美國醫院公司 (HCA) 2026 Q2 法說會逐字稿

Ladies and gentlemen, welcome to the HCA Healthcare second-quarter 2026 earnings conference call. Today's call is being recorded.

各位女士、先生，歡迎參加 HCA Healthcare 2026 年第二季財報電話會議。今天的電話會議將被錄音。

At this time, for opening remarks and introductions, I would like to turn the call over to Vice President of Investor Relations, Mr. Frank Morgan. Please go ahead, sir.

此刻，為了開場致詞與介紹，我想把電話會議交給投資人關係副總裁 Frank Morgan 先生。先生，請開始。

Good morning, and welcome to everyone on today's call. With me this morning is our CEO, Sam Hazen; and CFO, Mike Marks. Sam and Mike will provide some prepared remarks, and then we'll take questions.

各位早安，歡迎大家參加今天的電話會議。今天早上與我一同出席的有我們的執行長 Sam Hazen，以及財務長 Mike Marks。Sam 與 Mike 將先發表準備好的談話，接著我們會進行問答。

Before I turn the call over to Sam, let me remind everyone that should today's call contain any forward-looking statements, they are based on management's current expectations. Numerous risks, uncertainties and other factors may cause actual results to differ materially from those that might be expressed today. More information on forward-looking statements and these factors are listed in today's press release and in our various SEC filings.

在我把電話會議交給 Sam 之前，提醒各位：若今天的電話會議包含任何前瞻性陳述，皆係基於管理階層目前的預期。眾多風險、不確定性及其他因素可能導致實際結果與今日所表達者有重大差異。關於前瞻性陳述及上述因素的更多資訊，已列於今日新聞稿以及我們向 SEC 提交的各項文件中。

On this morning's call, we may reference measures such as adjusted EBITDA, which is a non-GAAP financial measure. A table providing supplemental information on adjusted EBITDA and reconciling net income attributable to HCA Healthcare Inc is included in today's release. This morning's call is being recorded, and a replay of the call will be available later today

在今天早上的電話會議中，我們可能會提及如調整後 EBITDA 等指標，該等指標屬於非 GAAP 財務衡量。今日發布內容中包含一份表格，提供調整後 EBITDA 的補充資訊，並將歸屬於 HCA Healthcare Inc 的淨利進行調節。今天早上的電話會議將被錄音，並將於今日稍晚提供重播。

With that, I'll now turn the call over to Sam.

接下來，我把電話會議交給 Sam。

Good morning. We believe that access to health care and affordability for Americans begins and ends with health insurance coverage. Most people need support to secure it, whether that is through an employer, the federal government or some other means. Throughout 2025, our teams advocated for extending, in some form, the enhanced premium tax credits for those individuals who needed it. Unfortunately, the enhanced premium tax credits expired at the end of the year and the effects, as expected, were that many people became uninsured and still needed emergency care from hospitals.

各位早安。我們相信，對美國人而言，醫療可近性與可負擔性始於也終於健康保險覆蓋。大多數人需要協助才能取得保險，不論是透過雇主、聯邦政府或其他方式。在 2025 年期間，我們的團隊倡議以某種形式延長對有需要個人的加強版保費稅額抵免。不幸的是，加強版保費稅額抵免於年底到期；如預期所見，其影響是許多人變成無保險狀態，但仍需要醫院提供急診照護。

As we look at the first half of the year, our expectations proved accurate, although the impact was greater than our estimates. Our colleagues, however, have continued to deliver high-quality compassionate care to an increased number of patients during the first half of the year while managing well through the various headwinds we faced. On behalf of our Board and our senior team, I want to thank our colleagues for their great work.

回顧今年上半年，我們的預期證明是正確的，儘管影響程度大於我們的估計。然而，我們的同仁在上半年面對各種逆風時，仍持續為更多病患提供高品質且富同理心的照護，並妥善因應。我代表董事會與高階團隊，感謝同仁們的卓越工作。

When I look at the company's midyear results, I'll focus on three factors. But before I get to those, I do want to indicate that the company had solid diluted earnings per share growth of 11% in the quarter and 11% year-to-date. First, we experienced an unfavorable payer mix shift, which created most of the financial pressure for the company. Overall, adjusted admissions for patients who were formerly covered by the health insurance exchanges declined by 15%. We expected some of these patients to shift to other forms of coverage, but this did not happen. Instead, these patients migrated almost one for one to uninsured.

在檢視公司年中業績時，我將聚焦三項因素。但在談到這些之前，我想先指出：公司本季稀釋每股盈餘成長 11%，年初至今亦成長 11%，表現穩健。第一，我們經歷了不利的付款方組合（payer mix）變化，這造成公司大部分的財務壓力。整體而言，先前由健康保險交易所（exchange）承保的病患，其調整後入院人次下降 15%。我們原本預期其中部分病患會轉向其他形式的保險，但並未發生。相反地，這些病患幾乎一比一地轉為無保險。

We had 3 of our 15 domestic divisions that had outsized effects for this payer mix shift, and they accounted for around 50% of the company's overall impact. In the quarter, we had an incremental net benefit from Medicaid supplemental payment programs primarily related to Florida. These programs, which are fundamental to our providing services to Medicaid patients play an important role in supporting access to care. This support has been especially important for hospitals as they are now providing more uncompensated care to uninsured patients.

在我們 15 個美國本土事業部中，有 3 個事業部對這次付款方組合變化的影響特別顯著，約占公司整體影響的 50%。本季，我們從 Medicaid 補充支付計畫獲得額外的淨利益，主要與佛羅里達州相關。這些計畫對我們向 Medicaid 病患提供服務至關重要，並在支持醫療可近性方面扮演重要角色。這項支持對醫院尤其重要，因為目前醫院正為無保險病患提供更多無償照護。

Our updated guidance for the year incorporates what we have learned through the first six months with respect to patients who have lost their coverage on the exchanges. We believe most of the attrition this year is attributable to the expiration of the enhanced premium tax credits.

我們更新後的年度指引，已納入我們在前六個月中，對於在交易所失去保險覆蓋之病患所獲得的經驗與認知。我們認為，今年大部分的流失可歸因於加強版保費稅額抵免到期。

The second factor was the strength in demand. Despite the payer mix shift, we were pleased with our volume growth. Insured volumes, excluding exchanges across many of our services were solid with improving trends over the course of the first six months. Emergency room visits, cardiac procedures and rehab volumes helped drive these improvements. With respect to surgery volumes, the primary explanation for the decline was from reduced demand in elective surgeries across both inpatient and outpatient settings.

第二項因素是需求的強勁。儘管付款方組合出現變化，我們仍對量能成長感到滿意。在我們多項服務中，排除交易所後的投保量能表現穩健，且在前六個月期間趨勢持續改善。急診就診、心臟相關處置與復健量能推動了這些改善。就手術量而言，下滑的主要原因是住院與門診場域的選擇性手術需求減少。

We believe there are several factors contributing to this dynamic, including declines from patients who were previously covered through the exchanges. Emergency inpatient surgery volumes, which account for approximately two-thirds of our total inpatient cases, were up as compared to last year.

我們認為有多項因素促成此一態勢，包括先前透過交易所投保的病患減少。急診住院手術量約占我們住院總病例的三分之二，與去年相比有所增加。

As stated, we continue to be encouraged by the overall backdrop in demand. We believe our longer-term assumptions for demand growth of 2% to 3% are supported by market factors and population growth rates that we see in the communities we serve. To meet this expected demand, we have continued to add capacity and facilities to our networks this year. Additionally, we have approved more than $7 billion in capital expenditures that should come online in the next three years. We believe these investments will increase offerings and quality for our patients, improve our competitive positioning and help us grow.

如前所述，我們仍對整體需求環境感到鼓舞。我們相信，對需求成長 2% 至 3% 的長期假設，受到市場因素以及我們所服務社區的人口成長率所支持。為滿足這項預期需求，我們今年持續在網絡中增加產能與設施。此外，我們已核准超過 70 億美元的資本支出，預計在未來三年內陸續投入營運。我們相信，這些投資將提升對病患的服務內容與品質、改善我們的競爭定位，並協助我們成長。

HCA Healthcare has produced strong returns on invested capital over the years, and we believe there will be opportunities to do more in the future. We expect to use our cash flow and balance sheet strength to invest further in our business while also returning capital to our shareholders through our capital allocation plan.

多年來，HCA Healthcare 一直展現強勁的投入資本報酬率，我們相信未來仍有更多機會可為。我們預期將運用現金流與資產負債表的強健實力，進一步投資於本業，同時也依據資本配置計畫，透過資本回饋將資金返還給股東。

The last factor I want to focus on is the advancement of our financial resiliency program. We continue to see improvement in cost metrics as we move through the first two quarters. For years, HCA Healthcare has found ways to create economies of scale, increased operational efficiency and enhance margins. We believe the resiliency program we are advancing now has more capacity through digital transformation, global capabilities and enhanced workforce development programs. We believe our program will continue to add value this year and on into subsequent years.

我想聚焦的最後一項因素，是我們財務韌性計畫的推進。隨著我們走過前兩季，我們持續看到成本指標的改善。多年來，HCA Healthcare 一直設法創造規模經濟、提升營運效率並強化利潤率。我們相信，目前推進的韌性計畫，將透過數位轉型、全球能力以及強化的人才發展計畫，帶來更大的潛力。我們相信，我們的計畫今年將持續創造價值，並延續至往後年度。

I'll close with this. HCA Healthcare has a strong track record of effectively responding to challenges regardless of the event. From these experiences, we have built a culture of discipline. This culture has helped us stay true to our core mission to care and improve human life. Next, it has allowed us to allocate resources productively to generate solid returns for our shareholders. And lastly, it keeps us focused on execution to deliver the outcomes necessary to make the company stronger.

我以此作結。無論面對何種事件，HCA Healthcare 一向具備有效因應挑戰的良好紀錄。從這些經驗中，我們建立了自律的文化。這種文化幫助我們堅守核心使命：關懷並改善人類生命。其次，它使我們能夠有效配置資源，為股東創造穩健報酬。最後，它讓我們專注於執行，以交付使公司更強健所需的成果。

With that, I will turn the call over to Mike for more details on the quarter.

