HCA puts third-quarter cost of patients who lost exchange coverage at $400 million
The hospital chain said people who dropped their marketplace plans kept coming for care without insurance, and Tenet reported the same shift two days later.
HCA Healthcare said Oct. 27 that a rise in uninsured patients, mainly people who lost coverage on the Affordable Care Act (ACA) health insurance exchanges, reduced its income before taxes by about $400 million in the third quarter. The estimate appeared in the company's third-quarter earnings release1, in a quarter when revenue still grew 3.6% to $19.849 billion.
The figure is one of the clearest measures so far of what happened after marketplace coverage shrank this year. Hospital operators have said that people who dropped ACA plans went uninsured at almost a one-to-one rate rather than finding other coverage, Healthcare Dive reported5. That leaves those patients without a plan to share their hospital bills, and leaves hospitals collecting less for the same care.
Coverage shrank after the enhanced federal premium tax credits that had lowered marketplace premiums expired at the end of 2025. Enrollees faced an average premium payment increase of 114% to keep the same plan, and paid enrollment in February 2026 was 19.2 million, about 3 million or 13% below 2025's 22.1 million, according to a KFF analysis7 of federal data published June 29.
HCA runs 190 hospitals and about 2,600 other care sites in the US and UK, according to Healthcare Dive. Net income attributable to the company fell 3.9% to $1.579 billion, even as same-facility admissions rose 2.7% and emergency room visits rose 5.1%, the company reported.
On the investor call, executives gave more detail, according to Healthcare Dive. Admissions of ACA patients fell 19% from a year earlier, a decline Chief Financial Officer Mike Marks called "a little bit higher than we estimated." Uninsured admissions grew to 10.5% of HCA's overall volume. The company has lost about $950 million in pretax earnings so far in 2026 from ACA-related uninsured patients, against a full-year estimate of $1 billion to $1.2 billion that it left unchanged.
The hit did not knock HCA off course for the year. The company said it now expects results in the upper half of the ranges it issued July 14.
Tenet Healthcare reported a similar trend in its Oct. 29 results2, saying a less favorable payer mix, driven by fewer exchange admissions, held back its earnings growth. In its quarterly filing3, Tenet estimated that the cost of caring for uninsured patients rose to $144 million in the third quarter, from $99 million a year earlier.
Tenet's exchange admissions and exchange revenue each fell 18% from a year earlier, Chief Financial Officer Sun Park said, according to Healthcare Dive6. Exchange revenue made up 5.5% of Tenet's net operating revenues. Chief Executive Saum Sutaria said the effect of the subsidy expiration appeared to be stabilizing compared with earlier in the year. Tenet still raised its 2026 outlook, lifting its adjusted earnings before interest, taxes, depreciation and amortization forecast to $5.05 billion to $5.20 billion.
Open enrollment for 2027 marketplace coverage began Nov. 1 and runs through Jan. 15, with a Dec. 15 deadline for coverage that starts Jan. 1, according to HealthCare.gov4. Sign-ups will show whether coverage losses carry into 2027. For the rest of this year, HCA's unchanged full-year estimate implies only about $250 million in fourth-quarter losses from ACA-related uninsured patients, analysts noted, according to Healthcare Dive.
