ACA market dynamics cost HCA $150M in Q1
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ACA market dynamics cost HCA $150M in Q1 Underlying shifts in payer mix resulting from the changes in the exchanges were generally in line with expectations, says CEO Sam Hazen. Accounting & Financial Management By Susan Morse , Executive Editor | April 28, 2026 | 11:13 AM Photo: Rusty Russell/Getty Images HCA Healthcare reported a 0.6% net income increase to $1.6 billion during the first quarter and revenue gains of 4.3% to $19.1 billion.One unexpected factor drove down patient volume related to profits.“From a volume perspective, we did not experience the typical lift related to seasonal respiratory conditions,” said Director and CEO Sam Hazen. “Compared to the first quarter of last year, our respiratory-related admissions were down 42%, and our respiratory-related emergency room visits were down 32%.”Additionally, storms impacted some of the for-profit health system’s markets.“The respiratory-related and winter storm impacts were mostly contained to January, with February and March volumes rebounding nicely,” Hazen said.Another issue was a $150 million cost due to the lack of the enhanced subsidies in the Affordable Care Act market.“We estimate the adjusted EBITDA impact from the exchanges to be approximately $150 million in the first quarter of 2026 versus the prior year quarter,” said CFO and Executive Vice President Mike Marks.“Regarding payer mix for the quarter, the underlying shifts resulting from the changes in the health insurance exchanges were generally in line with our expectations,” Hazen said. “This area remains fluid. As we stated in our fourth quarter call, we have considered a range of potential scenarios as the effects continue to evolve.”Marks gave same-facility volume comparisons for the first quarter of 2026 versus the first quarter of 2025.Admissions increased 0.9%, equivalent admissions increased 1.3%, inpatient surgeries were down 0.3% and outpatient surgeries declined 1.7%, Marks said. ER visits increased 0.3%. “As Sam mentioned, we had a much milder respiratory season in the quarter,” Marks said. “This produced a drag on our quarterly volume growth in admissions and ER visits of 70 basis points and 140 basis points, respectively.”Email the writer: [email protected] Topic: Accounting & Financial Management, Operations, Strategic Planning