接下來，我把電話會議交給 Mike，請他就本季提供更多細節。

Thank you, Sam, and good morning, everyone. Let me start by providing a [commentary] on second quarter same facility volume compared to prior year. Admissions increased 2.5% and equivalent admissions increased 2.7%. Inpatient surgeries were down 2.3%, and outpatient surgeries were down 3.4%. ER visits increased 3.6%.

謝謝你，Sam，各位早安。我先就第二季同院（same facility）量能與去年同期相比提供一段[commentary]。入院人次增加 2.5%，等同入院人次增加 2.7%。住院手術下降 2.3%，門診手術下降 3.4%。急診就診增加 3.6%。

Regarding payer mix, same facility equivalent admissions and our insured population excluding exchanges increased 3.2% in the second quarter and 2.2% year-to-date versus prior year. Exchanges declined 15%. As Sam noted, these patients losing coverage on the exchanges migrated almost one-for-one to uninsured. This one-for-one migration makes up approximately 80% of our uninsured volume growth with the remaining 20% related to a decrease in Medicaid conversions, mostly in Texas, which has had a modest financial impact.

關於付款方組合（payer mix），同院區等值入院人次以及我們排除交易所（exchanges）的已投保人口，在第二季較去年同期增加3.2%，年初至今較去年同期增加2.2%。交易所下降15%。如Sam所提，這些在交易所失去保障的病患幾乎一比一地轉為無保險。這種一比一的轉移約占我們無保險量成長的80%，其餘20%則與Medicaid轉換率下降有關，主要發生在德州，對財務影響相對溫和。

Our second quarter net revenue per equivalent admission growth of 6.4% was probably (inaudible) payment benefit during the quarter. In addition, our contracted rate increases and governmental payment updates offset the negative rate impacts from payer mix changes relating to the exchanges and to a lesser extent, service mix.

我們第二季每等值入院人次的淨營收成長6.4%，可能是（聽不清）在本季帶來的付款效益。此外，我們的合約費率調升與政府支付更新，抵銷了因付款方組合變動（與交易所有關，且在較小程度上與服務組合有關）所造成的負面費率影響。

Let me now transition to the impact of the exchanges and Medicaid supplemental payment programs in the quarter. The significant payer mix shift related to the exchanges has had an unfavorable impact on adjusted EBITDA of approximately $400 million. This amount includes an increase of our -- of approximately $75 million related to our previous estimate of our first quarter exchange impact.

接下來我轉到本季交易所與Medicaid補充支付計畫的影響。與交易所有關的顯著付款方組合轉移，對調整後EBITDA造成約4億美元的不利影響。此金額包含我們——相較於先前對第一季交易所影響的估計——增加約7,500萬美元。

During the second quarter, the company recognized approximately $400 million of incremental net benefit from Medicaid supplemental payment programs. This included a $540 million incremental net benefit related to the recently approved Florida program from October 1, 2024, to June 30, 2026. This benefit was partially offset by retro payments received in the second quarter of 2025.

在第二季，公司認列了約4億美元來自Medicaid補充支付計畫的增量淨效益。其中包含與近期核准的佛羅里達計畫相關、涵蓋2024年10月1日至2026年6月30日的5.4億美元增量淨效益。該效益部分被於2025年第二季收到的追溯付款所抵銷。

Sam touched on the advancement of our financial resiliency program. Resiliency is core to how we operate the business. Our resiliency program is a long-term multifaceted enterprise-wide set of initiatives designed to generate efficiencies across the organization. We were pleased with our cost results in the second quarter. Same facility cost per equivalent admission when considering Medicaid supplemental payment programs was essentially flat versus prior year quarter, and it improved 1.4% sequentially.

Sam提到了我們財務韌性計畫的推進。韌性是我們經營業務的核心。我們的韌性計畫是一項長期、多面向、全企業的倡議組合，旨在於整個組織中創造效率。我們對第二季的成本結果感到滿意。在納入Medicaid補充支付計畫的考量下，同院區每等值入院人次成本與去年同期基本持平，且較前一季改善1.4%。

Let me add a note on our year-to-date performance. Given the challenging policy and reform backdrop, we are pleased with our operating performance at the halfway mark of the year. When we consider the impacts of the exchanges, Medicaid supplemental payment programs and the impact from the [respiratory] season and winter storm in the first quarter. Our year-to-date operational performance has moderated from our 2025 growth and our initial guidance assumptions. Our revised guidance in 2026 is more in line with our long-term adjusted EBITDA growth rate target of 4% to 6%.

我再補充一下我們年初至今的表現。在充滿挑戰的政策與改革背景下，我們對上半年時點的營運表現感到滿意。當我們考量交易所、Medicaid補充支付計畫，以及第一季的[呼吸道]季節與冬季風暴的影響。我們年初至今的營運表現相較於2025年的成長與我們最初的指引假設已有所趨緩。我們在2026年的修正後指引更貼近我們長期調整後EBITDA成長率目標4%至6%。

Moving to capital allocation and cash flow. Capital expenditures totaled $1.2 billion in the quarter. Additionally, we purchased $2.1 billion of our outstanding shares, and we paid $171 million in dividends for the quarter. Cash flow from operations was $2.3 billion in the quarter, which is a 45% decline from prior year quarter. This decline was primarily due to timing differences in cash flows related to Florida's Medicaid supplemental payment program as well as the prior year deferral of federal income tax payments to the fourth quarter of 2025.

接著談資本配置與現金流。本季資本支出合計12億美元。此外，我們回購了21億美元的流通在外股份，並於本季支付1.71億美元股利。本季營運活動現金流為23億美元，較去年同期下降45%。此下降主要由於與佛羅里達Medicaid補充支付計畫相關的現金流時點差異，以及去年將聯邦所得稅付款遞延至2025年第四季所致。

Our debt to adjusted EBITDA leverage remains in the lower half of our stated target range, and we believe our balance sheet is strong and well positioned for the future. So with that, let me speak to our revised 2026 guidance ranges. Revenue between $77 billion and $79.5 billion, adjusted EBITDA between $15.4 billion and $16.1 billion. Net income attributable to HCA Healthcare between $6.3 billion and $6.7 billion. Diluted earnings per share between $28.70 and $30.50.

我們的債務對調整後EBITDA槓桿比率仍位於既定目標區間的下半部，我們認為資產負債表穩健，且已為未來做好良好布局。因此，接下來我說明我們修正後的2026年指引區間。營收介於770億至795億美元，調整後EBITDA介於154億至161億美元。歸屬於HCA Healthcare的淨利介於63億至67億美元。稀釋後每股盈餘介於28.70至30.50美元。

We also included revised key assumptions related to the expected unfavorable impact on adjusted EBITDA from payer mix shifts due to the health insurance exchange as well as anticipated incremental net benefit from Medicaid supplemental payment programs as follows. Health insurance exchanges between a negative $1 billion and $1.2 billion. Medicaid supplemental payment program net benefit between $300 million and $500 million. The variables on the exchanges are difficult to predict and require significant judgments.

我們也納入了修正後的關鍵假設，內容涉及因健康保險交易所導致的付款方組合轉移對調整後EBITDA的預期不利影響，以及來自Medicaid補充支付計畫的預期增量淨效益如下。健康保險交易所介於負10億至負12億美元。Medicaid補充支付計畫淨效益介於3億至5億美元。交易所相關變數難以預測，且需要做出重大判斷。

We have now revised our estimated impact to adjusted EBITDA based on the updated information through the first half of the year. Specifically, the key change in our updated estimate is driven by our evaluation that almost all of the individuals losing coverage on the exchanges of becoming uninsured versus our original assumption of 80% to 85%. In addition, our original assumption around declining utilization for patients that become unsure due to the loss of insurance coverage did not materialize.

我們已根據截至上半年更新的資訊，修正對調整後EBITDA影響的估計。具體而言，我們更新估計中的主要變動，來自我們評估幾乎所有在交易所失去保障的個人都轉為無保險，而非我們原先假設的80%至85%。此外，我們原先假設因失去保險保障而轉為無保險的病患其就醫使用量會下降，但並未發生。

Regarding Medicaid supplemental payment programs, our updated guidance implies a $100 million to $300 million headwind in the back half of the year. This second half headwind reflects program approvals and retro payments received in 2025, which are projected to exceed the incremental benefit of the Florida program.

就Medicaid補充支付計畫而言，我們更新後的指引意味著下半年將有1億至3億美元的逆風。此下半年逆風反映了在2025年取得的計畫核准與追溯付款，預計將超過佛羅里達計畫的增量效益。

As we think about the quarterly progression for the remainder of 2026, we believe the fourth quarter adjusted EBITDA growth rate compared to the prior year may be higher than for the third quarter. This is based on our assumptions around the timing effects of exchanges, Medicaid supplement payment programs and our resiliency growth. We are maintaining our stated CapEx range of $5 billion to $5.5 billion and currently plan to complete most of the existing authorized share repurchase program, subject to market conditions and other factors.

在思考2026年剩餘期間的季度走勢時，我們認為第四季相較去年同期的調整後EBITDA成長率可能高於第三季。這是基於我們對交易所、Medicaid補充支付計畫以及韌性成長的時點效應之假設。我們維持既定的資本支出區間50億至55億美元，並且目前計畫在視市場狀況及其他因素而定的前提下，完成現有已授權股份回購計畫的大部分。

I will now hand the call back to Frank Morgan for questions.

我現在把電話交回給Frank Morgan進行提問。

Thank you, Mike. As a reminder, please limit yourself to one question so we might give as many as possible in the queue an opportunity to ask a question. Abby, you may now give instructions to those who would like to ask a question.

謝謝你，Mike。提醒一下，請各位將問題限制為一題，以便讓隊列中盡可能多的人有機會提問。Abby，請你現在向想提問的人說明操作方式。

(Operator Instructions)

(接線員指示)

Ben Hendrix, RBC Capital Markets.

