The Ledger
HCA Healthcare cut its full-year profit guidance after preliminary second-quarter results showed a bigger-than-expected hit from patients migrating out of Affordable Care Act marketplace plans, and its stock fell about 6.7 percent. The country’s largest for-profit hospital operator said preliminary second-quarter 2026 revenue came in around 20.23 billion dollars, up from 18.605 billion dollars a year earlier, with net income of about 1.7 billion dollars, or $7.62 a diluted share, versus $6.83 a year earlier, and adjusted earnings before interest, taxes, depreciation and amortization of about 4.027 billion dollars, up from 3.849 billion dollars. But HCA narrowed and cut its full-year 2026 guidance: net income to a range of 6.3 billion to 6.7 billion dollars, down from 6.495 billion to 7.035 billion dollars; diluted earnings per share to $28.70 to $30.50, down from $29.10 to $31.50; and adjusted EBITDA to 15.4 billion to 16.1 billion dollars, down from 15.55 billion to 16.45 billion dollars. The company said patients shifting out of ACA exchange plans cost it about 400 million dollars pretax in the second quarter alone, and it now expects a full-year hit of 1.0 billion to 1.2 billion dollars, up from a prior estimate of 600 million to 900 million dollars; higher Medicaid supplemental payment programs partly offset the damage, adding about 400 million dollars in the quarter and now projected to add 300 million to 500 million dollars for the full year, a reversal from HCA’s earlier expectation that the program would be a net drag. Confidence: High on the reported figures; Low on how much of the exchange erosion is HCA specific versus a leading indicator for other hospital operators with material ACA exchange exposure, since HCA’s release does not break out membership by state or plan type. Source: HCA Healthcare’s second-quarter 2026 results preview, company investor relations.
The Federal Trade Commission struck a settlement with CVS Health’s Caremark unit that could save consumers up to 8.5 billion dollars over 10 years, making Caremark the second of the three dominant pharmacy benefit managers, the industry middlemen that negotiate drug prices and rebates between insurers, pharmacies and manufacturers, to settle antitrust claims over insulin pricing. The FTC announced the settlement July 14, 2026, resolving its lawsuit alleging Caremark used anticompetitive rebating practices that inflated insulin list prices and interfered with patient and pharmacy access to hub pharmacy services; Express Scripts settled a related FTC case in February 2026, and Optum Rx remains the one major PBM still facing the litigation. Under the deal, Caremark must align member cost sharing with net, post-rebate drug costs, eliminate rebate guarantees and spread pricing, expand point-of-sale rebate passthrough to patients, and launch a new 25 dollar monthly insulin cap program; the settlement also resolves all other outstanding FTC litigation and investigations tied to CVS Health’s pharmacy benefit management and affiliated pharmacy businesses. Confidence: High on the settlement terms; Medium on the 8.5 billion dollar savings estimate, since that figure is the FTC’s own projection rather than an audited outcome. Sources: FTC’s announcement of the Caremark settlement, CVS Health’s announcement of the agreement.
Elevance Health beat Wall Street’s earnings estimate and raised its full-year guidance, even as the insurer’s medical loss ratio climbed and its membership shrank. The company reported second-quarter 2026 operating revenue of 49.8 billion dollars, up 0.8 percent from a year earlier, with GAAP diluted earnings per share of $6.71 and adjusted diluted earnings per share of $7.45, roughly 1.27 dollars ahead of Wall Street’s consensus estimate near $6.18. Its benefit expense ratio, the share of premium dollars spent on medical claims, rose 80 basis points year over year to 89.7 percent, while medical membership fell to about 44.9 million, down 469,000 from the prior quarter; the company said results benefited from roughly 80 cents a share in below-the-line gains. Elevance raised its full-year 2026 guidance to diluted earnings per share of at least $20.10, adjusted diluted earnings per share of at least $27.00, and operating cash flow of at least 6.0 billion dollars. Confidence: High. Source: Elevance Health’s second-quarter 2026 earnings release.
