HCA Healthcare, Inc.

HCA Healthcare, Inc. is one of the leading health care services companies in the United States, operating 190 hospitals (comprised of 179 general acute care hospitals, seven behavioral hospitals, and four rehabilitation hospitals), 121 freestanding ambulatory surgery centers, and 31 freestanding endoscopy centers at December 31, 2025. Its facilities are located in 19 states and England. The company's primary objective is to provide a comprehensive array of quality health care services in the most cost-effective manner possible, and its strategy is organized around a framework that seeks to drive sustained growth by delivering operational excellence, attracting exceptional physicians and other health care professionals, developing comprehensive services, creating greater access, and coordinating higher quality care for patients.

The health care business is highly competitive, and competition among hospitals and other health care providers for patients has intensified in recent years. HCA's hospitals and other facilities compete within local communities on the basis of many factors, including the quality of care, ability to attract and retain quality physicians, skilled clinical personnel and other health care professionals, location, breadth of services, technology offered, and quality and condition of the facilities. Two of the most significant factors that impact the competitive position of a hospital are the number and quality of physicians affiliated with or employed by the hospital. The company's facilities are heavily concentrated in Florida and Texas, with 102 of its 190 hospitals located in those states, and their combined revenues represented 51% of consolidated revenues for the year ended December 31, 2025.

HCA generates revenue by providing health care services to patients, receiving payments from the federal government under the Medicare program, state governments under their respective Medicaid or similar programs, managed care plans (including plans offered through federal and state-based health insurance marketplaces), private insurers, and directly from patients. Revenues depend upon inpatient occupancy levels, the medical and ancillary services ordered by physicians and other professionals and provided to patients, the volume of outpatient procedures, and the charges or reimbursement rates for such services. For the year ended December 31, 2025, revenues from managed care and other insurers (domestic) accounted for 48.9% of total revenues, managed Medicare for 17.8%, Medicare for 14.9%, Medicaid for 7.8%, managed Medicaid for 4.9%, international (managed care and other insurers) for 2.5%, and other (including uninsured patients) for 3.2%.

HCA's general, acute care hospitals typically provide a full range of services to accommodate such medical specialties as internal medicine, general surgery, cardiology, oncology, neurosurgery, orthopedics and obstetrics, as well as diagnostic and emergency services. Outpatient and ancillary health care services are provided by its general, acute care hospitals, ASCs, freestanding emergency care facilities, urgent care facilities, walk-in clinics, physician practices, diagnostic centers, home health agencies, hospices, and rehabilitation facilities and various other facilities. Its behavioral hospitals provide a full range of mental health care services through inpatient, partial hospitalization and outpatient settings. At December 31, 2025, HCA owned and operated 179 general, acute care hospitals with 50,436 licensed beds, seven behavioral hospitals with 714 licensed beds, 121 freestanding ambulatory surgery centers, and 31 freestanding endoscopy centers.

HCA's revenues from Medicaid state directed and supplemental payment programs totaled approximately $6.2 billion in 2025, $5.5 billion in 2024, and $4.4 billion in 2023. The estimated cost of total uncompensated care was $4.605 billion for 2025, $4.366 billion for 2024, and $3.720 billion for 2023. During 2025, consolidated admissions increased 2.7% and same facility admissions increased 2.3% compared to 2024. Consolidated inpatient surgical volumes increased 0.9% and same facility inpatient surgical volumes increased 0.4% during 2025 compared to 2024. Consolidated outpatient surgical volumes declined 0.2% and same facility outpatient surgical volumes declined 0.5% during 2025 compared to 2024. Emergency room visits increased 1.6% on a consolidated basis and 1.8% on a same facility basis during 2025 compared to 2024.

During 2025, HCA repurchased 26.739 million shares of its common stock for $10.067 billion. The Board of Directors declared four quarterly dividends of $0.72 per share, or $2.88 per share in the aggregate, on its common stock. In January 2025, the Board of Directors authorized a share repurchase program for up to $10 billion of the company's outstanding common stock. At December 31, 2025, there was $750 million of share repurchase authorization that remained available under the January 2025 authorization. On January 26, 2026, the Board of Directors declared a quarterly dividend of $0.78 per share on common stock payable on March 31, 2026.

Net income attributable to HCA Healthcare, Inc. totaled $6.784 billion, or $28.33 per diluted share, for 2025, compared to $5.760 billion, or $22.00 per diluted share, for 2024. Revenues increased to $75.600 billion for 2025 from $70.603 billion for 2024, an increase of 7.1%. The consolidated revenues increase can be primarily attributed to the combined impact of a 2.9% increase in equivalent admissions and a 4.0% increase in revenue per equivalent admission. Same facility revenues increased 6.6% for 2025 compared to 2024. Cash flows from operating activities increased $2.122 billion, from $10.514 billion for 2024 to $12.636 billion for 2025.

HCA's growth strategy emphasizes growing its presence in existing markets, which it believes are large and growing and will allow the opportunity to generate long-term, attractive growth through expansion. The company plans to continue recruiting and strategically collaborating with the physician community and developing comprehensive service lines such as cardiology, neurology, oncology, orthopedics, and women's services. Additional components of this growth vector include providing access and convenience through developing various outpatient facilities, including surgery centers, urgent care clinics, freestanding emergency care facilities, imaging centers, and home health and hospice services, as well as seeking to improve coordination of care and patient retention across its markets.