Ben Hendrix，RBC Capital Markets。

Thank you very much. Hoping you can give us a little more color on your increased estimate for exchange headwinds. What were those key variables that were informing the $1 billion to $1.2 billion estimate? And what's giving you confidence in the magnitude of that increase? And then also by extension, kind of how we think about that directionally as it paces through the back half of the year? Thanks.

非常感謝。希望你們能就你們提高對交易所逆風的估計提供更多說明。有哪些關鍵變數支撐了負10億到負12億美元的估計？你們對這個增幅的幅度有何信心來源？另外延伸來看，我們該如何從方向性角度理解它在下半年推進時的節奏？謝謝。

Thanks, Ben. This is Mike. If you think about first half of the year, we've gained a lot of experience and especially in the second quarter. And given that experience and understanding of the exchange is better, we've adjusted our estimates accordingly. If you go back to our original set of assumptions, the volume declines that we are seeing in first and second quarter on the exchanges, which are 15% in both first and second quarter, are in line with our original guidance estimates in terms of exchange volume decline.

謝謝，Ben。我是Mike。如果你看上半年，尤其是第二季，我們累積了很多經驗。基於這些經驗、對交易所的理解更深入後，我們相應調整了估計。回到我們原先的一組假設，我們在第一、第二季看到的交易所量下滑——兩季都是15%——在交易所量下滑幅度上與我們原先指引估計一致。

What's different as we have gone through second quarter is that we originally have seen that about 80% to 85% of the patients who lose exchange coverage would become uninsured. And our data is telling us now that it's closer to one-for-one. And so that's really the biggest driver of the updated estimate of the impact.

不同之處在於，隨著我們走過第二季，我們原先看到大約80%到85%失去交易所保障的病患會轉為無保險。而我們的數據現在告訴我們，這更接近一比一。因此，這確實是更新後影響估計的最大驅動因素。

When I think about kind of first half versus second half, first, we are providing a range. And so this $1 billion to $1.2 billion range that we're calculating for the first -- for the full year 2026 considers a variety of scenarios. But to come up with that estimate for second half, we're using what we've learned through the first six months of the year. And we've also stated our past attrition rates over the last several years. In addition, we have pulled, I'm sure just like all of you have, all the external data that we can with updates as we've gone through the year. So based on that, that is the driver of our full year guidance update.

當我思考上半年相較於下半年時，首先，我們提供的是一個區間。因此，我們為2026年全年所計算的10億至12億美元區間，涵蓋了多種情境。但要得出下半年的估計，我們是運用我們在今年前六個月所學到的資訊。我們也說明了過去幾年我們的歷史流失率。此外，我們也像各位一樣，盡可能蒐集所有外部資料，並在年度進行過程中持續更新。因此，基於上述因素，這就是我們更新全年指引的驅動因素。

I would note, though, as we look back to last year, we began to see some slowing exchanging volume in the fourth quarter of 2025. Historically, over many years, our exchange volume would typically peak in fourth quarter. But this was not the case last year. In hindsight, we now believe that the exchange reforms that actually started late last year started having an impact and specifically in fourth quarter.

不過我想指出，回顧去年，我們在2025年第四季開始看到交易所（exchange）投保量增速放緩。歷史上多年以來，我們的交易所投保量通常會在第四季達到高峰。但去年並非如此。事後回看，我們現在認為，實際上在去年年底啟動的交易所改革開始產生影響，尤其是在第四季。

I'll give you one example. The pausing of the low-income special enrollment period during 2025, we think now in hindsight have an impact. Our fourth quarter 2025 exchange volume growth to prior year was only 2.5%. The full year 2025 versus 2024 is over 10%. So that gives you a sense of it. So we do think when we think about second half of last year -- '26 compared to prior year, that fourth quarter had a bit of an easier comparison. So Ben, that's a wrap on the HICS assumptions and our second half guidance.

我舉一個例子。2025年期間暫停低收入特殊投保期（special enrollment period），我們現在事後認為確實造成了影響。我們2025年第四季交易所投保量相較前一年的成長只有2.5%。而2025年全年相較2024年則超過10%。這能讓你感受到差異。因此，當我們思考去年下半年——也就是'26相較前一年——第四季的比較基期確實稍微容易一些。所以，Ben，以上就是關於HICS假設與我們下半年指引的說明。

Thank you.

謝謝。

AJ Rice, UBS.

AJ Rice，瑞銀（UBS）。

Hi, everybody. Let me maybe just drill down a little bit on surgeries. That's been a topic of conversation this quarter across the board with companies. Your inpatient and outpatient surgeries were down. I wondered if you could go talk a little bit more about the types of surgeries that were impacted relative to service lines. Do you see this as being more elective procedures, postponable procedures that are being deferred and are you attributing this mainly to the HICS, this enrollment?

大家好。我想就手術部分再深入問一下。這一季各家公司都在討論這個話題。你們的住院與門診手術量都下滑。我想請你們多談談，哪些類型的手術、相對於各服務線（service lines），受到的影響較大。你們認為這比較像是選擇性手術、可延後的手術被推遲嗎？你們主要把這歸因於HICS、也就是這些投保人嗎？

And finally, on surgeries. Are you giving any allowance for people hitting deductibles as the year progresses and maybe doing those surgeries that have been postponed from the first half later this year?

最後還是關於手術。你們是否有考量到，隨著年度推進，民眾達到自付額（deductibles）後，可能會在今年稍晚把上半年延後的手術補做回來？

AJ, this is Sam. There's a lot of questions in there. I will see if I can sort through a condensed answer here. I think it's important to understand our surgical business. We have, on the inpatient side, two sources of channels, if you will, for surgery. We have the emergency room, which represents about two-thirds of our inpatient surgeries, trauma programs, cardiac events, general surgeries, you name it. That continues to grow. We've seen in '25 over '24, our emergent inpatient cases were up 2% year-over-year. And thus far, through the first six months of this year, that particular component of our surgical business is also up 2% year-over-year.

AJ，我是Sam。你這裡面有很多問題。我看看能不能整理出一個精簡的回答。我認為理解我們的手術業務很重要。在住院端，我們的手術來源大致可分為兩個管道。一個是急診室，約占我們住院手術的三分之二，包括創傷計畫、心臟事件、一般外科等等。這部分仍在成長。我們看到'25相較'24，緊急住院病例年增2%。而截至今年前六個月，這個手術業務組成同樣年增2%。

So that's a stable component of our surgical business, and we continue to invest heavily in our emergency room capacity in network offerings to enhance opportunities for patients to enter our system and get the care they need. That's number one. The other piece of our inpatient surgery is clearly elective, which represents about a third. And we are down this year more than we were last year. Last year, we were down on elective 2%. This year, we're down on elective 6%. We do believe that HICS demand which is a big piece of our elective declines on both inpatient and outpatient is a part of it.

因此，這是我們手術業務中相對穩定的一塊；我們也持續在急診容量與網路內（in-network）服務供給上大力投資，以提升病人進入我們體系並獲得所需照護的機會。這是第一點。住院手術的另一部分則明顯屬於選擇性手術，約占三分之一。而今年的下滑幅度比去年更大。去年選擇性手術下滑2%。今年選擇性手術下滑6%。我們確實認為，HICS需求是造成住院與門診選擇性手術下滑的重要因素之一。

So this discussion that Mike just referenced around HICS, it's cutting across all aspects of our business. We're seeing it in the ER with our payer mix there. We're seeing it in outpatient surgery from an elective standpoint and we're seeing it on the inpatient. On the outpatient, it's predominantly all elective, as you would expect, there are some cases that do migrate through the emergency room, but 9 out of 10 patients are roughly elective. Here again, HICS demand was a big piece of it, not the sole piece of it, but a big piece of it.

因此，Mike剛才提到的這段關於HICS的討論，正在影響我們業務的各個面向。我們在急診室的付款方組合（payer mix）上看得到。我們在門診手術的選擇性手術面向看得到，也在住院端看得到。在門診端，如你所預期，幾乎全部都是選擇性手術；確實有一些病例會經由急診轉入，但大約10位病人中有9位屬於選擇性。同樣地，HICS需求是其中很大的一部分——不是唯一因素，但確實是很大的一部分。

We do hear from our physicians that their activity flow is off a little bit this year. They're attributing it, as you would suspect, to sort of the general affordability and pressures that people are experiencing with the economy as a whole. It's hard for us to tease that apart, but that's the best feedback loop that we have.

我們也從醫師那裡聽到，他們今年的病人流量（activity flow）有些偏弱。他們的解讀如你所想，與整體經濟下民眾面臨的一般可負擔性與壓力有關。我們很難把這些因素完全拆開，但這是我們目前能得到的最佳回饋迴路。

And then I think there's just a handful of other things that are connected to it. Obviously, the Medicare inpatient rule change has had an impact, and we've seen some cases move from inpatient to outpatient. We do capture some of those and we lose some of those, as you would expect, because the outpatient surgery market is a little bit larger than the inpatient surgery market.

另外，我認為還有少數其他相關因素。顯然，Medicare住院規則的變更已造成影響，我們看到部分病例從住院轉到門診。如你所預期，我們會承接其中一部分，也會流失其中一部分，因為門診手術市場規模比住院手術市場稍大。

So those are some of the factors that we see. We have a response to this, as you would expect of us. We are investing in our ORs to make sure they have the equipment that they need. We're optimizing our operations so that the patient and the physician has the flow and efficiency that they require. And then we're aligning with our physicians where it makes sense to ensure that they have a connection to our network.

以上是我們看到的一些因素。如你所預期，我們也有相應的因應措施。我們正在投資手術室（OR），確保它們具備所需設備。我們也在優化營運，讓病人與醫師能有他們所需要的流程與效率。此外，在合適之處，我們也會與醫師進行對齊合作，確保他們與我們的醫療網路保持連結。

With our ASC business, our ASC division actually had earnings growth over the first six months of this year. We have roughly the same number of facilities in that division. And for both surgery and what we consider non-surgical cases like endoscopies, colonoscopy, lithotripsy pain, our overall volume in our surgery center due to more units is up slightly year-over-year, but the acuity of those cases is growing.

