HCA Healthcare looks for clarity from Washington

As HCA Healthcare leaders reviewed their earnings for the first quarter of 2025, they cited a number of reasons to be pleased.

The nation’s largest for-profit hospital system, HCA reported revenues of $18.3 billion in the first quarter of 2025, up from $17.3 billion in the same quarter a year ago. HCA saw an uptick in admissions (2.6%), and a 4% bump in emergency department visits, compared to the first quarter of 2024. Surgeries were a bit mixed, with a small increase (0.2%) in inpatient surgeries and a 2% drop in outpatient procedures.

Overall, Sam Hazen, president and CEO of HCA Healthcare, expressed confidence in HCA’s outlook in a call with investors Friday.

“We will focus on maintaining our operational discipline while continuing to invest appropriately in our strategic agenda,” Hazen said. “We believe this balanced approach should position the company favorably to meet our objectives.”

But Hazen also tried to address what’s on the mind of many: the impact of the Trump administration’s changing federal policy and its impact on HCA Healthcare. And like many, Hazen’s still awaiting answers and clarity as well.

“We are in a very fluid situation,” Hazen said on the call. “While we have a general sense for the new administration's stated priorities, we do not have any specifics. It is unclear how these efforts might be carried out, and what effects they may have on our business.”

• Read more: Hospitals are facing what they dread: Uncertainty

Hazen said he understood that analysts and investors were hoping for more.

“I know you would like us to size the potential impacts of health policy risks and now tariff risks, but we are not comfortable with providing estimates at this time,” Hazen said. “We just do not have enough insight into what might happen. When we gain a better understanding, we will share more information as part of our quarterly earnings process.”

Many hospitals are worried about the prospects of cuts in Medicaid, which could mean fewer Americans would have health coverage. Medicaid also provides critical support for hospitals and health systems, and is especially vital for safety net hospitals and rural hospitals. Analysts at Fitch Ratings say Medicaid cuts would threaten the recovery of the nonprofit hospital sector.

HCA is “very engaged in advocacy” on health policy at the federal level, Hazen said.

“Our general approach is to support reasonable reforms,” Hazen said. “However, we do not support reforms that harm coverage for families or individuals, nor do we support policies that compromise the ability for hospitals across the country to care for people in their times of utmost need.”

HCA is also assessing the potential impact of tariffs. While President Trump has paused tariffs on most of America’s trading partners, tariffs remain on China, which produces a wide variety of medical supplies and products used by hospitals.

The company said the bulk of its supply expense comes from the United States, Canada, and Mexico, along with some products exempt from tariffs for the time being, including pharmaceuticals. HCA also said it's working to secure fixed price contracting and assess risks in supply chain management but said tariff risks are manageable, while conceding the situation remains fluid.

Still, Hazen said HCA is at minimum developing contingencies for cuts in federal aid.

“As you would expect, we are developing plans in the event we face adverse impacts,” Hazen said. “Our planning draws from the experiences we had during the COVID-19 pandemic, and considers both adjustments to operations and how we may utilize the flexibility our cash flow and balance sheet provide us.

“As part of this planning process, we will maintain a long-term horizon and move forward with a sense of calm, steadiness and confidence,” Hazen said. “We believe we can use our financial strength, mission-oriented culture, and can-do attitude of our people to navigate through this uncertain period and deliver the results our stakeholders deserve.”

HCA could see some opportunities in the market. Hazen noted the possibility of challenges in funding from the National Institutes of Health, the prime source of federal funds for medical research.

If academic medical centers are affected by changes in NIH funding, Hazen said, “maybe that presents an opportunity for us to pick up even more market share.”