HCA Healthcare Shares Tumble on Flat 2027 Earnings Forecast

HCA Healthcare (NYSE:HCA) shares fell more than 5% on Tuesday after the hospital operator signaled that its 2027 earnings would likely be flat compared to 2026. The muted outlook, driven by anticipated reductions in Medicaid payments and an increase in uninsured patients, overshadowed a third-quarter earnings beat and sent shares of industry peers lower.

Outlook Disappoints Investors

On a post-earnings call, CEO Sam Hazen told analysts, "we anticipate our earnings in 2027 will be generally consistent with 2026," adding that the company will provide a full formal outlook in January. This projection disappointed investors and analysts, who, according to LSEG data, had on average been expecting 2027 earnings of $32.14 per share.

The guidance suggests next year's earnings will fall below consensus estimates. Morningstar analyst Julie Utterback noted that "the market appeared disappointed by management’s flat 2027 outlook." For the current year, HCA said it expects 2026 results to finish in the upper half of its forecasted range for annual profit, which is between $28.70 and $30.50 per share.

Medicaid and Uninsured Headwinds

HCA detailed two significant financial pressures heading into 2027. The company anticipates a substantial drop in government reimbursements, with $550 million to $650 million less in net benefits from Medicaid supplemental payments compared to 2026.

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Additionally, the company is facing challenges from a shifting payer mix. A rise in uninsured patients, particularly individuals who lost coverage through Affordable Care Act exchanges, reduced HCA's pretax income by approximately $400 million in the third quarter alone. Hazen said the company expects a continued "meaningful impact on payer mix" next year.

Broader Market Impact

The downbeat forecast from the nation's largest for-profit hospital operator weighed on the broader sector. Shares of competitors Tenet Healthcare (NYSE:THC) and Universal Health Services (NYSE:UHS) also declined, falling 2% and 6%, respectively.

While HCA's forward guidance drove the stock's decline, its third-quarter performance exceeded Wall Street expectations. The company reported an adjusted profit of $7.22 per share on revenue of $19.85 billion. HCA also projects solid patient volume growth of 2% to 3% next year, indicating that underlying demand for services remains steady despite the profitability headwinds.