就我們的ASC業務而言，我們的ASC事業部在今年前六個月其實有獲利成長。該事業部的設施數量大致與之前相同。無論是手術，或我們認為的非手術病例（例如內視鏡、結腸鏡、碎石術、疼痛治療），由於單位數增加，我們手術中心的整體量年增小幅上升，但這些病例的嚴重度（acuity）正在提高。

So we continue to add to that network also, as you would expect, so that we have multiple offerings for our patients, multiple offerings for our physicians and making our network more resilient with additional capacity. So we're obviously sorting this out, and we think that we're in a good position competitively. And we'll have to see, AJ, as we move through the balance of the year whether or not we see a recovery from some of the early indicators that we've seen in the first six months.

因此，如你所預期，我們也持續擴增該網路，讓病人有多元選擇、醫師也有多元選擇，並透過增加產能使我們的網路更具韌性。所以我們顯然正在釐清並處理這些狀況，我們也認為在競爭上處於良好位置。AJ，接下來要看在今年剩餘期間，我們是否會從前六個月看到的一些早期指標中出現回升。

Okay, thanks so much. That was great.

好的，非常感謝。講得很棒。

Ann Hynes, Mizuho Securities.

Ann Hynes，瑞穗證券（Mizuho Securities）。

Great. Thank you. Just a follow-on to that question. And I think in your prepared remarks, you said you'll be investing $7 billion over three years. And is that more offensive and defensive, just almost as a response to your last question that maybe there's an acceleration of like a shift from inpatient to outpatient because some of the CMS regulatory changes?

很好。謝謝。我想就那個問題再追問一下。而且我記得在你們事先準備的發言中，你提到三年內將投資70億美元。這筆投資是偏向進攻性還是防禦性？也就是說，是否幾乎是在回應你剛才最後一個問題：由於CMS的一些監管變更，住院轉向門診的趨勢可能正在加速？

And can you just talk about the competitive environment? Do you think you're still gaining market share? And where do you see the biggest opportunities to gain market share over the next couple of years? And just given some of the markets that are under pressure, I'm assuming your not-profit peers are also under pressure. And are you seeing any change in behavior when it comes to their investments competitively? Thanks.

另外，你能談談競爭環境嗎？你認為你們仍在提升市占率嗎？未來幾年你們認為最大的市占率提升機會在哪裡？再者，考量到部分市場正承受壓力，我猜你們的非營利同業也同樣承壓。在競爭性投資方面，你們是否看到他們的行為有任何改變？謝謝。

Okay, Ann. Thank you. This is Sam. Let me see if I can pull all that together and respond to your questions there. If you look at our company over the past, let's just say, five or six years with our capital spending, we have added to our inpatient chassis.

好的，Ann。謝謝。我是Sam。我看看能不能把這些整合起來，回覆你的問題。如果你回顧我們公司過去大概五、六年的資本支出，我們已經擴增了住院端的基礎量體。

Just to give you some numbers on that, we had roughly 37,000 beds at the end of 2018 operation -- in operations. We have 42,000 today. Our occupancy level since that time, it's grown from 71% to 75%. So in addition to adding roughly 15% inpatient capacity to our company, our utilization of that capacity has grown by 5 points.

給你一些數字：2018年底我們大約有37,000張病床在營運中——現在我們有42,000張。自那時起，我們的住院床位使用率從71%提升到75%。所以，除了我們為公司增加了約15%的住院容量之外，該容量的使用率也提高了5個百分點。

Within our $7 billion that I referenced earlier, we do have another 1,000 to 1,200 inpatient beds that we're adding. But in addition to that, we are also adding to our outpatient network. In the second quarter of 2026, as compared to the second quarter of 2025, we had 5% more sites of care than we did last year. And that's roughly 250 or so, if I remember correctly. In our pipeline, we have another 250 to 300 outpatient facilities either in our capital plan or in our acquisition plans that will come online, we believe, sometime later this year and early next year. So that will add roughly 10% to our overall network capacity, more units on the outpatient, as you would suspect.

在我先前提到的70億美元之中，我們確實還會新增約1,000到1,200張住院病床。但除此之外，我們也在擴充門診網絡。以2026年第二季相較於2025年第二季，我們的照護據點數比去年多了5%。如果我沒記錯，大約增加了250個左右。在我們的開發管線中，還有另外250到300家門診機構，已納入資本計畫或併購計畫，我們相信會在今年稍晚及明年初陸續啟用。因此，這將使我們整體網絡容量大約再增加10%，而新增的單位主要會在門診端，這也符合你的預期。

The $7 billion includes components for all of that. It includes new beds, actually new hospitals, in some cases, a number of outpatient facilities, some of which I just referenced. And all of that goes to help us compete. We are losing no competitive positioning. We have judged through our midyear reviews, through our market share analytics that our competitive positioning is stable to growing net-net.

這70億美元包含上述所有項目的組成。其中包括新增病床，某些情況下也包括新建醫院，以及我剛提到的一些門診設施。這些投資都是為了幫助我們競爭。我們的競爭地位沒有任何流失。透過年中檢視與市占率分析，我們判斷整體而言，我們的競爭地位是穩定到淨增長。

Yeah, there may be a market or two here that has had a competitor to do something that we have to now respond to. But that's fluid and dynamic always. And our touch points with our markets allow us to make adjustments, invest in initiatives to respond to those dynamics.

是的，可能有一兩個市場，競爭對手做了某些動作，我們現在需要回應。但這一直都是流動且動態的。而我們與各市場的接觸點，讓我們能夠做出調整，投資相關措施來回應這些動態變化。

And so we do believe we're gaining market share in many of our markets, some are flat and some are modestly down. That is a normal course for us. But overall, we feel good about our programs that are necessary to extend our networks and create convenience and more offerings for our patients. And then the investment back in our hospital-centric components of our facilities, increasing capacity, increasing technology offerings for our physicians and patients and then creating the kind of availability so that patients can get into the system, it's positive because we see, again, demand growing. And our job, given our position in these communities, is to meet that demand.

因此，我們確實相信在許多市場正在提升市占率；有些市場持平，有些則小幅下滑。這對我們而言是正常的情況。但整體來說，我們對於延伸網絡、提升便利性並為病患提供更多服務選項所需的各項計畫感到樂觀。此外，回投資到以醫院為核心的設施組成，包括擴增容量、提升提供給醫師與病患的科技能力，並打造讓病患能進入體系的可近性——這些都是正向的，因為我們再次看到需求正在成長。而以我們在這些社區中的角色而言，我們的工作就是滿足這些需求。

Let me make this last comment on our markets because I think this is a very important component, and we shared it with our Board with our midyear review just this week. The demographic trends that we see in HCA markets, we believe are as positive or more positive than they were during the COVID migration that we saw to the southeastern and southwestern parts of the country.

我想就我們的市場再補充最後一點，因為我認為這非常重要；我們也在本週的年中檢視中向董事會分享了。我們在HCA市場看到的人口結構趨勢，我們認為其正向程度不亞於、甚至更勝於COVID期間我們看到人口移入美國東南部與西南部的那波遷徙。

Through our study, through our understanding of other people's studies, we believe those trends are going to be supportive to the overall growth that we expect in HCA's markets, Florida, Texas, Utah, Nevada, South Carolina, Georgia, Tennessee, all of these states are targeted for growth that we think is going to support these investments, provide for more health care demand and create great opportunity for HCA to grow.

透過我們的研究，以及對其他研究的理解，我們相信這些趨勢將支持我們對HCA市場整體成長的預期：佛羅里達、德州、猶他、內華達、南卡羅來納、喬治亞、田納西——這些州都被我們視為成長重點，我們認為這將支撐這些投資、帶來更多醫療照護需求，並為HCA成長創造極佳機會。

Brian Tanquilut, Jefferies.

Brian Tanquilut，Jefferies。

Hey, good morning, guys. Maybe, Mike, as I look at the P&L, shifting gears to the cost side a little bit. The other OpEx line was up a decent bit. And I'm guessing now that's primarily tech. But if you can just walk us through other moving pieces potentially there. And pulling to a broader view, just curious how you're thinking about the resiliency programs. Obviously, HICS was a surprise. So any other incremental offsets that we can be thinking about maybe as we even think through 2027 and beyond? Thank you.

各位早安。Mike，也許我從損益表來看，稍微把焦點轉到成本端。其他營運費用（other OpEx）那一行上升得不少。我猜現在主要是科技相關。但你能否帶我們了解一下那裡可能還有哪些其他變動因素？再拉高到更宏觀的角度，我也想了解你們如何看待韌性（resiliency）計畫。顯然HICS是一個意外。那麼，是否還有其他可望的增量抵銷項目，讓我們在思考2027年及更長期時可以納入考量？謝謝。

Yeah. Brian, thank you. As I mentioned in my prepared comments, when you kind of consider labor. And you're right. I mean our other operating expenses are being inflated because of the provider tax associated with our way of benefit for sure. If I pull up and just look at our total cash, total cost per adjusted addition to prior year in the quarter -- the second quarter and think about that, and that would be SWB supplies and other operating expenses combined, Brian.

好的。Brian，謝謝。如我在事先準備的評論中提到，當你把人力成本納入考量時——你說得沒錯。我們的其他營運費用確實因為與我們SWB相關的提供者稅（provider tax）而被推高。如果我把視角拉高，只看本季（第二季）相較去年，我們每單位調整後增加量（adjusted addition）的總現金、總成本——也就是把SWB、耗材與其他營運費用合併來看，Brian。

When I look at that compared to prior year, we're only up about kind of, call it, flat, just slightly up over the prior year. That really reflects really good work in second quarter related to our resilience plan. As Sam noted in his comments and as I reinforced in mine, resiliency is really core to the business, and it's something we've been working on for a long time. You'll remember that we've highlighted this in our Investor Day back in 2023. And resiliency has been in the company's results going back to the pandemic.

