Cover Page
Cover Page - shares | 6 Months Ended | |
Jun. 30, 2020 | Jul. 28, 2020 | |
Cover [Abstract] | ||
Document Type | 10-Q | |
Amendment Flag | false | |
Document Period End Date | Jun. 30, 2020 | |
Document Fiscal Year Focus | 2020 | |
Document Fiscal Period Focus | Q2 | |
Trading Symbol | HCA | |
Entity Registrant Name | HCA Healthcare, Inc. | |
Entity Central Index Key | 0000860730 | |
Current Fiscal Year End Date | --12-31 | |
Entity Current Reporting Status | Yes | |
Entity Filer Category | Large Accelerated Filer | |
Entity Shell Company | false | |
Entity Small Business | false | |
Entity Emerging Growth Company | false | |
Entity Interactive Data Current | Yes | |
Entity File Number | 1-11239 | |
Entity Incorporation, State or Country Code | DE | |
Entity Tax Identification Number | 27-3865930 | |
Entity Address, Address Line One | One Park Plaza | |
Entity Address, City or Town | Nashville | |
Entity Address, State or Province | TN | |
Entity Address, Postal Zip Code | 37203 | |
City Area Code | 615 | |
Local Phone Number | 344-9551 | |
Document Transition Report | false | |
Title of 12(b) Security | common stock | |
Security Exchange Name | NYSE | |
Document Quarterly Report | true | |
Entity Common Stock, Shares Outstanding | 338,033,300 |
Condensed Consolidated Income S
Condensed Consolidated Income Statements - USD ($) shares in Thousands, $ in Millions | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2020 | Jun. 30, 2019 | Jun. 30, 2020 | Jun. 30, 2019 | |
Income Statement [Abstract] | ||||
Revenues | $ 11,068 | $ 12,602 | $ 23,929 | $ 25,119 |
Salaries and benefits | 5,330 | 5,837 | 11,448 | 11,484 |
Supplies | 1,748 | 2,118 | 3,871 | 4,159 |
Other operating expenses | 2,147 | 2,362 | 4,574 | 4,661 |
Government stimulus income | (822) | (822) | ||
Equity in earnings of affiliates | (1) | (8) | (8) | (19) |
Depreciation and amortization | 691 | 636 | 1,365 | 1,255 |
Interest expense | 388 | 477 | 816 | 938 |
Losses (gains) on sales of facilities | 27 | (18) | 20 | (17) |
Losses on retirement of debt | 0 | 0 | 295 | 0 |
Total expenses including equity in earnings of affiliates | 9,508 | 11,404 | 21,559 | 22,461 |
Income before income taxes | 1,560 | 1,198 | 2,370 | 2,658 |
Provision for income taxes | 344 | 271 | 456 | 550 |
Net income | 1,216 | 927 | 1,914 | 2,108 |
Net income attributable to noncontrolling interests | 137 | 144 | 254 | 286 |
Net income attributable to HCA Healthcare, Inc. | $ 1,079 | $ 783 | $ 1,660 | $ 1,822 |
Per share data: | ||||
Basic earnings | $ 3.20 | $ 2.29 | $ 4.91 | $ 5.32 |
Diluted earnings | $ 3.16 | $ 2.25 | $ 4.84 | $ 5.22 |
Shares used in earnings per share calculations (in millions): | ||||
Basic | 337,760 | 342,170 | 338,001 | 342,513 |
Diluted | 341,599 | 348,373 | 342,848 | 349,334 |
Condensed Consolidated Comprehe
Condensed Consolidated Comprehensive Income Statements - USD ($) $ in Millions | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2020 | Jun. 30, 2019 | Jun. 30, 2020 | Jun. 30, 2019 | |
Statement of Comprehensive Income [Abstract] | ||||
Net income | $ 1,216 | $ 927 | $ 1,914 | $ 2,108 |
Other comprehensive income (loss) before taxes: | ||||
Foreign currency translation | (8) | (38) | (81) | (18) |
Unrealized gains on available-for-sale securities | 17 | 6 | 12 | 14 |
Defined benefit plans | 0 | 0 | 0 | 0 |
Pension costs included in salaries and benefits | 4 | 4 | 8 | 7 |
Total defined benefit plans | 4 | 4 | 8 | 7 |
Change in fair value of derivative financial instruments | (6) | (34) | (66) | (52) |
Interest expense (benefits) included in interest expense | 7 | (6) | 6 | (11) |
Total change in fair value of derivative financial instruments | 1 | (40) | (60) | (63) |
Other comprehensive income (loss) before taxes | 14 | (68) | (121) | (60) |
Income taxes (benefits) related to other comprehensive income items | 5 | (11) | (19) | (10) |
Other comprehensive income (loss) | 9 | (57) | (102) | (50) |
Comprehensive income | 1,225 | 870 | 1,812 | 2,058 |
Comprehensive income attributable to noncontrolling interests | 137 | 144 | 254 | 286 |
Comprehensive income attributable to HCA Healthcare, Inc. | $ 1,088 | $ 726 | $ 1,558 | $ 1,772 |
Condensed Consolidated Balance
Condensed Consolidated Balance Sheets - USD ($) $ in Millions | Jun. 30, 2020 | Dec. 31, 2019 |
Current assets: | ||
Cash and cash equivalents | $ 4,638 | $ 621 |
Accounts receivable | 6,139 | 7,380 |
Inventories | 1,834 | 1,849 |
Other | 1,420 | 1,346 |
Total current assets | 14,031 | 11,196 |
Property and equipment, at cost | 48,484 | 47,235 |
Accumulated depreciation | (25,413) | (24,520) |
Property and equipment, net | 23,071 | 22,715 |
Investments of insurance subsidiaries | 364 | 315 |
Investments in and advances to affiliates | 275 | 249 |
Goodwill and other intangible assets | 8,578 | 8,269 |
Right-of-use operating lease assets | 1,863 | 1,834 |
Other | 527 | 480 |
Total assets | 48,709 | 45,058 |
Current liabilities: | ||
Accounts payable | 2,882 | 2,905 |
Accrued salaries | 1,631 | 1,775 |
Other accrued expenses | 3,181 | 2,932 |
Contract liabilities-deferred revenues | 4,999 | 0 |
Long-term debt due within one year | 163 | 145 |
Total current liabilities | 12,856 | 7,757 |
Long-term debt, less debt issuance costs and discounts of $252 and $239 | 30,779 | 33,577 |
Professional liability risks | 1,485 | 1,370 |
Right-of-use operating lease obligations | 1,531 | 1,499 |
Income taxes and other liabilities | 1,490 | 1,420 |
Stockholders' equity (deficit): | ||
