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Millions of Americans dropped their ACA coverage after subsidies expired, and hospitals are paying the price. HCA Healthcare has already absorbed ~$950 million in pretax earnings losses this year, with uninsured admissions climbing to 10.5% of total volume. The trend is hitting elective surgery volumes hard, and losses could exceed HCA's earlier $1.2 billion forecast.
When enhanced ACA subsidies expired last year, premiums spiked — and millions of Americans simply walked away from their coverage. About 4.6 million fewer people were enrolled in ACA exchange plans by June 2026 compared to a year earlier, an 18% drop. Hospitals had hoped many of those patients would shift to other forms of insurance. Instead, they went uninsured at nearly a 1-to-1 rate.
HCA Healthcare, which operates 190 hospitals across the U.S. and U.K., has been one of the hardest-hit operators. The company absorbed a $400 million pretax earnings hit in Q3 alone, and total losses for the year have reached ~$950 million. Uninsured patients not only generate more uncompensated care — they also delay elective procedures, a key revenue driver for large hospital chains. HCA's outpatient elective volumes fell 5.4% in Q3, with ACA losses accounting for a "very large" share of that decline.
By the Numbers:
Why it matters: HCA's struggles are a bellwether for the broader for-profit hospital sector. As uninsured rates climb and elective volumes shrink, the financial strain on hospital systems could ripple into staffing, capacity, and patient access — making this a system-wide concern, not just a balance-sheet problem.
