HCA Healthcare, Inc. (HCA) Risk Factors

Recent key developments

Concrete developments — dated events, named agreements and instruments, legal proceedings — that HCA Healthcare, Inc. surfaced in its latest filing.

• As of December 31, 2025, total indebtedness was $46.492 billion and availability under the senior unsecured credit facility was $5.779 billion (after giving effect to letters of credit and intention to maintain minimum available borrowing capacity equal to the commercial paper program balance of $2.207 billion).December 31, 2025
• Enhanced premium tax credits for Exchange coverage expired at the end of 2025, which is expected to adversely impact Exchange enrollment and increase the uninsured rate.2025
• The FBA includes health care policy changes expected to impact Exchange insurance coverage, reduce Medicaid spending, and impose work requirements for adults under 65 in expansion states.
• In June 2025, CMS issued a final rule making changes to Exchange affordability, consumer protections, and integrity; a federal district court issued a nationwide stay of several provisions in August 2025.June 2025
• HHS announced a significant agency restructuring in March 2025 intended to reduce its workforce and consolidate divisions, potentially altering rulemaking conventions and timelines for reimbursement rules.March 2025
• U.S. Supreme Court decisions including Loper Bright Enterprises v. Raimondo increase judicial scrutiny of agency authority and extend the period to sue regulators, potentially delaying agency rulemaking.
• CMS finalized payment reductions under the outpatient PPS for non-drug services in calendar year 2023, with additional reductions taking effect in calendar year 2026 and continuing for several years until past invalidated payments are offset.2026
• The FBA requires HHS to cap total payment rates paid by Medicaid managed care organizations for specified services, tying caps to Medicare payment rates instead of average commercial rates, anticipated to impact payment rates in many states including Texas.
• Sequestration under the BCA results in a 2% reduction in Medicare payments extending through the first five months of federal fiscal year 2033.2033
• Under the July 2024 HHS rule, hospitals engaging in information blocking lose 75% of the annual market basket increase under the Medicare Promoting Interoperability Program.July 2024
• California’s AB 3030 requires disclaimers and instructions when generative AI creates patient communications pertaining to clinical information.
• Utah’s AIPA requires disclosure when an individual is interacting with generative AI in a high-risk manner, including collection of health data or provision of medical advice.
• Colorado’s CAIA imposes significant requirements on companies using AI systems to recommend certain health decisions.
• Beginning January 2026, CMS requires hospitals in selected markets to participate in TEAM, a mandatory bundled payment model focused on five specified surgical episodes.January 2026
• Beginning January 2027, specialists treating heart failure and low back pain in outpatient settings in selected geographic areas will be required to participate in the Ambulatory Specialty Model.January 2027
• Medicare's elimination of the inpatient-only list over a three-year period beginning in 2026 may reduce inpatient volumes as procedures become eligible for outpatient reimbursement.2026
• In 2026, CMS is implementing the WISeR model requiring prior authorization or post-service, pre-payment medical review for selected services under fee-for-service Medicare.2026
• End of continuous enrollment requirement and resumption of Medicaid redeterminations in 2023 resulting in significant dis-enrollments and coverage disruptions.2023
• The Board of Directors declared a quarterly dividend of $0.78 per share on January 26, 2026, payable March 31, 2026 to stockholders of record on March 17, 2026.January 26, 2026
• Property insurance coverage is subject to deductibles and self-insured retention levels generally at $110 million per occurrence ($120 million effective January 1, 2026).January 1, 2026
• At December 31, 2025, estimated implicit price concessions of $7.674 billion had been recorded.December 31, 2025
• Estimated cost of total uncompensated care was $4.605 billion for 2025, $4.366 billion for 2024 and $3.720 billion for 2023.2025
• Investment securities held by insurance subsidiaries were $588 million at December 31, 2025, with net unrealized losses of $14 million.December 31, 2025
• Affiliates of HCA founder Dr. Thomas F. Frist, Jr. hold approximately 31% of outstanding common stock as of January 31, 2026.January 31, 2026