Common stock $0.01 par; authorized 1,800,000,000 shares; outstanding 337,960,400 shares in 2020 and 338,445,600 shares in 2019 | 3 | 3 |
Capital in excess of par value | 88 | |
Accumulated other comprehensive loss | (562) | (460) |
Retained deficit | (1,315) | (2,351) |
Stockholders' deficit attributable to HCA Healthcare, Inc. | (1,786) | (2,808) |
Noncontrolling interests | 2,354 | 2,243 |
Total stockholders' deficit | 568 | (565) |
Total liabilities and stockholders' deficit | $ 48,709 | $ 45,058 |
Condensed Consolidated Balanc_2
Condensed Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Millions | Jun. 30, 2020 | Dec. 31, 2019 |
Statement of Financial Position [Abstract] | ||
Debt issuance costs | $ 252 | $ 239 |
Common stock, par value | $ 0.01 | $ 0.01 |
Common stock, shares authorized | 1,800,000,000 | 1,800,000,000 |
Common stock, shares outstanding | 337,960,400 | 338,445,600 |
Condensed Consolidated Statemen
Condensed Consolidated Statements of Stockholders' Deficit - USD ($) shares in Thousands, $ in Millions | Total | Common Stock [Member] | Capital in Excess of Par Value [Member] | Accumulated Other Comprehensive Loss [Member] | Retained Deficit [Member] | Equity Attributable to Noncontrolling Interests [Member] |
Balances at Dec. 31, 2018 | $ (2,918) | $ 3 | $ (381) | $ (4,572) | $ 2,032 | |
Balance, shares at Dec. 31, 2018 | 342,895 | |||||
Comprehensive income (loss) | 1,188 | 7 | 1,039 | 142 | ||
Repurchase of common stock | (278) | $ 32 | (310) | |||
Repurchase of common stock, shares | (2,106) | |||||
Share-based benefit plans | (29) | (29) | ||||
Share-based benefit plans, shares | 2,242 | |||||
Cash dividends declared | (140) | (140) | ||||
Distributions | (136) | (136) | ||||
Other | 58 | (3) | 61 | |||
Balance at Mar. 31, 2019 | (2,255) | $ 3 | (374) | (3,983) | 2,099 | |
Balance, shares at Mar. 31, 2019 | 343,031 | |||||
Balances at Dec. 31, 2018 | (2,918) | $ 3 | (381) | (4,572) | 2,032 | |
Balance, shares at Dec. 31, 2018 | 342,895 | |||||
Comprehensive income (loss) | 2,058 | |||||
Balance at Jun. 30, 2019 | (1,770) | $ 3 | (431) | (3,474) | 2,132 | |
Balance, shares at Jun. 30, 2019 | 341,517 | |||||
Balances at Mar. 31, 2019 | (2,255) | $ 3 | (374) | (3,983) | 2,099 | |
Balance, shares at Mar. 31, 2019 | 343,031 | |||||
Comprehensive income (loss) | 870 | (57) | 783 | 144 | ||
Repurchase of common stock | (242) | (107) | (135) | |||
Repurchase of common stock, shares | (1,928) | |||||
Share-based benefit plans | 118 | 118 | ||||
Share-based benefit plans, shares | 414 | |||||
Cash dividends declared | (139) | (139) | ||||
Distributions | (111) | (111) | ||||
Other | (11) | (11) | ||||
Balance at Jun. 30, 2019 | (1,770) | $ 3 | (431) | (3,474) | 2,132 | |
Balance, shares at Jun. 30, 2019 | 341,517 | |||||
Comprehensive income (loss) | 734 | (30) | 612 | 152 | ||
Repurchase of common stock | (239) | (132) | (107) | |||
Repurchase of common stock, shares | (1,846) | |||||
Share-based benefit plans | 128 | 128 | ||||
Share-based benefit plans, shares | 382 | |||||
Cash dividends declared | (138) | (138) | ||||
Distributions | (157) | (157) | ||||
Other | (5) | 4 | (9) | |||
Balance at Sep. 30, 2019 | (1,447) | $ 3 | (461) | (3,107) | 2,118 | |
Balance, shares at Sep. 30, 2019 | 340,053 | |||||
Comprehensive income (loss) | 1,274 | 1 | 1,071 | 202 | ||
Repurchase of common stock | (272) | (95) | (177) | |||
Repurchase of common stock, shares | (2,069) | |||||
Share-based benefit plans | 96 | 96 | ||||
Share-based benefit plans, shares | 462 | |||||
Cash dividends declared | (138) | (138) | ||||
Distributions | (138) | (138) | ||||
Other | 60 | (1) | 61 | |||
Balance at Dec. 31, 2019 | (565) | $ 3 | (460) | (2,351) | 2,243 | |
Balance, shares at Dec. 31, 2019 | 338,446 | |||||
Comprehensive income (loss) | 587 | (111) | 581 | 117 | ||
Repurchase of common stock | $ (441) | 35 | (476) | |||
Repurchase of common stock, shares | (3,287) | (3,287) | ||||
Share-based benefit plans | $ (33) | (33) | ||||
Share-based benefit plans, shares | 2,449 | |||||
Cash dividends declared | (148) | (148) | ||||
Distributions | (154) | (154) | ||||
Other | 51 | (2) | 53 | |||
Balance at Mar. 31, 2020 | (703) | $ 3 | (571) | (2,394) | 2,259 | |
Balance, shares at Mar. 31, 2020 | 337,608 | |||||
Balances at Dec. 31, 2019 | (565) | $ 3 | (460) | (2,351) | 2,243 | |
Balance, shares at Dec. 31, 2019 | 338,446 | |||||
Comprehensive income (loss) | 1,812 | |||||
Balance at Jun. 30, 2020 | 568 | $ 3 | 88 | (562) | (1,315) | 2,354 |
Balance, shares at Jun. 30, 2020 | 337,960 | |||||
Balances at Mar. 31, 2020 | (703) | $ 3 | (571) | (2,394) | 2,259 | |
Balance, shares at Mar. 31, 2020 | 337,608 | |||||
Comprehensive income (loss) | 1,225 | 9 | 1,079 | 137 | ||
Share-based benefit plans | 93 | 93 | ||||
Share-based benefit plans, shares | 352 | |||||
Distributions | (45) | (45) | ||||
Other | (2) | (5) | 3 | |||
Balance at Jun. 30, 2020 | $ 568 | $ 3 | $ 88 | $ (562) | $ (1,315) | $ 2,354 |
Balance, shares at Jun. 30, 2020 | 337,960 |
Condensed Consolidated Statem_2
Condensed Consolidated Statements of Stockholders' Deficit (Parenthetical) - $ / shares | 3 Months Ended | ||||
Mar. 31, 2020 | Dec. 31, 2019 | Sep. 30, 2019 | Jun. 30, 2019 | Mar. 31, 2019 | |
Statement of Stockholders' Equity [Abstract] | |||||
Cash dividends declared, per share | $ 0.43 | $ 0.40 | $ 0.40 | $ 0.40 | $ 0.40 |
Condensed Consolidated Statem_3
Condensed Consolidated Statements of Cash Flows - USD ($) $ in Millions | 6 Months Ended | |
