texas program and an earlier-than-expected payment from Virginia.
Mr. Marks said that HCA expects to offset the exchange headwinds by about $400 million through resiliency initiatives.
HCA CEO Sam Hazen added that the for-profit system strengthened its resiliency program in three key areas in 2025, positioning the 190-hospital system to manage expected headwinds in 2026.
On the organizational side, HCA added capabilities aligned with its operating imperatives, strengthened management systems to improve execution and expanded leadership development, Mr. Hazen said.
From a competitive standpoint, HCA increased hospital capacity, clinical service offerings and outpatient facilities across its networks to expand patient access and assess community needs, Mr. Hazen said.
Financially, HCA advanced cost management and improved its balance sheet through strong cash flow and disciplined capital allocation, Mr. Hazen said. He added that these results allowed the system to invest significantly in its networks, its people and its AI tech agenda.
HCA reported a net income of $6.8 billion in 2025, a 17.8% increase year over year. The system reported revenue of $75.6 billion, a 7.1% increase year over year.
In 2026, HCA is projecting a net income between $6.5 billion and $7 billion and an adjusted EBITDA between $15.6 and $16.5 billion. It is projecting revenue between $76.5 billion and $80 billion.
“Given what we see today, including the demand in our markets, our resiliency program and our digital transformation initiatives, we remain confident that we will perform within our long-term plan over time,” Mr. Marks said.
