Uninsured patients cost HCA $400 million in a quarter

HCA Healthcare estimates that a rise in uninsured patients cut about $400 million from its pretax income in the third quarter, the company said in its Oct. 27 earnings release. HCA said the shift came mainly from patients who lost coverage on the health insurance exchanges.

HCA ran 189 hospitals and about 2,600 ambulatory sites in 19 states and the United Kingdom as of Sept. 30, per the release. Its emergency rooms give an early read on what happens when people drop their marketplace plans.

Where the patients went

HCA’s release lists the expiration of the enhanced premium tax credits among the assumptions in its guidance. CMS also canceled marketplace coverage for more than 760,000 people on Aug. 31, as covered in 760,000 ACA cancellations: senators press 10 insurers.

What the quarter looked like

Revenue rose 3.6% to $19.849 billion. Net income fell 3.9% to $1.579 billion, or $7.27 a share.

Demand was strong where people had no choice:

• Same facility admissions: up 2.7%
• Same facility emergency room visits: up 5.1%
• Inpatient surgeries: down 1.4%
• Outpatient surgeries: down 3.7%

The surgery drop is the tell. Emergency room visits rose while inpatient and outpatient surgeries both fell.

Revenue per equivalent admission rose 0.6%. More patients came in, but what HCA collected per admission barely moved.

Why it matters to you

People who lost coverage still come to the emergency room. Surgery that can wait is what gets put off. HCA’s numbers show emergency care rising while planned surgery falls.

HCA still expects to land in the upper half of its 2026 guidance ranges. It absorbed a $400 million hit in one quarter and still grew revenue.

Open enrollment starts Nov. 1

Marketplace open enrollment starts Nov. 1 on HealthCare.gov. If you dropped coverage this year because of the price, compare 2027 plans and subsidies there before you decide to go without.

For the insurer side of the same shift, see Centene lost 2.4 million ACA members in a year.