Jun. 30, 2020 | Jun. 30, 2019 | |
Cash flows from operating activities: | ||
Net income | $ 1,914 | $ 2,108 |
Increase (decrease) in cash from operating assets and liabilities: | ||
Accounts receivable | 1,215 | (174) |
Inventories and other assets | (57) | (231) |
Accounts payable and accrued expenses | (336) | (238) |
Contract liabilities-deferred revenues | 4,999 | 0 |
Depreciation and amortization | 1,365 | 1,255 |
Income taxes | 472 | 27 |
Losses (gains) on sales of facilities | 20 | (17) |
Losses on retirement of debt | 295 | 0 |
Amortization of debt issuance costs and discounts | 14 | 16 |
Share-based compensation | 148 | 158 |
Other | 49 | 67 |
Net cash provided by operating activities | 10,098 | 2,971 |
Cash flows from investing activities: | ||
Purchase of property and equipment | (1,598) | (1,745) |
Acquisition of hospitals and health care entities | (346) | (1,504) |
Sales of hospitals and health care entities | 39 | 41 |
Change in investments | (11) | 59 |
Other | (37) | 36 |
Net cash used in investing activities | (1,953) | (3,113) |
Cash flows from financing activities: | ||
Issuances of long-term debt | 2,700 | 6,451 |
Net change in revolving bank credit facilities | (2,480) | (3,040) |
Repayment of long-term debt | (3,364) | (98) |
Distributions to noncontrolling interests | (199) | (247) |
Payment of debt issuance costs | (35) | (63) |
Payment of dividends | (153) | (278) |
Repurchases of common stock | (441) | (520) |
Other | (144) | (135) |
Net cash (used in) provided by financing activities | (4,116) | 2,070 |
Effect of exchange rate changes on cash and cash equivalents | (12) | 0 |
Change in cash and cash equivalents | 4,017 | 1,928 |
Cash and cash equivalents at beginning of period | 621 | 502 |
Cash and cash equivalents at end of period | 4,638 | 2,430 |
Interest payments | 854 | 910 |
Income tax (refunds) payments, net | $ (16) | $ 523 |
Basis of Presentation and Signi
Basis of Presentation and Significant Accounting Policies | 6 Months Ended |
Jun. 30, 2020 | |
Accounting Policies [Abstract] | |
Basis of Presentation and Significant Accounting Policies | NOTE 1 — BASIS OF PRESENTATION AND SIGNIFICANT ACCOUNTING POLICIES Reporting Entity HCA Healthcare, Inc. is a holding company whose affiliates own and operate hospitals and related health care entities. The term “affiliates” includes direct and indirect subsidiaries of HCA Healthcare, Inc. and partnerships and joint ventures in which such subsidiaries are partners. At June 30, 2020, these affiliates owned and operated 186 hospitals, 122 freestanding surgery centers and provided extensive outpatient and ancillary services. HCA Healthcare, Inc.’s facilities are located in 21 states and England. The terms “Company,” “HCA,” “we,” “our” or “us,” as used herein and unless otherwise stated or indicated by context, refer to HCA Healthcare, Inc. and its affiliates. The terms “facilities” or “hospitals” refer to entities owned and operated by affiliates of HCA and the term “employees” refers to employees of affiliates of HCA. Basis of Presentation The accompanying unaudited condensed consolidated financial statements have been prepared in accordance with generally accepted accounting principles for interim financial information and with the instructions to Form 10-Q Regulation S-X. The majority of our expenses are “costs of revenues” items. Costs that could be classified as general and administrative would include our corporate office costs, which were $76 million and $94 million for the quarters ended June 30, 2020 and 2019, respectively , Form 10-K COVID-19 On March 11, 2020, the World Health Organization designated COVID-19 COVID-19 non-emergent re-imposing COVID-19 Our pandemic response plan has multiple facets and continues to evolve as the pandemic unfolds. We have taken precautionary steps to enhance our operational and financial flexibility, and react to the risks the COVID-19 • Implemented certain cost reduction initiatives; • Suspended our authorized share repurchase program; • Suspended our quarterly dividend program; COVID-19 • Reduced certain planned projects and capital expenditures; • During March 2020, executed a new $2 billion 364-day • During the second quarter of 2020, we received approximately $4.4 billion of accelerated Medicare payments and approximately $1.4 billion in general and targeted Provider Relief Fund distributions, both as provided for under the Coronavirus Aid, Relief, and Economic Security (“CARES”) Act. We believe the extent of the COVID-19 stay-at-home During the second quarter of 2020, we received $922 million from the $50 billion general distribution fund and $454 million of targeted distributions from the CARES Act Provider Relief Fund. These distributions from the Provider Relief Fund are not subject to repayment, provided we are able to attest to and comply with the terms and conditions of the funding , including demonstrating that the distributions received have been used for healthcare-related expenses or lost revenue attributable to COVID-19. Such payments are accounted for as government grants, and are recognized on a systematic and rational basis as other income once there is reasonable assurance that the applicable terms and conditions required to retain the funds will be met. Based on an analysis of the compliance and reporting requirements of the Provider Relief Fund and the impact of the pandemic on our operating results through