我把它跟去年相比，其實只上升了大約——可以說幾乎持平，只是略高於去年。這反映出我們在第二季針對韌性計畫做得非常到位。正如Sam在他的評論中提到、我也在我的發言中強調的，韌性是業務的核心，我們已經投入很長一段時間。你會記得我們在2023年的投資人日曾特別強調這點。而韌性也一直反映在公司的經營成果中，從疫情期間就開始了。

As we look at all of the work in flight with resiliency, the gaining maturity of these programs, we're confident that we're going to be able to bend the cost curve and bend the cost curve, improving our cost trends, if you will, in the second half of the year and into 2027.

當我們檢視所有正在進行中的韌性工作、以及這些計畫日益成熟的程度時，我們有信心能夠讓成本曲線下彎——也就是說，在今年下半年以及進入2027年時，改善我們的成本趨勢。

And then from the next generation of that work, when you think about digital transformation, building global capabilities and all the work we're doing to expand shared services, we believe this will produce multiyear benefits for the company as we go out in time. The only other thing I would mention to your question, if I think about kind of other operating expenses would be potentially professional fees that are in other operating expenses. They're up about 8.5% on a same facility basis to prior year, which has moderated and is pretty flat sequentially to first quarter. And so we're pleased with that work. It's still a little elevated from our other cost trends, but we believe we made progress here in terms of our professional fees.

接著，從下一代的工作來看，當你想到數位轉型、建立全球能力，以及我們為擴大共享服務所做的所有工作，我們相信這些將在未來多年為公司帶來效益。另外針對你提到的問題，我還想補充：其他營運費用中可能包含專業服務費（professional fees）。在同院（same facility）基礎上，專業服務費相較去年約增加8.5%，但增幅已趨緩，且相較第一季的序列變化幾乎持平。因此我們對這方面的進展感到滿意。它仍比我們其他成本趨勢略高一些，但我們相信在專業服務費方面已取得進展。

Yeah. And Mike, let me add to that for 1 minute. I've been with the company for 43 years, and I've seen our approach to our business grow when it comes to complexity of services that we offer, whether that's trauma, bone marrow, solid organ transplant, whatever the case may be.

是的。Mike，讓我再補充 1 分鐘。我在公司已經 43 年了，我看到我們在業務上的做法，隨著我們提供的服務複雜度提升而成長，不論是創傷、骨髓移植、實體器官移植，或其他任何情況。

If I juxtapose our resiliency program against sort of our service components and how complex and sophisticated our services are in our hospitals, that's exactly where we are with our financial resiliency program. We are getting more sophisticated. We're getting more sort of capabilities to execute on this piece of the agenda. And this has been an opportunity for us for years. We just didn't have the tools to get after it.

如果我把我們的韌性計畫，拿來對照我們在醫院的服務構成，以及服務有多複雜、多精密，那正是我們財務韌性計畫目前所處的位置。我們正變得更成熟。我們在執行這項議程上，正具備更多能力。而這對我們來說多年來一直是個機會。只是我們過去沒有工具可以把它做好。

And the tools and capacity that Mike just alluded to reminds me of where our networks were maybe seven or eight years ago, where we didn't have a full array of services or we didn't have the outpatient capabilities that we needed to build out a network.

而 Mike 剛剛提到的工具與產能，讓我想起大概七、八年前我們的網路布局，當時我們沒有完整的服務組合，或是沒有建立網路所需的門診能力。

Well, today, with our resiliency agenda, we have these additional components, technology, digital, global, capabilities corporately to support all that. That's why we think this particular program has durability and capability to add value for the company as we push into the future.

但今天，隨著我們的韌性議程，我們有了這些額外的組成要素——科技、數位、全球化，以及公司層面的能力來支援所有這些。這也是為什麼我們認為這個計畫具備持久性，並且在我們邁向未來時，有能力為公司創造價值。

Pito Chickering, Deutsche Bank.

Pito Chickering，德意志銀行。

Hey. Good morning, guys and thanks for taking my questions. Looking at 2Q core EBITDA, excluding DPP and HICS, can you help bridge us how you get to your guidance in the back half of the year, specifically can you call out any changes to assumptions on the top line like surgeries or payer mix? And on the bottom line, can you call out any savings initiatives that are coming online and details around those initiatives.

嗨。各位早安，謝謝讓我提問。看 2Q 核心 EBITDA（排除 DPP 與 HICS），你們能否協助我們銜接一下，下半年如何達到你們的指引？具體來說，能否說明在營收端（例如手術量或付款方組合）假設是否有任何變動？以及在成本端，能否點出有哪些節省成本的措施將開始上線，並提供這些措施的細節。

Sure. Hey, Pito, this is Mike. First, just a couple of background statements. One, we do have a range. So it's always important to note that when we gave our updated full year guidance, we gave a range to ensure that it contemplates a variety of scenarios. And then inherent in your question, we do think about in the second half of the year the assumptions that we're making related to health insurance exchanges and the incremental net benefit from the Medicaid supplemental payment programs.

當然。嗨，Pito，我是 Mike。先講幾點背景。第一，我們的指引是區間。所以要特別注意，當我們更新全年指引時，我們提供的是一個區間，以確保涵蓋各種情境。另外，你的問題也隱含了我們對下半年所做的假設：與健保交易所相關的假設，以及來自 Medicaid 補充支付計畫的增量淨效益。

When we think about the rest of the business, what I really think about is three drivers that give us confidence here in our guidance for the back half of the year. The first one is really volume. And our second quarter results profile, solid volume growth, particularly in our insured population, excluding exchanges. And we do believe that, that demand momentum will continue through the balance of the year.

當我們看其餘業務時，我主要想到三個驅動因素，讓我們對下半年指引有信心。第一是量（volume）。我們第二季的結果顯示量的成長很穩健，尤其是在已投保族群（不含交易所）方面。我們也相信這股需求動能會延續到今年剩餘時間。

The second is our costs. And you know that, that it's clear in second quarter, we have really good performance in our cost trends. From what we're seeing in our resiliency plan and the visibility into the execution of that plan and as well, if you think about the operating leverage that we generated in second quarter from volume growth that we believe continues, we are confident that we'll be able to improve our cost trends in the back half of the year and into 2027 as well.

第二是成本。你也知道，第二季我們在成本趨勢上表現非常好，這點很清楚。從我們看到的韌性計畫、以及對該計畫執行的可視性來看；再加上你若思考第二季因量成長所帶來、且我們相信會持續的營運槓桿，我們有信心在下半年、以及到 2027 年，都能改善成本趨勢。

And then lastly, I think it's important to say that we have an excellent management team in the field and in corporate, and our management team has demonstrated through many past challenging cycles the ability to handle challenges and exceed and thrive during environments like that and like the one we're in now. And so I'm confident that as we kind of go through the year, our management team (inaudible)

最後，我認為也很重要的一點是，我們在前線與公司端都有非常優秀的管理團隊；而我們的管理團隊在過去多次充滿挑戰的週期中，已證明有能力應對挑戰，並在那樣的環境、以及我們現在所處的環境中超越並茁壯。因此我有信心，當我們一路走過今年，我們的管理團隊(聽不清楚)

Abby?

Abby？

My apologies, I wasn't sure if the line had cut out.

抱歉，我不確定線路是不是斷了。

Matthew Gillmor, KeyBanc.

Matthew Gillmor，KeyBanc。

Hey. Thanks for the question. Just circling back on the exchange headwind discussion. You had mentioned that three divisions represented 50% of the impact. Can you give some context in terms of either the geographies or just the commonalities in terms of those divisions and why they're seeing a bigger impact.

嗨。謝謝讓我提問。我想回到剛才關於交易所逆風的討論。你提到有三個事業部占了 50% 的影響。你能否提供一些背景，例如地理區域，或這些事業部之間的共通點，以及為什麼它們受到的影響更大？

Yes. This is Sam Hazen. We are -- we have three divisions, our Gulf Coast division, North Florida and South Atlantic division are the three that had a lot of HICS exposure going into the year, and they've had dramatic impacts from the HICS exchange volume shift. Their composite adjusted admission decline in HICS, it's somewhere between 25% and 28% for the first half of the year, and that has obviously created a lot of pressure. We didn't expect it to be that much in those markets and the teams have tried to adapt to it. As you would expect, as best they possibly can, but that's a fairly sizable impact.

可以。我是 Sam Hazen。我們有三個事業部——墨西哥灣沿岸事業部（Gulf Coast）、北佛羅里達（North Florida）以及南大西洋事業部（South Atlantic）——在今年一開始就有較多 HICS 曝險，而它們也因 HICS 交易所量的轉移而受到劇烈影響。它們在 HICS 的合併調整後入院量下滑，上半年大約在 25% 到 28% 之間，這顯然造成很大壓力。我們原本沒預期這些市場會這麼大幅度，團隊也一直嘗試去適應。如你所料，他們已盡其所能，但這確實是相當可觀的影響。

So it has had an outsized effect on the company. Obviously, we're all in on all of our divisions. And typically, we have a more balanced performance across the company. But in this instance, it's been a bit imbalanced with those three situations. And so we're reacting to it appropriately.

因此它對公司造成了不成比例的影響。當然，我們對所有事業部都全力以赴。而通常我們在公司各事業部之間的表現會更均衡。但在這個情況下，因為這三個狀況而顯得有些不均衡。所以我們也在做出適當的因應。

In two of the three divisions, actually, we have more volume than we did in the previous year in total. But again, the payer mix in those divisions have been compromised by the expiration of the enhanced premium tax credits, and that's produced a significant move from HICS to uninsured in those markets.

其實在這三個事業部中的兩個，我們的總量比前一年還高。但同樣地，因為加強版保費稅額抵免（enhanced premium tax credits）到期，這些事業部的付款方組合受到影響，導致這些市場出現從 HICS 轉向無保險（uninsured）的顯著變化。

Got it. Thanks.

了解。謝謝。

Whit Mayo, Leerink Partners.

