HCA Healthcare, like other companies, is keeping an eye on an uncertain economy and regulatory environment as it looks ahead to the coming year.

"We continue to monitor several policy matters, including the expired enhanced premium tax credits, the ongoing developments related to Medicaid supplemental payment programs and the Rural Health Transformation Program," CEO Sam Hazen said on a Tuesday earnings call with investors. "These matters continue to evolve. As we learn more, we will provide updates at the appropriate times. That said, we believe our core business remains strong, with forecasted volumes in our long-term 2% to 3% growth range."

The company compared financial metrics from the fourth quarter of 2025 to the same period the previous year:

  • Revenues increased 6.7% to $19.513 billion.
  • Net income attributable to HCA Healthcare increased 30.6% to $1.878 billion.
  • Diluted earnings per share increased 44.6% to $8.14 per share, and diluted. earnings per share, as adjusted, increased 28.8% to $8.01 per share.
  • Adjusted EBITDA increased 10.8% to $4.114 billion.
  • Cash flows from operating activities totaled $2.359 billion, compared to $2.559 billion in the fourth quarter of 2024.
  • Same-facility admissions increased 2.4%, and same-facility equivalent admissions increased 2.5%.

"Reflecting on 2025, this was another successful year for HCA Healthcare," Hazen said. "Throughout the year, our teams executed at a high level, we gained ground with our strategic agenda and we stayed focused on the fundamentals. Additionally, we invested significantly in network expansion, workforce development and clinical capabilities. These investments help deliver positive outcomes across the HCA Healthcare System. As a result, our networks had approximately 47 million patient encounters during the year, representing a record level of patient care activity for the company."

Looking ahead to this year, CFO Mike Hart expects revenues to range between $76.5 billion and $80 billion; adjusted EBITDA between $15.55 billion and $16.45 billion; net income attributable to HCA Healthcare between $6.5 billion and $7 billion; and diluted earnings per share between $29.01 and $31.50. "Further, we continue to see opportunities to deploy capital and drive organic growth in our markets through investing in high acuity programs, increasing our network through new access points and building new inpatient capacity," he said.

Hart is bullish on HCA's long-range outlook despite such challenges as administrative reforms enacted in 2025, the One Big Beautiful Bill Act and the expiration of enhanced premium tax credits. "We expect an offset to this exchange headwind of approximately $400 million through resiliency initiatives designed to generate efficiencies throughout the organization," he said.

Also on Tuesday, UnitedHealth Group executives predicted that the number of people with its fully insured commercial health coverage will fall about 16% this year, to less than 6.9 million.

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