the end of the second quarter, we recognized $822 million ($590 million net of tax), or $1.73 per diluted share, related to these general distribution funds, and these payments are recorded under the caption “government stimulus income” in our condensed consolidated income statements. The unrecognized amount of general distributions and targeted distributions are recorded under the caption “contract liabilities-deferred revenues” in our condensed consolidated balance sheet. We will continue to monitor compliance with the terms and conditions of the Provider Relief Fund and the impact of the pandemic on our revenues and expenses. If we are unable to attest to or comply with current or future terms and conditions our ability to retain some or all of the distributions received may be impacted. The CARES Act also provides for a deferral of payments until Revenues Our revenues generally relate to contracts with patients in which our performance obligations are to provide health care services to the patients. Revenues are recorded during the period our obligations to provide health care services are satisfied. Our performance obligations for inpatient services are generally satisfied over periods that average approximately five days, and revenues are recognized based on charges incurred in relation to total expected charges. Our performance obligations for outpatient services are generally satisfied over a period of less than one day. The contractual relationships with patients, in most cases, also involve a third-party payer (Medicare, Medicaid, managed care health plans and commercial insurance companies, including plans offered through the health insurance exchanges) and the transaction prices for the services provided are dependent upon the terms provided by (Medicare and Medicaid) or negotiated with (managed care health plans and commercial insurance companies) the third-party payers. The payment arrangements with third-party payers for the services we provide to the related patients typically specify payments at amounts less than our standard charges. Medicare generally pays for inpatient and outpatient services at prospectively determined rates based on clinical, diagnostic and other factors. Services provided to patients having Medicaid coverage are generally paid at prospectively determined rates per discharge, per identified service or per covered member. Agreements with commercial insurance carriers, managed care and preferred provider organizations generally provide for payments based upon predetermined rates per diagnosis, per diem rates or discounted fee-for-service out-of-network During the second quarter of 2020, we requested accelerated Medicare payments as provided for in the CARES Act, which allows for eligible health care facilities to request up to six months of advance Medicare payments for acute care hospitals or up to three months of advance Medicare payments for other health care providers. After 120 days past receipt of the advance payments Our revenues are based upon the estimated amounts we expect to be entitled to receive from patients and third-party payers. Estimates of contractual adjustments under managed care and commercial insurance plans are based upon the payment terms specified in the related contractual agreements. Revenues related to uninsured patients and uninsured copayment and deductible amounts for patients who have health care coverage may have discounts applied (uninsured discounts and contractual discounts). We also record estimated implicit price concessions (based primarily on historical collection experience) related to uninsured accounts to record these revenues at the estimated amounts we expect to collect. Patients treated at our hospitals for non-elective Quarter 2020 Ratio 2019 Ratio Medicare $ 2,272 20.5 % $ 2,635 20.9 % Managed Medicare 1,488 13.4 1,595 12.7 Medicaid 564 5.1 416 3.3 Managed Medicaid 531 4.8 554 4.4 Managed care and insurers 5,631 50.9 6,425 50.9 International (managed care and insurers) 239 2.2 284 2.3 Other 343 3.1 693 5.5 Revenues $ 11,068 100.0 % $ 12,602 100.0 % Six Months 2020 Ratio 2019 Ratio Medicare $ 5,015 21.0 % $ 5,405 21.5 % Managed Medicare 3,314 13.8 3,184 12.7 Medicaid 978 4.1 763 3.0 Managed Medicaid 1,197 5.0 1,167 4.6 Managed care and insurers 12,276 51.4 12,851 51.1 International (managed care and insurers) 531 2.2 581 2.3 Other 618 2.5 1,168 4.8 Revenues $ 23,929 100.0 % $ 25,119 100.0 % Revenues (continued) To quantify the total impact of the trends related to uninsured patient accounts, we believe it is beneficial to view total uncompensated care, which is comprised of charity care, uninsured discounts and implicit price concessions. A summary of the estimated cost of total uncompensated care for the quarters and six months ended June 30, 2020 and 2019 follows (dollars in millions): Quarter Six Months 2020 2019 2020 2019 Patient care costs (salaries and benefits, supplies, other operating expenses and depreciation and amortization) $ 9,916 $ 10,953 $ 21,258 $ 21,559 Cost-to-charges 12.6 % 12.2 % 12.2 % 12.0 % Total uncompensated care $ 6,729 $ 7,695 $ 14,602 $ 14,780 Multiply by the cost-to-charges 12.6 % 12.2 % 12.2 % 12.0 % Estimated cost of total uncompensated care $ 844 $ 938 $ 1,781 $ 1,774 The total uncompensated care amounts include charity care of $3.077 billion and $3.311 billion, respectively , respectively , Reclassifications Certain prior year amounts have been reclassified to conform to the current year presentation. |