Whit Mayo，Leerink Partners。

Hey, good morning. Mike, I just wanted to get an update on the internal views on work requirements for 2027. Just any thoughts on potential coverage leakage or headwinds or just general thoughts would be helpful. Thanks,

嗨，早安。Mike，我想了解一下你們對 2027 年工作要求（work requirements）的內部看法更新。任何關於可能的保障流失、逆風，或一般性的想法都會很有幫助。謝謝，

Sure. Hey, Whit. Obviously, there's a proposed rule out for Medicaid work requirements. Just a couple of notes. One, we believe work requirements will have an impact in non-expansion states (inaudible) I'm sorry. That will have an impact in expansion states way more than non-expansion states because of this focus on working adults. As a reminder, all of our Medicaid revenues, about 40% of our Medicaid revenues are in expansion state, and 60% are not.

當然。嗨，Whit。顯然目前有一項關於 Medicaid 工作要求的擬議規則。我補充幾點。第一，我們認為工作要求會在非擴張州（inaudible）抱歉。它對擴張州的影響會遠大於非擴張州，因為重點放在有工作的成年人。提醒一下，我們所有 Medicaid 收入中，大約 40% 來自擴張州，60% 不是。

We are monitoring this proposed rule, as you can imagine. And we're going to have to see how it plays out. I mean it's -- there are some litigation and legal challenges around the way that CMS is implementing the work requirements. We'll have to see how they move through the system. And we're also monitoring how the states implement these plans.

如你所想，我們正在監控這項擬議規則。我們必須看看它會如何發展。我的意思是，圍繞 CMS 推動工作要求的方式，存在一些訴訟與法律挑戰。我們得觀察它們如何在體系中推進。同時我們也在關注各州如何落實這些計畫。

Most of these, if not all of these expansion states, tend to be a little bit more blue, a little bit more democratic. And we are working with those states to make sure and try to support the notion of a good supportive approach towards implementing work requirements within the [bounds of the] rule, of course.

這些擴張州大多（如果不是全部）政治光譜上偏藍、偏民主黨一些。我們正與這些州合作，確保並嘗試支持在（當然是在規則的[範圍內]）推動工作要求時，採取良好且具支持性的做法。

And so our Parallon teams are also getting really worried. [Last year] I think about the coverage benefit support teams that we have embedded in all of our facilities in these states and the work that they do with patients to help them work through the Medicaid application process and help them work through the work requirements process. And so we beefed up those teams with -- and we are preparing as best we can.

因此，我們的 Parallon 團隊也開始非常擔心。[去年]我想到我們在這些州的所有院所都配置了保險給付覆蓋/福利支援團隊，以及他們與病患合作所做的工作，協助他們完成 Medicaid 申請流程，並協助他們處理工作要求流程。因此我們也擴編了這些團隊——並且正盡我們所能做好準備。

I will say, when I just think about the distribution of our assets between the expansion and non-expansion states and the work that we're doing to prepare, we still think that on balance, while Medicaid work requirements are going to have an impact, we believe, we do believe we are going to manage through those in a reasonable way.

我想說的是，當我只看我們在擴張州與非擴張州之間的資產分布，以及我們為此所做的準備工作，我們仍然認為整體而言，雖然 Medicaid 的工作要求會帶來影響，但我們相信——我們確實相信——我們將能以合理的方式加以因應。

Great. Thanks.

很好。謝謝。

Justin Lake, Wolfe Research.

Wolfe Research 的 Justin Lake。

Thanks, good morning. Sam, really helpful on the surgeries. You gave us six-month numbers for the inpatient coming through the ER and the electives, the down 2% and the down 6%. Maybe you can give us first quarter versus second quarter and just how things were running through the second quarter? And then can you guys also run us the volume growth by payer and hopefully give us commercial employers separately from exchanges? Thanks a lot.

謝謝，早安。Sam，關於手術的說明非常有幫助。你給了我們六個月的數據：經由急診入院的住院病例，以及選擇性手術，分別是下降 2% 與下降 6%。也許你可以提供第一季對比第二季，以及第二季的走勢如何？另外你們也能否提供按付款方（payer）的量增長，並希望能把商業雇主保險與交易所（exchanges）分開列示？非常感謝。

Yeah. I don't have a different explanation for the second quarter versus the year-to-date. I think it's hard sometimes in short cycles to make judgments about demand, and 90 days is a short cycle. So I think from that standpoint, I don't think the explanation varies much from quarter-to-quarter. And so a midyear review, I think, is a more relevant perspective on that. So I don't really have anything to add additionally to the commentary on surgeries.

好的。我對第二季相較年初至今沒有不同的解釋。我認為在短週期下，有時很難對需求做判斷，而 90 天就是一個短週期。因此從這個角度看，我不認為解釋在各季之間有太大差異。所以我認為年中檢視是更相關的觀點。因此關於手術，我沒有額外補充。

And then Justin, if I look at same facility equivalent admissions in the second quarter of 2026 compared to prior year. All-in Medicare is up 3.6%, Medicaid is up 2.7%. Commercial, excluding the exchanges are up 2.4%. The exchanges are down 15% and the total uninsured is up 15%. I would note the total unassured equivalent admissions now represents about -- a little over 10% of our total equivalent admissions and the exchanges now represent about 6.8% of our total equivalent admissions.

另外 Justin，如果我看 2026 年第二季同院所（same facility）的等值入院（equivalent admissions）相較去年同期。整體來看，Medicare 上升 3.6%，Medicaid 上升 2.7%。商業保險（不含交易所）上升 2.4%。交易所下降 15%，而未投保合計上升 15%。我會補充，未投保的等值入院目前約占——略高於我們總等值入院的 10%，而交易所目前約占我們總等值入院的 6.8%。

If you look at the payer mix, Mike, of the company on the inpatient side, this year versus last year. It's almost identical by payer class. And then when you put health insurance exchanges and uninsured together, and this is why we conclude that there's a bit of a one for one, it's the same number. And so that's what's happened here is our payer mix is actually the same in Medicare as it was last year. Medicaid, as it was last year.

Mike，如果你看公司住院端的付款方組合（payer mix），今年相較去年。按付款方類別幾乎完全相同。然後當你把健康保險交易所與未投保合併來看——這也是我們得出「一換一」結論的原因——數量是相同的。因此這裡發生的情況是，我們的付款方組合在 Medicare 上其實與去年相同。Medicaid 也與去年相同。

Managed care and other, as it was last year. And then HICS and self-pay uninsured together are exactly as they were last year. And so our conclusion on one for one is reinforced, we believe, by that sort of fact. And for us, obviously, it's not a good thing. We still have to take care of these patients, and we do, and our people do a wonderful job, but it does put pressure on the P&L.

管理式照護（managed care）及其他，也與去年相同。然後 HICS 與自付未投保（self-pay uninsured）合併後，與去年完全一致。因此我們認為，這類事實進一步強化了我們對「一換一」的結論。而對我們而言，顯然這不是好事。我們仍必須照顧這些病患，我們也確實如此，我們的同仁做得非常出色，但這確實會對損益表（P&L）造成壓力。

Sam, to that point. Another way we've looked at this, and this again seeing year-to-date same facility compared to prior year. Our health care exchange equivalent admissions are down about 22,000 and our uninsured equipment admissions are up about 26,500. And so we get the one-for-one migration from the exchanges. And then with the uninsured, we also, on top of that, have a little bit of this Medicaid conversion slowdown in Texas. And so to Sam's point, that is the payer mix dynamic we're doing.

Sam，針對你剛剛那點。我們另外一種看法是——同樣是看年初至今同院所相較去年同期。我們的醫療保險交易所等值入院約減少 22,000，而未投保等值入院約增加 26,500。因此我們看到從交易所出現「一換一」的移轉。此外，在未投保方面，除了這個之外，我們在德州也看到 Medicaid 轉換（conversion）放緩的一點影響。因此如 Sam 所說，這就是我們正在面對的付款方組合動態。

And to put that into context, those 20,000-some patients, Mike, that you referenced. We took care of about 1.1 million people. And so the implications for the company are really hinging on those 22,000 patients. It is what it is. We understand that.

為了把它放在脈絡中，Mike，你提到的那兩萬多名病患。我們照護了大約 110 萬人。因此公司層面的影響其實很大程度取決於那 22,000 名病患。情況就是如此。我們理解。

But you've got to appreciate the context here in the backdrop of 1.1 million adjusted admissions and 22,000 or whatever that number was we gave represents about 2% of that. And that movement, it's had obviously a disproportionate effect and we're responding to it as well as we can.

但你必須理解其背景脈絡：在 110 萬調整後入院（adjusted admissions）之下，22,000 或我們提到的那個數字大約占 2%。而這樣的移動顯然造成了不成比例的影響，我們也正盡可能妥善回應。

Stephen Baxter, Wells Fargo.

Wells Fargo 的 Stephen Baxter。

Hi, thanks. I think in the past, you discussed an expectation that the moderation of exchange coverage and volumes could take place over a couple of years rather than all of it occurring in 2026. I guess, based on what you observed this year in the larger headwind that you faced, do you still think that's a reasonable planning assumption? Do you think there's any change to the way that the dynamics around coverage transitions and volume (inaudible) could look versus this year? Thank you.

嗨，謝謝。我記得過去你們曾討論過一個預期：交易所保險覆蓋與量的降溫，可能會在幾年內逐步發生，而不是在 2026 年一次發生。我想問，基於你們今年觀察到的情況，以及你們面臨更大的逆風，你們仍認為這是合理的規劃假設嗎？你們是否認為，關於覆蓋轉換與量（聽不清）周邊的動態，相較今年可能會有任何改變？謝謝。

So as we think about attrition rates for the exchanges in 2027, we believe it's reasonable to estimate at this point, even with premium increases that we're starting to see that the loss of coverage will be less than 2026. This estimation assumes the core premium tax credits, which are central to the original Affordable Care Act will continue with no new enhanced premium support.

因此，當我們思考 2027 年交易所的流失率（attrition rates）時，我們認為在目前這個時間點，即便我們開始看到保費上調，估計失去覆蓋的人數仍會少於 2026 年，這是合理的。此估計假設《平價醫療法案》（Affordable Care Act）原始架構中的核心保費稅額抵免（premium tax credits）將會延續，且不會新增加強版的保費補助。

Clearly, there are other factors from both a policy and a market standpoint that could change our thinking, but at this particular point in time, that's where we are. We, again, believe most of the attrition this year is directly attributable to patients who were benefiting from the enhanced premium tax credits. Now that those have gone away, we think we'll be in a normal course as we push into 2027.

