HCA Healthcare, Inc. (HCA): what the price requires
The current priced-in claim for HCA Healthcare, Inc. (HCA) is temporarily suppressed because the live engine record is unavailable. The dated report remains a snapshot, not a current market read.
Generated: 2026-07-14 · Exported: 2026-07-16 · Source: https://boothcheck.com/report/HCA
Headline
| Field | Value |
|---|---|
| Ticker | HCA |
| Company | HCA Healthcare, Inc. |
| Current price | $394.40/sh |
| Composition | Medicare 15% / Managed Medicare 18% / Medicaid 8% / Managed Medicaid 5% / Managed care and other insurers 49% / International (managed care and other insurers) 2% / Other 3% |
What The Price Requires (Inversion)
The assumption today's price embeds, recovered by inverting the valuation.
| Field | Value |
|---|---|
| Inversion basis | whole-company |
| Operating margin needed | 6.4% |
| Operating margin today | 12.6% |
| Margin compression implied | -6.2pp |
| Multiple paid | 15x operating income |
The operating-margin requirement is derived from the framework's value band at year 12, a separately labeled basis from the headline growth/duration solve.
The price sits below what even a 5%/yr operating-profit decline would warrant; the inversion reports a bound, not a solved growth path.
Solve inputs: computed at a 7% cost of capital with 4% terminal growth over a 5-year stage (computed at the 7% minimum rate; the CAPM rate 6.9% sits below it).
Reconcile: at the x-ray's 9.3% required return this reads ~7.5%/yr; the models below use their own rates.
How unusual the bet is: within-range
| Reference | Value |
|---|---|
| vs own history | -3.32σ |
| cohort percentile (of 112 peers) | 26 |
| implied end-window share | 0% |
Valuation X-Ray
The price is justified by relative-multiple; earnings-power land below the price.
How the valuation models price the stock relative to the market price. Price/FV above 1.0 means the market pays more than that lens defends (expensive); at or below 1.0 the lens can defend the price.
| Family | Median price/FV | Models | Reads |
|---|---|---|---|
| Asset | — | 0 | — |
| Earnings | 2.80x | 3 | expensive |
| Relative | 1.19x | 1 | expensive |
| Growth | — | 0 | — |
Families that justify the price: Relative Families that call it expensive: Earnings
The models below discount at their own flat-beta convention rates (cost of equity 9.3%, WACC 6.1%); the inversion above states its own rate.
Per-Model Detail (n=4)
| Model | Family | FV | Price/FV | Applicable | Methodology |
|---|---|---|---|---|---|
| DCF Perpetual Growth | Growth | — | — | no | — |
| DCF Exit Multiple | Growth | $683.09 | 0.58x | no | Exit EV/EBITDA: 37.8x / 39.8x / 41.8x (bear / base = today's held flat / bull), 5yr |
| Relative Valuation | Relative | $330.65 | 1.19x | yes | P/E 18x (static sector reference · 2026-04), scenarios: 15.1x / 18.0x / 20.9x (bear / base = reference held flat / bull), EV/EBITDA 20.35x |
| Simple DDM | Growth | — | — | no | — |
| Two-Stage DDM | Growth | — | — | no | — |
| Simple Excess Return | Asset | — | — | no | — |
| Two-Stage Excess Return | Asset | — | — | no | — |
| Discounted Future Market Cap | Growth | $409.86 | 0.96x | no | Rev $76.4B, growth 7% (input: historical growth; tapered), Terminal P/S: 1.0x / 1.2x / 1.4x (bear / base = today's held flat / bull, cap 8x) |
| Peter Lynch Fair Value | Relative | $870.30 | 0.45x | no | EPS $29.03, growth 30% (input: historical EPS growth), PEG=0.44 (Undervalued) |
| Margin Trajectory | Growth | — | — | no | — |
| Earnings Power Value | Earnings | — | — | no | — |
| Residual Income | Asset | — | — | no | — |
| Graham Number | Asset | — | — | no | — |
| EV/EBITDA Relative | Relative | $0.01 | 39440.00x | yes | EBITDA $3.59B × sector EV/EBITDA 12.0x (excluded from median) |
| FCF Yield | Earnings | $140.79 | 2.80x | yes | FCF $7927.0M / Kₑ 9.3% — zero-growth perpetuity |
| SBC-Adj FCF Yield | Earnings | $122.24 | 3.23x | yes | SBC-adj FCF $7.54B (FCF $7.93B − SBC $0.39B) capitalized at Kₑ |
| Ben Graham Formula | Earnings | $936.70 | 0.42x | yes | EPS $29.03 × (8.5 + 2×15.0%) × (4.4 / 5.3%) |
| ROIC-Justified P/B | Asset | — | — | no | — |
| P/Sales Sector | Relative | $842.57 | 0.47x | no | Revenue $76.39B × sector P/S 2.5x |
| PEG Fair Value | Relative | $1088.63 | 0.36x | no | EPS $29.03 × (PEG 1.5 × growth 25.0% (input: historical EPS growth)) → PE 37.5x |
| Earnings Yield | Earnings | $313.84 | 1.26x | no | EPS $29.03 / required return 9.3% (Rf 4.3% + ERP 5.0%) |
| Funds From Operations Multiple | Relative | — | — | no | — |
| Clinical Phase NPV | Growth | — | — | no | — |
| Merton | Asset | — | — | no | — |
| V5 Mechanical | — | — | — | no | — |
Solvency
| Field | Value |
|---|---|
| Net debt | $52.7b |
| Net debt / NOPAT (after-tax) | 6.87x |
| Net debt / operating income (pre-tax) | 5.58x |
| Interest coverage | 4.2x |
| Share count CAGR (buyback) | -7.3% |
| Burning cash | no |
Bullet Takeaways
- HCA is the largest for-profit hospital operator in the country, and its scale lets it raise revenue per admission even when volumes are soft: Q1 2026 revenue rose 4.3% to $19.1 billion while same-facility admissions grew under 1%.