Acquisitions and Dispositions
Acquisitions and Dispositions | 6 Months Ended |
Jun. 30, 2020 | |
Business Combinations [Abstract] | |
Acquisitions and Dispositions | NOTE 2 — ACQUISITIONS AND DISPOSITIONS During the six months ended June 30, 2020, we paid $346 million to acquire a hospital in New Hampshire and other nonhospital health care entities During the six months ended June 30, 2020, we received proceeds of $39 million and recognized a pretax gain of $3 million related to sales of real estate and other investments, and we also recognized a pretax loss of $23 million related to a hospital facility in Mississippi that we have executed a definitive agreement to sell in 2020. During the six months ended June 30, 2019, we received proceeds of $25 million and recognized a pretax loss of $1 million related to a sale of a hospital facility in one of our Louisiana markets, and we also received proceeds of $16 million and recognized a pretax gain of $18 million related to sales of real estate and other investments. |
Income Taxes
Income Taxes | 6 Months Ended |
Jun. 30, 2020 | |
Income Tax Disclosure [Abstract] | |
Income Taxes | NOTE 3 — INCOME TAXES Our provision for income taxes for the quarters ended June 30, 2020 and 2019 was $344 million and $271 million, respectively, and the effective tax rates were 24.2% and 25.7%, respectively. Our provision for income taxes for the six months ended June 30, 2020 and 2019 was $456 million and $550 million, respectively, and the effective tax rates were 21.6% and 23.2%, respectively. Our provision for income taxes included tax benefits related to the settlement of employee equity awards of $54 million and $53 million for the six months ended June 30, 2020 and 2019, respectively. Our liability for unrecognized tax benefits was $513 million, including accrued interest of $71 million, as of June 30, 2020 ($550 million and $62 million, respectively, as of December 31, 2019). Unrecognized tax benefits of $164 million ($160 million as of December 31, 2019) would affect the effective rate, if recognized. The Internal Revenue Service was conducting an examination of the Company’s 2016, 2017 and 2018 federal income tax returns at June 30, 2020. We are also subject to examination by state and foreign taxing authorities. Depending on the resolution of any federal, state and foreign tax disputes, the completion of examinations by federal, state or foreign taxing authorities, or the expiration of statutes of limitation for specific taxing jurisdictions, we believe it is reasonably possible that our liability for unrecognized tax benefits may significantly increase or decrease within the next 12 months. However, we are currently unable to estimate the range of any possible change. |
Earnings Per Share
Earnings Per Share | 6 Months Ended |
Jun. 30, 2020 | |
Earnings Per Share [Abstract] | |
Earnings Per Share | NOTE 4 — EARNINGS PER SHARE We compute basic earnings per share using the weighted average number of common shares outstanding. We compute diluted earnings per share using the weighted average number of common shares outstanding, plus the dilutive effect of outstanding equity awards and potential shares, computed using the treasury stock method. The following table sets forth the computation of basic and diluted earnings per share for the quarters and six months ended June 30, 2020 and 2019 (dollars and shares in millions, except per share amounts): Quarter Six Months 2020 2019 2020 2019 Net income attributable to HCA Healthcare, Inc. $ 1,079 $ 783 $ 1,660 $ 1,822 Weighted average common shares outstanding 337.760 342.170 338.001 342.513 Effect of dilutive incremental shares 3.839 6.203 4.847 6.821 Shares used for diluted earnings per share 341.599 348.373 342.848 349.334 Earnings per share: Basic earnings $ 3.20 $ 2.29 $ 4.91 $ 5.32 Diluted earnings $ 3.16 $ 2.25 $ 4.84 $ 5.22 |
Investments of Insurance Subsid
Investments of Insurance Subsidiaries | 6 Months Ended |
Jun. 30, 2020 | |
Investments, Debt and Equity Securities [Abstract] | |
Investments of Insurance Subsidiaries | NOTE 5 — INVESTMENTS OF INSURANCE SUBSIDIARIES A summary of our insurance subsidiaries’ investments at June 30, 2020 and December 31, 2019 follows (dollars in millions): June 30, 2020 Amortized Unrealized Fair Gains Losses Debt securities $ 380 $ 30 $ — $ 410 Money market funds and other 59 — — 59 $ 439 $ 30 $ — 469 Amounts classified as current assets (105 ) Investment carrying value $ 364 December 31, 2019 Amortized Unrealized Fair Gains Losses Debt securities $ 359 $ 18 $ — $ 377 Money market funds and other 85 — — 85 $ 444 $ 18 $ — 462 Amounts classified as current assets (147 ) Investment carrying value $ 315 At June 30, 2020 and December 31, 2019, the investments in debt securities of our insurance subsidiaries were classified as “available-for-sale.” Scheduled maturities of investments in debt securities at June 30, 2020 were as follows (dollars in millions): Amortized Fair Due in one year or less $ 14 $ 14 Due after one year through five years 114 122 Due after five years through ten years 180 197 Due after ten years 72 77 $ 380 $ 410 The average expected maturity of the investments in debt securities at June 30, 2020 was 5.3 years, compared to the average scheduled maturity of 9.8 years. Expected and scheduled maturities may differ because the issuers of certain securities have the right to call, prepay or otherwise redeem such obligations prior to their scheduled maturity date. |