顯然，從政策與市場角度還有其他因素可能改變我們的看法，但就目前這個時間點而言，我們的立場就是如此。我們再次認為，今年大部分的流失可直接歸因於先前受惠於加強版保費稅額抵免的病患。現在那些已經取消，我們認為在邁向 2027 年時將回到正常軌道。

Andrew Mok, Barclays.

Barclays 的 Andrew Mok。

Hi, good morning. Can you clarify how many quarters' worth of Florida DPP were recognized in the quarter itself and also clarify whether the retroactive sort of payments that offset the benefit in 2Q were included in initial guidance? And relatedly, can you share what line of sight you have into the approval of Florida for fiscal year '26 given the decision to recognize it in 2Q results? Thanks.

嗨，早安。你能否釐清本季本身認列了多少季的佛州 DPP，並且也釐清用來抵銷第二季效益的追溯性（retroactive）款項是否已包含在最初的指引（initial guidance）中？另外相關地，既然你們選擇在第二季結果中認列，你們對佛州 2026 財年的核准（approval）有多少能見度（line of sight）？謝謝。

Sure. So the (inaudible) context here in the quarter, we recognized $400 million of incremental net benefit from state supplementation in the second quarter. That included $540 million incremental net benefit related to the recently improved Florida [perk] And the time period that's October 1 of 2024 to June 30, 2026. So that's 21 months worth of benefit booked into the second quarter.

當然。所以就本季的（聽不清）背景而言，我們在第二季認列了來自州補助（state supplementation）的 4 億美元增量淨效益（incremental net benefit）。其中包含 5.4 億美元的增量淨效益，與近期改善的佛州 [perk] 有關，期間為 2024 年 10 月 1 日至 2026 年 6 月 30 日。因此這是 21 個月的效益一次入帳到第二季。

Now in the second quarter, that Florida benefit got a little bit netted down because there were some retro payments in the prior year of second quarter of 2025. If I just think about Florida specifically, the other -- I'd make maybe two other notes here. The new year that we have an accrual on clearly is the time period of October 1, 2025, through June 30, 2026. And we did accrue benefit into that. Given that the Florida program is a long-standing program, this approval is an enhancement to that program.

現在在第二季，佛羅里達州的那項利益因為2025年第二季前一年有一些追溯性付款而被部分抵銷。如果我只針對佛羅里達州來看，另外——我可能在這裡再補充兩點。我們明確計提的這個新年度期間是2025年10月1日至2026年6月30日。而我們也已將利益計入該期間的應計。鑑於佛羅里達州計畫是一項長期既有的計畫，這次核准是對該計畫的強化。

Given that the program was approved for state fiscal year 2025 and the state recently submitted the fiscal year 2026 program for preapproval, we feel comfortable going ahead and making that accrual. And then just as a note, as we kind of gone through July, we are receiving cash against that approval and feel good about the status of that. Obviously, our guidance also implies that we booked an accrual for the fourth quarter of 2026 as well as part of our overall guidance for the year on the way.

鑑於該計畫已獲核准適用於州財政年度2025，且州政府近期也已提交財政年度2026的計畫以供預先核准，我們對於先行進行該項應計感到有把握。另外補充一下，隨著我們進入7月，我們正收到與該核准相對應的現金款項，對其狀態也感到良好。當然，我們的指引也意味著，我們在2026年第四季也已入帳一筆應計，作為我們全年整體指引的一部分。

Ryan Langston, TD Cowen.

Ryan Langston，TD Cowen。

Great, thanks. Sorry if I missed it. Hoping you could give us the monthly cadence of surgical and non-surgical volumes in the second quarter. And looking -- or appreciate any thoughts on the proposed OPPS rule for '27 appears to be a nice tailwind for HCA and for profits in general, if it holds in the final rate. Just curious how you view the proposal. Thank you.

很好，謝謝。如果我漏聽了很抱歉。希望你們能提供第二季手術與非手術量的每月節奏。另外——也想聽聽你們對於擬議的2027年OPPS規則的看法；如果最終費率維持不變，這看起來會對HCA以及整體利潤形成不錯的順風。想請教你們如何看待這項提案。謝謝。

We don't comment about mid-quarter progression. So I'll pause on that. I will mention the proposed rule. I think about both the inpatient and the outpatient rules that have been recently proposed. We are generally pleased with the proposed payment updates in the aggregate. So generally pleased, especially on the outpatient rules to your point. But even in aggregate, we think they're [positive] Now obviously, we've got to get in for a proposed file. So that's what we're waiting for.

我們不評論季度中段的進展。所以這部分我先不談。我會提一下這個擬議規則。我會同時看待近期提出的住院與門診規則。整體而言，我們對擬議的支付更新感到滿意。所以整體上是滿意的，尤其如你所說在門診規則方面。但即便就整體而言，我們也認為它們是[正面]的。當然，我們還得等到擬議檔案出來。所以我們正在等待那個。

I mean it's difficult with the month-by-month because of business day alignment, and it sort of skews a comparison and you have to normalize for that. That's why I think, again, you need some longer runs to really judge what's going on as you push through the different month-to-month, and that's why it doesn't really make sense, we believe, to give you sort of an indication on the second quarter because there were different movements, and I don't think we have it in here.

我的意思是，逐月來看很困難，因為營業日對齊的問題會讓比較產生偏差，你必須把這些因素標準化。所以我認為，再次強調，你需要更長的期間序列，才能真正判斷在不同月份推進時到底發生了什麼；也因此我們認為，提供你第二季的某種指示其實沒有太大意義，因為其中有不同的變動，而且我不認為我們在這裡有把它放進來。

Okay, thank you.

好的，謝謝。

Scott Fidel, Goldman Sachs.

Scott Fidel，高盛。

Thanks. Good morning. Sam, I would be definitely interested if you wanted to provide, from HCA's perspective, the view on this very quickly sort of hyperscaling dynamic around the IDR claims from the No Surprises Act, and the payers are talking about this being a really significant sort of 50 to 100 basis point impact on overall medical cost trend in CMS, just really a whole bunch of data as well.

謝謝。早安。Sam，如果你願意的話，我很想聽你從HCA的角度，快速談談《無驚喜法案》（No Surprises Act）下IDR申索所出現的這種非常快速、近乎超尺度擴張的動態；付款方在談這對CMS口徑的整體醫療成本趨勢可能造成相當顯著的50到100個基點影響，而且也有很多相關數據。

And just curious around from -- particularly from HCA's perspective, just the potential as we think about sort of reimbursement dynamics and payers looking to offset those higher costs and doing that by trying to put reimbursement pressure on hospitals who may not even be involved in the IDR process. And so -- and just as the overall effect it's having on sort of overall health care costs in the US. Definitely curious on your perspective on that.

也想請教——特別從HCA的角度——當我們思考給付（reimbursement）動態時，付款方可能試圖抵銷這些較高成本，做法是對可能甚至未參與IDR流程的醫院施加給付壓力的潛在情況。因此——以及它對美國整體醫療成本所造成的整體影響。很想聽聽你們對此的看法。

Well, thank you for that question. Let me pull up first and give you some backdrop because I think it's important to our philosophy when it comes to our relationships with our payers. I mean, largely, and I mean, almost universally, we are an in-network participating provider with all of our facilities. There are a few one-off situations with provider-owned health plans in California or Utah, where we don't participate, and there's only a few other commercial contracts outside of the exchanges that we don't participate in.

好的，謝謝你的問題。我先補充一些背景，因為我認為這對我們在與付款方關係上的理念很重要。我的意思是，大體上，而且幾乎是普遍地，我們所有設施都是與付款方簽約的網內（in-network）參與型提供者。在加州或猶他州有少數由提供者擁有的健康保險計畫的個別情況，我們沒有參與；另外也只有少數幾個交易所（exchanges）以外的商業合約我們沒有參與。

Within the exchanges, roughly 85%, 80% to 85% of all available payer contracts, we participate in those, and that's a very important part of our strategy. With our acquisition of Valesco, we have gained control of many of our hospital hospital-based services. And through that control, we've been able to integrate them into our contracts appropriately with reimbursement that's improving and aligned with what those services need to operate.

在交易所內，大約80%到85%的所有可取得的付款方合約，我們都有參與，而這是我們策略中非常重要的一部分。透過收購Valesco，我們取得了對許多以醫院為基礎（hospital-based）的服務的控制權。而透過這種控制，我們得以將它們適當地整合進我們的合約中，並使給付改善且與這些服務營運所需相一致。

So as a company, we have very few of our accounts go through the IDR process, and it happens at times with some of the exchange contracts where we don't participate or in a few commercial contracts here or there that we don't participate in. We do not use the same methodology that I think is in question broadly across the industry, we have internal resources that appropriately work the process inside of Parallon with the payers following the protocols and so forth.

因此就公司而言，我們只有極少數帳款會進入IDR流程；有時會發生在某些我們未參與的交易所合約，或零星幾個我們未參與的商業合約上。我們並未採用我認為在整個產業中廣泛受到質疑的那套方法；我們在Parallon內部有資源，會依照流程與付款方遵循相關規範等，妥善處理該流程。

I don't have a good viewpoint into the full impact that it's having for the payers through these other situations that are developing. Like any early-stage regulatory solution for a marketplace, it takes a while to sort those out and maybe we're in that period where the regulatory framework that was established for the IDR process still needs refinement in order to balance out the process, I don't know. We're not that active in it. And so I've read some of the same stuff you've read. And so I can't really speak to the full effect on the industry as a whole, but I can give you our viewpoints on it from what our experiences have been.

我對於在其他正在發展的情況下，這對付款方造成的完整影響沒有很好的掌握。就像任何針對市場的早期監管解決方案一樣，需要一段時間才能理順；也許我們正處於這樣的階段：為IDR流程所建立的監管框架仍需要精進，以便讓流程更平衡——我不確定。我們在這方面並不活躍。所以我也讀了你讀到的一些內容。因此我無法真正談整個產業的全面影響，但我可以從我們的經驗出發，提供我們的觀點。

And we're hopeful in many of those instances, we can get the contracts that we need, so we don't have to use that process. But that's a very important point. Thank you.

