Payers and for-profit health systems alike are feeling the fallout from changes to the ACA environment, according to second-quarter 2026 earnings. Centene’s exchange membership fell by more than 2 million, Cigna announced plans to exit ACA exchanges entirely in 2027, and HCA Healthcare pointed to a $1 billion-to-$1.2 billion ACA-related headwind as the reason it cut its 2026 profit guidance.
But the disruption isn’t breaking cleanly along sector lines. Humana affirmed its adjusted earnings guidance even as it slashed its GAAP outlook, and Elevance Health raised its full-year forecast despite a 16% drop in profit — the only decline among the six payers. Hospital operators showed the same split: Tenet Healthcare raised its 2026 guidance on the heels of a strong quarter, while Universal Health Services and Community Health Systems joined HCA in trimming theirs.
Becker’s compared Q2 performance across six major payers — UnitedHealth Group, Cigna, Elevance Health, CVS Health, Centene and Humana — and four major for-profit hospital operators: HCA Healthcare, Tenet Healthcare, Community Health Systems and Universal Health Services:
Payers
- Net income: $5.5 billion (the largest profit among the six payers, and a 4.9% net margin)
- Revenue: $112 billion, essentially flat year over year
- Operating margin: 7.1%, up from 4.6% in the second quarter of 2025
- Medical loss ratio: 86.7%, a 270-basis-point improvement from the second quarter of 2025
- Raised full-year guidance to $18.45-$18.95 per share (adjusted: $19.50-$20.00)
- Net income: $3 billion, tripling from $1 billion in the second quarter of 2025
- Revenue: $106.1 billion, up 7.3% year over year
- Aetna medical benefit ratio: 87.4%, down from 89.9%
- Aetna membership: 26 million, including 18.3 million commercial and 4.2 million Medicare Advantage members
- Raised adjusted EPS guidance from $7.30-$7.50 to $7.90-$8.10
- Net income: $1.7 billion, up 8% year over year
- Revenue: $71.7 billion, up 7%
- Medical care ratio: 84.5%, up from 83.2%, which Cigna attributed to comparisons against a prior-year period that included higher risk-adjustment benefits
- Medical membership: 18.4 million, up 2%; pharmacy customers down 4% to 118.2 million
- Raised full-year adjusted income guidance to at least $30.45 per share; plans to exit ACA exchanges in 2027
- Net income: $1.5 billion, down 16% year over year — the only decline among the six payers
- Operating revenue: $49.8 billion, up 0.8%
- Operating margin: 3.5%; medical loss ratio: 89.7%, up 80 basis points
- Total medical membership: 44.9 million, down 1.5%
- Raised full-year guidance to at least $20.10 diluted EPS ($27 adjusted), citing favorable Medicare Advantage and ACA individual results offset by Medicaid pressure
- Net income: $1.1 billion, reversing a $253 million loss in the second quarter of 2025
- Revenue: $53.6 billion, up nearly 10%
- Health benefits ratio: 89.6%, improved from 93%
- Marketplace membership fell to 3.5 million from 5.9 million; Medicaid membership fell to 12.1 million from 12.8 million
- Boosted full-year adjusted EPS guidance to more than $4.80
- Net income: $694 million, up 27% year over year
- Revenue: $40.8 billion, up 26%
- Benefit ratio: 91.1%, up from 89.7%
- Total Medicare membership: 11.1 million, up from 8.2 million
- Affirmed adjusted EPS guidance of “at least $9,” but lowered GAAP EPS guidance to “at least $6.52” from $8.36
For-profit health systems
HCA Healthcare (Nashville, Tenn.)
- Net income: $1.7 billion, essentially flat with last year’s $1.7 billion, though margin narrowed to 8.4% from 8.9%
- Revenue: $20.2 billion, up from $18.6 billion
- Same-facility admissions up 2.5%; revenue per equivalent admission up 6.4%
- Cut 2026 net income guidance to $6.3 billion-$6.7 billion from $6.5 billion-$7 billion, citing a larger-than-expected $1 billion-$1.2 billion ACA headwind
Tenet Healthcare (Dallas)
- Net income: $826 million, up sharply from $288 million in the second quarter of 2025
- Operating margin: 26.7%, up from 15.6%
- Revenue: $5.6 billion, up 6.8%, boosted by a $413 million early-conclusion payment on Conifer’s CommonSpirit contract
- Raised full-year 2026 guidance, including operating revenue of $21.9 billion-$22.5 billion and net income of $2.87 billion-$3.02 billion
Universal Health Services (King of Prussia, Pa.)
- Net income: $364.6 million, roughly flat year over year
- Operating margin: 11.1%, down from 11.7%
- Revenue: $4.6 billion, up from $4.3 billion
- Behavioral health margin fell to 20.3% from 21.1%; acute care margin fell to 8.7% from 9.4%
- Trimmed 2026 adjusted EBITDA guidance by roughly 1.9% at the midpoint
Community Health Systems (Franklin, Tenn.)
- Net income: $70 million, down 75% year over year
- Operating margin: 13.8%, down from prior year
- Net operating revenues: $2.8 billion, down 9.8%, largely reflecting divestitures
- Hospital count fell to 60 from 70 a year ago after selling nine hospitals for about $1.2 billion in 2026
- Same-store revenue still grew 2.4% excluding divested facilities
- Cut 2026 revenue guidance to $11.4 billion-$11.6 billion, down from $11.6 billion-$12 billion, and trimmed adjusted EBITDA guidance to $1.3 billion-$1.375 billion, down from $1.3 billion-$1.5 billion
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