Financial Instruments
Financial Instruments | 6 Months Ended |
Jun. 30, 2020 | |
Derivative Instruments and Hedging Activities Disclosure [Abstract] | |
Financial Instruments | NOTE 6 — FINANCIAL INSTRUMENTS Interest Rate Swap Agreements We have entered into interest rate swap agreements to manage our exposure to fluctuations in interest rates. These swap agreements involve the exchange of fixed and variable rate interest payments between us and our counterparties based on common notional principal amounts and maturity dates. Pay-fixed The following table sets forth our interest rate swap agreements hedges Notional Maturity Date Fair Pay-fixed $ 2,000 December 2021 $ (40 ) Pay-fixed 500 December 2022 (24 ) During the next 12 months, we estimate $36 million will be reclassified from other comprehensive income (“OCI”) and will be included in interest expense. Derivatives — Results of Operations The following table presents the effect of our interest rate swaps on our results of operations for the six months ended June 30, 2020 (dollars in millions): Derivatives in Cash Flow Hedging Relationships Amount of Loss Location of Loss Amount of Loss Interest rate swaps $ 51 Interest expense $ 6 Credit-risk-related Contingent Features We have agreements with each of our derivative counterparties that contain a provision where we could be declared in default on our derivative obligations if repayment of the underlying indebtedness is accelerated by the lender due to our default on the indebtedness. As of June 30, 2020, we have not been required to post any collateral related to these agreements. If we had breached these provisions at June 30, 2020, we would have been required to settle our obligations under the agreements at their aggregate, estimated termination value of $65 million. |
Assets and Liabilities Measured
Assets and Liabilities Measured at Fair Value | 6 Months Ended |
Jun. 30, 2020 | |
Fair Value Disclosures [Abstract] | |
Assets and Liabilities Measured at Fair Value | NOTE 7 — ASSETS AND LIABILITIES MEASURED AT FAIR VALUE Accounting Standards Codification 820, Fair Value Measurements and Disclosures Level 1 inputs utilize quoted prices (unadjusted) in active markets for identical assets or liabilities. Level 2 inputs are inputs other than quoted prices included in Level 1 that are observable for the asset or liability, either directly or indirectly. Level 2 inputs may include quoted prices for similar assets and liabilities in active markets, as well as inputs observable for the asset or liability (other than quoted prices), such as interest rates, foreign exchange rates, and yield curves observable at commonly quoted intervals. Level 3 inputs are unobservable inputs for the asset or liability, which are typically based on an entity’s own assumptions, as there is little, if any, related market activity. In instances where the determination of the fair value measurement is based on inputs from different levels of the fair value hierarchy, the level in the fair value hierarchy within which the entire fair value measurement falls is based on the lowest level input significant to the fair value measurement in its entirety. Our assessment of the significance of a particular input to the fair value measurement in its entirety requires judgment. Cash Traded Investments Our cash traded investments are generally classified within Level 1 or Level 2 of the fair value hierarchy because they are valued using quoted market prices, broker or dealer quotations, or alternative pricing sources with reasonable levels of price transparency. Derivative Financial Instruments We have entered into interest rate swap agreements to manage our exposure to fluctuations in interest rates. The valuation of these instruments is determined using widely accepted valuation techniques, including discounted cash flow analysis on the expected cash flows of each derivative. This analysis reflects the contractual terms of the derivatives, including the period to maturity, and uses observable market-based inputs, including interest rate curves and implied volatilities. We incorporate credit valuation adjustments to reflect both our own nonperformance risk and the respective counterparty’s nonperformance risk in the fair value measurements of these instruments. The following tables summarize our assets and liabilities measured at fair value on a recurring basis as of June 30, 2020 and December 31, 2019, aggregated by the level in the fair value hierarchy within which those measurements fall (dollars in millions): June 30, 2020 Fair Value Measurements Using Fair Value Quoted Prices in Significant Other Significant Assets: Investments of insurance subsidiaries: Debt securities $ 410 $ — $ 410 $ — Money market funds and other 59 59 — — Investments of insurance subsidiaries 469 59 410 — Less amounts classified as current assets (105 ) (58 ) (47 ) — $ 364 $ 1 $ 363 $ — Liabilities: Interest rate swaps (Income taxes and other liabilities) $ 64 $ — $ 64 $ — December 31, 2019 Fair Value Measurements Using Fair Value Quoted Prices in Significant Other Significant Assets: Investments of insurance subsidiaries: Debt securities $ 377 $ — $ 377 $ — Money market funds and other 85 85 — — Investments of insurance subsidiaries 462 85 377 — Less amounts classified as current assets (147 ) (83 ) (64 ) — $ 315 $ 2 $ 313 $ — Interest rate swaps (Other) $ 3 $ — $ 3 $ — Liabilities: Interest rate swaps (Income taxes and other liabilities) $ 7 $ — $ 7 $ — The estimated fair value of our long-term debt was $34.000 billion and $37.026 billion at June 30, 2020 and December 31, 2019, respectively, compared to carrying amounts, excluding debt issuance costs and discounts, aggregating $31.194 billion and $33.961 billion, respectively. The estimates of fair value are generally based upon the quoted market prices or quoted market prices for similar issues of long-term debt with the same maturities. |