而且我們希望在許多這類情況下，我們能取得所需的合約，如此就不必使用那個流程。但那是一個非常重要的點。謝謝。

Ben Rossi, JPMorgan.

Ben Rossi，摩根大通。

Great. Good morning. Thanks for taking the question, here. I heard you're making some good progress on professional fees. One of your peers called out the elevated growth here, particularly for anesthesia and radiology. How did those pro fees trend in 2Q across those two areas specifically? And how sensitive are anesthesia subsidies to the current slowdown among elected surgical procedures? Thanks.

很好。早安。謝謝讓我提問。我聽說你們在專業費用（professional fees）方面取得了一些不錯的進展。你們的一位同業提到這裡的成長偏高，特別是在麻醉與放射科。第二季在這兩個領域的專業費用趨勢如何？另外，在目前選擇性手術程序放緩的情況下，麻醉補貼對此有多敏感？謝謝。

Well, I don't know in my previous answer, I think Mr. Brian. What we're seeing now is about an 8.5% growth, same facility on pro fees to the prior year. And year-to-date through June, it's almost 10%. So we are seeing some stability here in our pro fees. I mean, clearly, if you go back to our last couple of years, we've come off two previous years that -- where our pro fees were inflated, as we've been dealing with all of these hospital-based physician group pressures for sure.

嗯，我不知道在我前一個回答裡，我想是Brian先生。我們目前看到的是，專業費用在同院（same facility）口徑下相較去年約成長8.5%。而截至6月的年初至今（year-to-date），接近10%。所以我們在專業費用方面看到了一些穩定性。我的意思是，很明顯，如果你回看我們過去幾年，我們是從前兩年回落下來——當時在處理所有這些以醫院為基礎的醫師團體壓力時，我們的專業費用確實被墊高了。

If you go back in time, as Sam mentioned, the acquisition of the Valesco joint venture and bringing it in, through that work, we've been able to stabilize our emergency room physician component in our hospital medicine physician component, and we're in a much better shape there as it relates to the cost side. And it's also, by the way, a great asset for the company, and we believe will drive strategic value in our facility.

如果你回到過去，如 Sam 所提到的，收購 Valesco 合資企業並將其納入之後，透過那項工作，我們已能穩定我們在醫院醫療（hospital medicine）醫師組成中的急診室醫師部分，且就成本面而言，我們的狀況好很多。而且順帶一提，這對公司來說也是一項很棒的資產，我們相信將在我們的設施端帶來策略性價值。

What we're doing with now is similar to what you're hearing. The components of hospital-based proceeds that are still elevated are anesthesia and radiology. And those are really the components that are driving even our, call it, 8.5% growth to prior year quarter are continued pressures there. And we continue to work diligently through both of those. Those lines of businesses, if you will, using that same playbook.

我們現在正在做的事情，與你所聽到的類似。目前仍偏高的院內（hospital-based）費用項目是麻醉與放射科。而這些確實是推動我們所謂相較去年同季 8.5% 成長的因素，因為那裡仍持續有壓力。我們也持續在這兩個領域努力推進。就這些業務線而言，我們會沿用同一套作法。

We're working on people, process and technology and our management teams in the field are hard at work in both of those components as our clinical services group here in Nashville. So I do think we have stabilized. It's still the part of our cost structure that's running at above inflationary levels for sure. But we feel better today as we sit here in June coming off the last couple of years.

我們正從人員、流程與科技著手，我們在第一線的管理團隊正全力投入這兩個項目，我們位於納許維爾的臨床服務團隊亦是如此。所以我確實認為我們已經穩定下來。它仍然是我們成本結構中，確定高於通膨水準在運行的部分。但在經歷過過去幾年之後，今天我們坐在這裡、來到六月，感覺好多了。

Sarah James, Cantor Fitzgerald.

Sarah James，Cantor Fitzgerald。

Thank you. On the uninsured build from Medicaid, can you talk a little bit about what your conversion assumption was versus where it landed. And what's specifically weakening in Texas?

謝謝。關於因 Medicaid 造成的無保險人數增加，你能否談談你們的轉換假設與實際落點之間的差異？以及德州具體是哪些地方在轉弱？

Sure. I think the right way to profile this is as follows. Like if you look at our growth in uninsured volume, about 80% of that growth is coming from the one-for-one operation out of the exchanges. About 20% of that growth in our uninsured volume to prior year is coming from the slowdown in Medicaid conversions. So that will give you a bit of a sizing of the driver here.

當然。我認為描述這件事的正確方式如下。如果你看我們無保險量的成長，其中約 80% 的成長來自交易所（exchanges）的一對一流出操作。約 20% 的無保險量年對年成長，來自 Medicaid 轉換放緩。所以這能讓你大致掌握這裡的驅動因素規模。

And we talked about this a little bit in first quarter as well. But there's really a couple of components that we're watching for that are frankly different than what we saw last year. The first one is that the applications for emergency Medicaid from people mostly undocumented people are down. And so that is a piece of what's driving Medicaid conversions down is the slowdown in applications to emergency Medicaid. The other component is that the general slowing down of people who are eligible for Medicaid as we see the self-pay volume attributes.

我們在第一季也稍微談過這點。但我們正在觀察的其實有幾個面向，坦白說，與去年看到的不同。第一個是，申請緊急 Medicaid 的人（多數是無證件人士）的申請量下降。因此，推動 Medicaid 轉換下降的一部分原因，是緊急 Medicaid 申請放緩。另一個面向是，隨著我們看到自付（self-pay）量的變化，一般符合 Medicaid 資格的人也整體放緩。

We're just seeing less people to qualify for Medicaid conversions as part of that. And so that's -- those are the two factors we see. And Texas seems to be feeling the (inaudible) I mean, not that we don't have any Medicaid conversion slowdown and other components of the business, but Texas is uniquely being affected here. And so those will be the drivers I would call out.

我們只是看到符合 Medicaid 轉換資格的人變少了，這是其中一部分。所以——我們看到的就是這兩個因素。而德州似乎特別感受到（聽不清楚），我的意思是，並不是說我們在其他業務部分沒有 Medicaid 轉換放緩，但德州在這裡受到的影響是獨特的。所以我會點出的驅動因素就是這些。

Abby, I think we have one more question.

Abby，我想我們還有最後一個問題。

Kevin Fischbeck, Bank of America.

Kevin Fischbeck，美國銀行。

Great, thanks. I just wanted to get a little bit more color on the building blocks to the volume with the guidance change. I guess you guys lowered your overall EBITDA by $250 million. It looks like you raised the SEP number by [$550] So it kind of feels like the SEP number was cut by about [$800] And it sounds like $350 million is because of the exchanges. It's just sort of not clear to me what the other $450 million is as far as the guidance reduction.

很好，謝謝。我想更了解一下，在指引變動下，量的組成（building blocks）有哪些。我猜你們把整體 EBITDA 下調了 2.5 億美元。看起來你們把 SEP 數字上調了 [5.5 億]，所以感覺 SEP 數字大概被削減了約 [8 億]；而聽起來其中 3.5 億美元是因為交易所（exchanges）。只是我不太清楚，指引下修的另外 4.5 億美元是什麼原因。

And Kevin, I tried to deal with that a little bit in my prepared comments. But as we've gone through the first six months, and you think about our updated guidance and to your point, if you take into account the change in assumptions related to the exchanges and the change in assumptions related to say, supplemental payments. You're left with, call it, $500 million roughly of reduction to guidance. And when I think about that, that really reflects a bit of the moderation in our growth rates that we are seeing this year compared to where we were at '24 to '25, and we started the year with our initial guidance rates.

Kevin，我在事先準備的發言中有試著稍微處理這點。但當我們走過前六個月，並思考我們更新後的指引，如你所說，如果把與交易所相關的假設變動，以及例如補充性付款（supplemental payments）相關的假設變動納入考量，剩下的就是大約 5 億美元的指引下修。而我看待這件事時，這其實反映了我們今年看到的成長率相較於 '24 到 '25 的水準有所降溫；而我們在年初提出初始指引時，是以當時的成長率為起點。

I would note, though, when you build it up from the bottom and think about kind of what that implies in terms of operating performance, again, considering those adjustments that we talked about, it looks like kind of back to our long-term plan levels of adjusted EBITDA growth and really even for a full year basis, maybe in the top end of that range. And so that's how I think about it, Kevin.

不過我也要指出，當你從底層往上建構，並思考這對營運表現意味著什麼——再次把我們談到的那些調整納入考量——看起來我們大致回到長期計畫所設定的調整後 EBITDA 成長水準，甚至以全年來看，可能還在該區間的上緣。所以我就是這樣看待的，Kevin。

Okay. So just to view that the original guidance had a little bit above the long-term growth algorithm starting point and now you're back at the long-term growth algorithm?

好的。所以可以這樣理解：原先的指引起點略高於長期成長算法，而現在你們回到長期成長算法？

Yeah. And that's really what our experience through the first six months has helped us. And so we're reflecting that in our full year update.

對。而這正是我們在前六個月的經驗所帶給我們的結論。因此我們在全年更新中反映了這點。

All right. Perfect. Thanks.

好。非常好。謝謝。

And that concludes our question-and-answer session. I will now turn the conference back over to Mr. Frank Morgan for closing remarks.

以上結束我們的問答環節。我現在把電話會議交回給 Frank Morgan 先生作結語。

Abby, thank you for your help today, and thanks, everyone, for joining us on the call. Hope you have a great weekend. I'm around this afternoon if you have questions. Have a great weekend. Thank you.

Abby，謝謝你今天的協助，也謝謝各位參與本次電話會議。祝大家週末愉快。如果你們有問題，我今天下午都在。祝大家週末愉快。謝謝。

And ladies and gentlemen, this concludes today's call, and we thank you for your participation. You may now disconnect.

各位女士、先生，今天的電話會議到此結束，感謝各位的參與。您現在可以掛線。