- The biggest risk is the balance sheet, not the operations: net debt of roughly $53 billion sits at about 5.6 times operating income, and the company runs with negative book equity by design.
- Watch volume normalization and the buyback pace: HCA repurchased $1.571 billion of stock last quarter with $9.179 billion left on the authorization, and the share count is shrinking about 7% a year.
Bull Case
The trajectory is the bull case. Over the last several quarters HCA has kept revenue and earnings grinding higher even as patient volumes softened, which is the signature of a company whose pricing and mix do the work when traffic does not. In Q1 2026 revenue rose 4.3% year over year to $19.1 billion and diluted earnings per share climbed 10.9% to $7.15, despite same-facility admissions growing only 0.9% and a respiratory season that ran 42% below the prior year. Same-facility revenue per equivalent admission rose 3.1%, and that is the lever: a weak flu season and a January winter storm dented bodies through the door, and the income statement barely noticed.
That resilience comes from scale and network density. HCA runs the largest collection of acute-care hospitals in the United States, clustered in growing Sun Belt markets, and the concentration lets it negotiate harder with commercial payers and absorb fixed costs across more beds than any competitor. The company is candid in its filing that uninsured care is a real cost, noting it provides "discounts to uninsured patients who do not qualify" for charity care, but the commercial and managed-care payer mix carries the margin, and HCA's market positions in its metros give it leverage in those rate negotiations that a single-hospital system cannot match.
The capital engine compounds the per-share story. HCA generated free cash flow well above its reported earnings, and management returns nearly all of it: the company repurchased 26.739 million shares in 2025, part of a multi-year buyback that has pulled the share count down at roughly a 7% annual pace. Fewer shares against rising earnings is why per-share growth outruns the headline revenue line. For 2026 management reaffirmed revenue of $76.5 billion to $80.0 billion and diluted EPS of $29.10 to $31.50 on a base of 223.5 million shares, a guide that bakes in continued shrinkage of the count. A buyer is paying for a high-volume cash machine that turns flat traffic into rising earnings per share.
Bear Case
The way HCA deploys capital is the bear case, because the per-share growth that looks so clean is partly engineered with leverage. The company carries about $53 billion of net debt against roughly $9.4 billion of trailing operating income, a ratio near 5.6 times, and runs with negative book equity: years of debt-funded buybacks have returned more capital than the business retains. The filing lays out the scale of it, with senior unsecured notes alone running to "$43.250 billion aggregate principal amount of senior notes" across a ladder of maturities. Interest coverage near four times is adequate today, but it is the kind of structure that converts an operating wobble into an equity problem, because the debt holders are paid first and the equity is what is left.
That matters because the equity is also where the buybacks land. Returning nearly all free cash flow to shareholders while financing the balance sheet with $53 billion of borrowings is a choice that flatters earnings per share in good years and offers no cushion in bad ones. A hospital operator faces reimbursement risk from Medicare and Medicaid policy, the payer categories that headline its revenue mix, and from commercial-rate pressure; a single adverse shift in the rate environment compresses the operating margin that the entire leveraged structure rests on. The bull frames the buyback as disciplined capital return; the bear notes that buying back stock with borrowed money is most aggressive exactly when the operating environment is most benign, and 2026's soft volumes are a reminder that the environment does not stay benign.
The near-term operating signal is also softer than the headline. Same-facility admissions grew under 1% in Q1 2026, and the company acknowledged it "did not experience a typical seasonal volume increase" as respiratory admissions fell 42%. Volume is the raw material of a hospital, and HCA offset the shortfall with price this quarter; it cannot offset it with price indefinitely if utilization keeps drifting lower. The market already reacted, marking the stock down sharply after the print. A levered company priced for steady volume growth has little room for the volume line to keep disappointing.
