The hospital operator has lost about $950 million in pretax earnings this year as more patients leave the exchanges.

HCA has already lost about $950 million in pretax earnings this year as a result of more people going uninsured after being priced out of the ACA exchanges.

Millions of people dropped their ACA coverage this year following the expiration of more generous subsidies last year, which caused premiums to skyrocket for many enrollees. About 18% fewer individuals — or more than 4.6 million people — signed up for ACA coverage in June 2026 compared to June 2025.

Ahead of the expiry, hospital operators said they expected some people previously covered by ACA plans to become uninsured, but expected others to migrate into other forms of health coverage.

Instead, people began dropping their ACA coverage and going uninsured at almost a 1-to-1 rate, hospital operators said this year.

As a bellwether for for-profit hospitals, HCA — which operates 190 hospitals and 2,600 other care sites in the U.S. and United Kingdom — was the first operator to flag the rising uninsured trend earlier this year. Executives cut its guidance and said they expected to lose about $1 billion more than they had previously thought from uncompensated care and a reduced demand for elective procedures. Other for-profit hospital operators followed suit, notching millions of dollars in losses.

Uninsured patients saddle hospital operators with higher uncompensated care. They also tend to postpone or defer elective procedures, a lucrative service line for chains like HCA.

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