The FTC hit Edwards Lifesciences and Genesis MedTech with a combined 12 million dollar penalty, the largest ever for dodging the federal government’s premerger antitrust review, over a 2024 heart-device deal structured just under the reporting threshold. The FTC said Edwards paid 115 million dollars for JC Medical, a Genesis MedTech subsidiary making transcatheter aortic valve replacement devices, in July 2024, just under the 119.5 million dollar threshold that would have triggered a mandatory filing under the Hart-Scott-Rodino Act, the federal law requiring companies to notify antitrust regulators before completing large mergers. The agency alleged Edwards simultaneously agreed to invest another 25 million dollars in Genesis MedTech Group, JC Medical’s parent, and that the two payments were part of the same economic arrangement, pushing the real transaction value well past the reporting threshold; Edwards will pay 10 million dollars and Genesis 2 million dollars, and Edwards is now subject to added prior-notice requirements on future deals. Confidence: High on the penalty and deal structure; Medium on how much this changes deal-structuring behavior across medtech, since it is the first penalty of its kind at this size. Source: FTC’s announcement of the Hart-Scott-Rodino penalties against Edwards Lifesciences and Genesis MedTech.
US digital health startups raised 7.4 billion dollars across 244 deals in the first half of 2026, and mega-deals of 100 million dollars or more soaked up 45 percent of that money in just 8 percent of the deals. Rock Health’s first-half 2026 market report, published July 13, found funding up roughly 1 billion dollars from the first half of 2025, with 115 digital-health merger-and-acquisition exits closing in the period, concentrated in revenue cycle management and metabolic health. The report underscores a barbell market: a small number of large, late-stage rounds are absorbing most of the capital while early-stage and mid-size digital health companies compete for a shrinking share, a dynamic that shapes which startups can still raise without a strategic sale. Confidence: High on the aggregate figures; Low on which individual companies drove the mega-deal concentration, since Rock Health’s public summary does not name every large round. Source: Rock Health’s H1 2026 digital health funding and market overview.
THE DEAL SHEET
| Target | Acquirer/Investor | Vertical | Value | Source |
|---|---|---|---|---|
| Buddy Healthcare Ltd Oy | VitalHub Corp | Digital care coordination and patient-flow software | 8.6 million euros upfront (8.3 million euros cash plus 75,000 VitalHub shares), up to 4.5 million euros earnout | VitalHub’s acquisition announcement, GlobeNewswire |
| Drug Farm | Series D investor group led by Shanghai Pudong Leading Area Investment Center and Shanghai Puxing Collaborative PE Fund | Biotech, ALPK1-pathway pipeline | $55 million first closing | Drug Farm’s financing announcement, BusinessWire |
| SONATA | Lux Capital, BoxGroup, Sunflower Capital and angel investors | Preventive-health membership, digital health | $7 million seed | Fierce Healthcare’s report on SONATA’s launch |
| Solutions Staffing, Canadian Health Care Agency and Premier Soin Nordik (Premier Health of America affiliates) | Polar Valley Investments Limited | Healthcare staffing and home care, Canada | Undisclosed, court-supervised sale | Premier Health of America’s restructuring closing announcement, GlobeNewswire |
| Volunteer Pharmacy, Inc. | Chapter 11 bankruptcy filing | Independent and compounding retail pharmacy | Undisclosed | WhatNow’s report on the Chapter 11 filing |
No 8-Ks or earnings landed in the last 24 to 48 hours from Humana, Cigna, Centene, Molina, Tenet, Universal Health Services, Community Health Systems, Oscar Health or Clover Health; UnitedHealth reports Q2 results July 16, Molina July 22, Community Health Systems around July 22 to 23, Tenet July 24, Universal Health Services July 27, Centene around July 28, Humana and Privia Health both around July 29 to August 6, and Cigna July 30.