HCA is investing in digital, data, and artificial intelligence capabilities to improve clinical quality, enhance the experience of patients and colleagues, and drive operational efficiency at scale. The company is focused on developing and deploying secure, enterprise-grade digital and AI-enabled solutions that support clinical decision-making, streamline workflows, reduce administrative burden, and improve the coordination of care. Its strategy emphasizes the use of standardized data platforms, advanced analytics, and responsible AI practices to enable scalable innovation across clinical, operational, and administrative functions, while maintaining appropriate governance, privacy, and security controls. HCA believes these investments will help improve patient outcomes, address workforce challenges, enhance efficiencies, and strengthen its ability to deliver high-quality, cost-effective care over the long term.

Salaries and benefits, as a percentage of revenues, were 43.5% in 2025, compared to 44.1% in 2024. Salaries and benefits per equivalent admission increased 2.4% in 2025 compared to 2024. Same facility salaries and benefits per full time equivalent increased 3.3% for 2025 compared to 2024. HCA continues to utilize certain contract, overtime, and other premium rate labor costs to support its clinical staff and patients, and while these labor costs have declined compared to the prior year period, future costs may be affected by labor market conditions and other factors. The company has seen inflation have a negative impact on certain other operating expenses and expects inflationary pressures will continue to impact operating expenses in 2026.

Planned capital expenditures are expected to approximate between $5.0 billion and $5.5 billion in 2026. At December 31, 2025, there were projects under construction which had an estimated additional cost to complete and equip over the next five years of approximately $7.1 billion. HCA expects to fund capital expenditures with internally generated and borrowed funds.

During January 2025, the Board of Directors authorized $10 billion for share repurchases of the company's outstanding common stock. At December 31, 2025, there was $750 million of share repurchase authorization that remained available under the January 2025 authorization. During 2025, the Board of Directors declared four quarterly dividends of $0.72 per share, or $2.88 per share in the aggregate, on common stock. On January 26, 2026, the Board of Directors declared a quarterly dividend of $0.78 per share on common stock payable on March 31, 2026.

HCA expects revenues from state directed payment arrangements to decline in 2026 compared to 2025, excluding the expected impact of any additional approvals. The company also expects certain administrative reforms relating to the Exchanges and the expiration of the enhanced premium tax credits at the end of 2025 to adversely affect its results of operations in 2026, offset in part by its ongoing resiliency efforts. The company is executing financial resiliency initiatives designed to generate efficiencies and cost reductions that it expects will offset in part the adverse effects on its business from recent health care policy reforms, including the expiration of the enhanced premium tax credits and changes resulting from the FBA.

HCA faces structural headwinds from the expiration of enhanced premium tax credits at the end of 2025, which it believes will adversely impact Exchange enrollment and significantly increase the uninsured rate. The FBA includes significant health care policy reforms expected to result in Medicaid spending reductions and changes in administration of state Medicaid programs, including limitations on provider tax arrangements and state directed payment arrangements. The company also faces headwinds from the FBA's requirement that HHS revise regulations governing SDP arrangements to cap total payment rates paid by Medicaid managed care organizations for specified services, tying caps to Medicare payment rates instead of average commercial rates, a change that it anticipates will impact payment rates in many states in which it operates, including Texas.

HCA's business is subject to significant risks from changes in government health care programs, as it derived 45.4% of its revenues from the Medicare and Medicaid programs in 2025. The FBA includes significant health care policy reforms expected to result in Medicaid spending reductions and changes in administration of state Medicaid programs, including limitations on provider tax arrangements and SDP arrangements, which the company anticipates will impact payment rates in many states in which it operates, including Texas. The company also faces risks from its significant indebtedness, which totaled $46.492 billion at December 31, 2025, and could adversely affect its ability to raise additional capital, limit its flexibility, and expose it to interest rate risk. Additionally, HCA's results of operations may be adversely affected by competition for staffing and the shortage of experienced nurses and other health care professionals, as the company's workforce consists of approximately 320,000 employees. The company's facilities are heavily concentrated in Florida and Texas, with 102 of its 190 hospitals located in those states, and their combined revenues represented 51% of consolidated revenues for the year ended December 31, 2025, making it particularly sensitive to regulatory, economic, public health, environmental, and competitive conditions in those states.

Management's message emphasizes the company's commitment to providing high-quality, convenient, and cost-effective health care while growing the business and creating long-term value for stockholders. The strategic priorities emphasized for the period ahead include growing presence in existing markets, achieving industry-leading performance in clinical, operational, and satisfaction measures, recruiting and retaining physicians and other health care professionals, continuing to utilize economies of scale to grow the company, pursuing a disciplined development strategy, and advancing digital and artificial intelligence capabilities. Management notes that the 2025 and 2024 results include gains on sales of facilities of $37 million, or $0.12 per diluted share, and $14 million, or $0.04 per diluted share, respectively, and that the 2024 results also include additional expenses and losses of revenues estimated at approximately $250 million, or $0.73 per diluted share, related to Hurricanes Helene and Milton.