HCA Healthcare Posts Q1 2026 Revenue Growth to $19.1B, Reaffirms 2026 Outlook

HCA Healthcare, Inc. reported first-quarter 2026 results featuring revenue of $19.109 billion, up 4.3% year over year for the three months ended March 31, 2026. Net income attributable to HCA Healthcare rose 0.6% to $1.620 billion, and diluted earnings per share increased 10.9% to $7.15 per share, as adjusted, according to a results release issued April 24, 2026. HCA’s results were covered by a June 5 RSS post on Yahoo Finance, but the company’s earnings announcement itself dates to April 24.

The company said adjusted EBITDA, a non-GAAP earnings measure often used in healthcare to approximate operating cash generation before certain non-cash and financing effects, increased 1.9% to $3.802 billion. Operating cash flow also climbed, rising 22.0% to $2.014 billion. On the business volume side, same-facility admissions rose 0.9% and same-facility equivalent admissions increased 1.3% during the quarter. Same-facility emergency room visits were up 0.3%, while inpatient surgeries fell 0.3% and outpatient surgeries declined 1.7%. Same-facility revenue per equivalent admission increased 3.1%.

HCA tied some of the quarter’s operating pattern to softer seasonal demand. The company said it did not experience a typical seasonal volume increase, primarily due to respiratory activity, with respiratory-related admissions down 42% and respiratory-related emergency room visits down 32% compared with the prior-year quarter. HCA also cited a winter storm in January that negatively impacted volumes in certain markets.

The company said those unfavorable volume impacts were mostly offset by the recognition of certain Medicaid supplemental programs that were not included in its initial 2026 guidance. The release did not quantify the dollar impact of those Medicaid items, but it emphasized that health policy developments and reimbursements across Medicare and Medicaid remain an important factor in its outlook.

Beyond results, HCA provided balance-sheet and capital return updates. As of March 31, 2026, the company reported $940 million in cash and cash equivalents and $48.023 billion in total debt, with total assets of $61.450 billion. During the quarter, capital expenditures totaled $1.119 billion excluding acquisitions. HCA also repurchased 3.157 million shares for $1.571 billion, leaving $9.179 billion remaining under its repurchase authorization as of quarter-end. Its board declared a quarterly cash dividend of $0.78 per share, payable June 30, 2026 to shareholders of record as of June 16, 2026.

For 2026, HCA said it is reaffirming the estimated guidance ranges it issued on January 27, 2026. The company’s guidance calls for full-year revenues of $76.5 billion to $80.0 billion. It projected net income attributable to HCA Healthcare of $6.495 billion to $7.035 billion, adjusted EBITDA of $15.550 billion to $16.450 billion, and diluted earnings per share, as adjusted, of $29.10 to $31.50. HCA characterized its forecast as dependent on volume growth, payer mix, health policy impacts (including exchange-related administrative reforms and expiration of enhanced premium tax credits), resiliency initiatives, inflation, and trade policy effects such as tariffs.

HCA operates 189 hospitals and approximately 2,600 ambulatory sites of care, including surgery centers, freestanding emergency rooms, urgent care centers, and physician clinics, across 19 states and the United Kingdom as of March 31, 2026. The company held its first-quarter earnings conference call on April 24, 2026, at 9:00 a.m. Central Time. Investors are likely to watch whether respiratory-related weakness in early 2026 was an anomaly or a sign of a longer demand shift, and whether Medicaid supplemental programs continue to provide offsets in subsequent quarters.

The company’s release also leaves several items unquantified at the headline level. While it describes the role of Medicaid supplemental programs and outlines major factors that could influence reimbursement, it does not break out payer-mix changes or provide a stand-alone estimate of the dollar contribution from Medicaid adjustments in the quarter. HCA also notes its guidance excludes certain potential items such as gains or losses on facility sales, losses on retirement of debt, and legal claim costs, meaning actual results could differ depending on those events.