HCA Healthcare, Inc.

HCA Healthcare, Inc. is the largest for-profit hospital operator in the United States, operating 189 hospitals and approximately 2,700 outpatient facilities across 19 states and England, with a workforce of roughly 320,000 employees. In fiscal 2025 the company generated $75.6 billion in revenue and $6.8 billion in net income attributable to HCA, making it one of the largest healthcare enterprises in the world by both measures.

This is a story about a business that combines two things that rarely go together: industrial scale and local-market execution. HCA runs roughly one of every twenty hospital beds in America, concentrated overwhelmingly in the fastest-growing regions of the country — Florida, Texas, and the Southeast — and has built a financial model around converting high-single-digit revenue growth into mid-teens EPS growth through aggressive share repurchases and operating leverage. It is also, as of mid-2026, navigating the most consequential policy disruption of the post-ACA era: the expiration of enhanced premium tax credits, which has shifted hundreds of thousands of previously insured patients into the uninsured column, compressing margins and forcing a downward revision to full-year guidance.

The file turns on a single question: whether HCA's structural advantages — its Sun Belt footprint, its purchasing and data-scale economies, and its demonstrated ability to extract cost from the enterprise — can compound through a period of deteriorating payer mix and uncertain federal health policy, or whether the exchange-to-uninsured shock marks the beginning of a tougher operating environment that the buyback cannot fully offset.