Long-Term Debt
Long-Term Debt | 6 Months Ended |
Jun. 30, 2020 | |
Debt Disclosure [Abstract] | |
Long-Term Debt | NOTE 8 — LONG-TERM DEBT A summary of long-term debt at June 30, 2020 and December 31, 2019, including related interest rates at June 30, 2020, follows (dollars in millions): June 30, December 31, Senior secured asset-based revolving credit facility $ — $ 2,480 Senior secured revolving credit facility — — Senior secured 364-day — — Senior secured term loan facilities (effective interest rate of 2.8%) 3,698 3,725 Senior secured notes (effective interest rate of 5.1%) 13,850 13,850 Other senior secured debt (effective interest rate of 5.0%) 694 654 Senior secured debt 18,242 20,709 Senior unsecured notes (effective interest rate of 5.5%) 12,952 13,252 Debt issuance costs and discounts (252 ) (239 ) Total debt (average life of 9.4 years, rates averaging 5.0%) 30,942 33,722 Less amounts due within one year 163 145 $ 30,779 $ 33,577 During February 2020, we issued $2.700 billion aggregate principal amount of 3.50% senior notes due 2030. During March 2020, we used the net proceeds for the redemption of all $1.000 billion outstanding aggregate principal amount of HCA Healthcare, Inc.’s 6.25% senior notes due 2021 and, together with available funds, for the redemption of all $2.000 billion outstanding aggregate principal amount of HCA Inc.’s 7.50% senior notes due 2022. The pretax loss on retirement of debt was $295 million. In response to the risks the COVID-19 a 364-day secured |
Contingencies
Contingencies | 6 Months Ended |
Jun. 30, 2020 | |
Commitments and Contingencies Disclosure [Abstract] | |
Contingencies | NOTE 9 — CONTINGENCIES We operate in a highly regulated and litigious industry. As a result, various lawsuits, claims and legal and regulatory proceedings have been and can be expected to be instituted or asserted against us. We are also subject to claims and suits arising in the ordinary course of business, including claims for personal injuries or wrongful restriction of, or interference with, physicians’ staff privileges. In certain of these actions the claimants may seek punitive damages against us which may not be covered by insurance. We are also subject to claims by various taxing authorities for additional taxes and related interest and penalties. The resolution of any such lawsuits, claims or legal and regulatory proceedings could have a material, adverse effect on our results of operations, financial position or liquidity. Health care companies are subject to numerous investigations by various governmental agencies. Under the federal False Claims Act (“FCA”), private parties have the right to bring qui tam individual facilities have received, and from time to time, other facilities may receive, government inquiries from, and may be subject to investigation by, federal and state agencies. Depending on whether the underlying conduct in these or future inquiries or investigations could be considered systemic, their resolution could have a material, adverse effect on our results of operations, financial position or liquidity. Texas operates a state Medicaid program pursuant to a waiver from CMS under Section 1115 of the Social Security Act (“Program”). The Program includes uncompensated-care pools; payments from these pools are intended to defray the uncompensated costs of services provided by our and other hospitals to Medicaid eligible or uninsured individuals. Separately, we and other hospitals provide charity care services in several communities in the state. In 2018, the Civil Division of the U.S. Department of Justice and the U.S. Attorney’s Office for the Southern District of Texas requested information about whether the Program, as operated in Harris County, complied with the laws and regulations applicable to provider related donations, and the Company cooperated with that request. On May 21, 2019, a qui tam qui tam qui tam |
Share Repurchase Transactions a
Share Repurchase Transactions and Other Comprehensive Loss | 6 Months Ended |
Jun. 30, 2020 | |
Federal Home Loan Banks [Abstract] | |
Share Repurchases Transactions and Other Comprehensive Loss | NOTE 10 — SHARE REPURCHASE TRANSACTIONS AND OTHER COMPREHENSIVE LOSS During January 2020 and 2019, our Board of Directors authorized share repurchase programs for up to $4 billion ($2 billion for each authorization) of our outstanding common stock. In response to the risks the COVID-19 the The components of accumulated other comprehensive loss are as follows (dollars in millions): Unrealized for-Sale Foreign Defined Change Total Balances at December 31, 2019 $ 14 $ (283 ) $ (187 ) $ (4 ) $ (460 ) Unrealized gains on available-for-sale 9 9 Foreign currency translation adjustments, net of $10 income tax benefit (71 ) (71 ) Change in fair value of derivative instruments, net of $15 income tax benefit (51 ) (51 ) Expense reclassified into operations from other comprehensive income, net of $2 and $1 income tax benefits, respectively 6 5 11 Balances at June 30, 2020 $ 23 $ (354 ) $ (181 ) $ (50 ) $ (562 ) |