Valuation
At about $375 (June 27, 2026) the market is paying roughly 15 times company-wide operating income, a multiple low enough that the price sits below what even a 5% annual decline in operating profit would warrant. That is an unusual setup: the inversion frames the price not as demanding heroic growth but as already discounting deterioration. The near-term pace HCA needs is within what it has recently delivered; the only stretch is in how long it must persist, not how fast.
The methods sort cleanly. The relative-multiple lens, anchored on a sector P/E near 18 times, lands close to the price, which is why the price reads as defensible on a peer basis. The earnings-power methods, which capitalize free cash flow, read the stock as expensive because they ignore growth entirely and value only the current cash stream at a flat rate. The absence of asset-value and book-based methods is not an oversight; HCA's negative book equity makes them inapplicable, which itself tells the valuation story. This is a company whose value lives in its cash generation and market position, not its balance sheet, and the cash-flow methods that strip out growth necessarily undershoot a business still growing earnings per share at double digits.
Solvency is where the caution belongs. Net debt of about $53 billion against operating income near $9.4 billion is roughly 5.6 times operating income, with interest coverage around four times. The company is not burning cash, and free cash flow comfortably services the debt, but this is a balance sheet built for steady operations rather than shocks. The share count falling about 7% a year is the clearest evidence of where management directs that cash, and it is the engine behind the per-share growth. What a holder underwrites at this price is straightforward: a dominant, cash-rich operator whose earnings per share keep rising, financed by a debt load that leaves little margin for a sustained downturn in volumes or reimbursement.
Catalysts
HCA's first quarter of 2026 set the recent tone: revenue up 4.3% year over year to $19.109 billion, net income attributable to HCA of $1.620 billion, and diluted EPS up 10.9% to $7.15. The cause behind the modest top line was volume: same-facility admissions rose only 0.9% and equivalent admissions 1.3%, with the company noting it did not get its usual seasonal lift because respiratory-related admissions fell 42% and respiratory ER visits 32% versus a year earlier, compounded by a January winter storm in several markets. Pricing carried the quarter, with same-facility revenue per equivalent admission up 3.1%. The stock fell about 9% on the print as investors focused on the soft volume rather than the price offset.
Capital return continued at pace. HCA repurchased 3.157 million shares for $1.571 billion in the quarter, leaving $9.179 billion under the current authorization. That buyback is the mechanism behind the per-share growth and the trajectory to watch alongside volume recovery.
Management reaffirmed full-year 2026 guidance: revenue of $76.5 billion to $80.0 billion, net income attributable to HCA of $6.495 billion to $7.035 billion, adjusted EBITDA of $15.550 billion to $16.450 billion, and diluted EPS of $29.10 to $31.50 on 223.5 million shares. The key forward variables are whether patient volumes normalize off the weak respiratory season and how the Medicare, Medicaid, and commercial reimbursement environment evolves through the year.
Peer Cohorts (Per Segment, With Filing Citations)
National Group / Atlantic Group / American Group (reported)
- THC (TENET HEALTHCARE CORP)
- (no filing in the citation store)
- UHS (UNIVERSAL HEALTH SERVICES, INC.)
- (no filing in the citation store)
- SGRY (Surgery Partners, Inc.)
- (no filing in the citation store)
- EHC (Encompass Health Corporation)
- (no filing in the citation store)
- ARDT (Ardent Health, Inc.)
- (no filing in the citation store)
- DVA (DAVITA INC.)
- (no filing in the citation store)
- FMS (FRESENIUS MEDICAL CARE AG)
- (no filing in the citation store)
- BTSG (BrightSpring Health Services, Inc.)
- (no filing in the citation store)
Methodology Note
- Priced-in inversion: the valuation is inverted on the current price to recover the operating-income growth, duration, and steady-state margin the price embeds (ROE for financials, FFO growth for REITs).
- Valuation x-ray: the valuation models, grouped into four families (asset, earnings, relative, growth). Each model is expressed as a price/FV ratio (distance from price), not a point fair-value estimate. The spread across families is the disagreement.
- Solvency: net cash/debt, net-debt-to-NOPAT, interest coverage, and share-count CAGR from EDGAR financials (net debt / FFO and fixed-charge coverage for REITs; regulatory-capital framing for financials).
- Peer cohorts: per-segment comparables with deep-linkable SEC filing citations.
Fundamentals sourced from SEC EDGAR filings. Current price from Databento. The priced-in inversion and valuation x-ray are computed by the boothcheck engine; narrative composed by AI from the structured data.
Sources
HCA Q1 2026 earnings release · HCA FY2025 10-K