Segment and Geographic Informat
Segment and Geographic Information | 6 Months Ended |
Jun. 30, 2020 | |
Segment Reporting [Abstract] | |
Segment and Geographic Information | NOTE 11 — SEGMENT AND GEOGRAPHIC INFORMATION We operate in one line of business, which is operating hospitals and related health care entities. We operate in two geographically organized groups: the National and American Groups. The National Group includes 96 hospitals located in Alaska, California, Florida, southern Georgia, Idaho, Indiana, northern Kentucky, Nevada, New Hampshire, North Carolina, South Carolina, Utah and Virginia, and the American Group includes 84 hospitals located in Colorado, northern Georgia, Kansas, southern Kentucky, Louisiana, Mississippi, Missouri, Tennessee and Texas. We also operate six hospitals in England, and these facilities are included in the Corporate and other group. Adjusted segment EBITDA is defined as income before depreciation and amortization, interest expense, losses (gains) on sales of facilities, losses on retirement of debt, income taxes and net income attributable to noncontrolling interests. We use adjusted segment EBITDA as an analytical indicator for purposes of allocating resources to geographic areas and assessing their performance. Adjusted segment EBITDA is commonly used as an analytical indicator within the health care industry, and also serves as a measure of leverage capacity and debt service ability. Adjusted segment EBITDA should not be considered as a measure of financial performance under generally accepted accounting principles, and the items excluded from adjusted segment EBITDA are significant components in understanding and assessing financial performance. Because adjusted segment EBITDA is not a measurement determined in accordance with generally accepted accounting principles and is thus susceptible to varying calculations, adjusted segment EBITDA, as presented, may not be comparable to other similarly titled measures of other companies. The geographic distributions of our revenues, equity in earnings of affiliates, adjusted segment EBITDA and depreciation and amortization for the quarters and six months ended June 30, 2020 and 2019 are summarized in the following table (dollars in millions): Quarter Six Months 2020 2019 2020 2019 Revenues: National Group $ 5,546 $ 6,444 $ 12,020 $ 12,761 American Group 5,103 5,626 10,847 11,221 Corporate and other 419 532 1,062 1,137 $ 11,068 $ 12,602 $ 23,929 $ 25,119 Equity in earnings of affiliates: National Group $ (4 ) $ (3 ) $ (3 ) $ (5 ) American Group (2 ) (11 ) (11 ) (22 ) Corporate and other 5 6 6 8 $ (1 ) $ (8 ) $ (8 ) $ (19 ) Adjusted segment EBITDA: National Group $ 1,485 $ 1,364 $ 2,700 $ 2,818 American Group 1,408 1,117 2,523 2,258 Corporate and other (227 ) (188 ) (357 ) (242 ) $ 2,666 $ 2,293 $ 4,866 $ 4,834 Depreciation and amortization: National Group $ 312 $ 283 $ 618 $ 548 American Group 295 270 582 551 Corporate and other 84 83 165 156 $ 691 $ 636 $ 1,365 $ 1,255 Adjusted segment EBITDA $ 2,666 $ 2,293 $ 4,866 $ 4,834 Depreciation and amortization 691 636 1,365 1,255 Interest expense 388 477 816 938 Losses (gains) on sales of facilities 27 (18 ) 20 (17 ) Losses on retirement of debt — — 295 — Income before income taxes $ 1,560 $ 1,198 $ 2,370 $ 2,658 |
Basis of Presentation and Sig_2
Basis of Presentation and Significant Accounting Policies (Policies) | 6 Months Ended |
Jun. 30, 2020 | |
Basis of Presentation | Basis of Presentation The accompanying unaudited condensed consolidated financial statements have been prepared in accordance with generally accepted accounting principles for interim financial information and with the instructions to Form 10-Q Regulation S-X. The majority of our expenses are “costs of revenues” items. Costs that could be classified as general and administrative would include our corporate office costs, which were $76 million and $94 million for the quarters ended June 30, 2020 and 2019, respectively , Form 10-K COVID-19 On March 11, 2020, the World Health Organization designated COVID-19 COVID-19 non-emergent re-imposing COVID-19 Our pandemic response plan has multiple facets and continues to evolve as the pandemic unfolds. We have taken precautionary steps to enhance our operational and financial flexibility, and react to the risks the COVID-19 • Implemented certain cost reduction initiatives; • Suspended our authorized share repurchase program; • Suspended our quarterly dividend program; • Reduced certain planned projects and capital expenditures; • During March 2020, executed a new $2 billion 364-day • During the second quarter of 2020, we received approximately $4.4 billion of accelerated Medicare payments and approximately $1.4 billion in general and targeted Provider Relief Fund distributions, both as provided for under the Coronavirus Aid, Relief, and Economic Security (“CARES”) Act. We believe the extent of the COVID-19 stay-at-home During the second quarter of 2020, we received $922 million from the $50 billion general distribution fund and $454 million of targeted distributions from the CARES Act Provider Relief Fund. These distributions from the Provider Relief Fund are not subject to repayment, provided we are able to attest to and comply with the terms and conditions of the funding , including demonstrating that the distributions received have been used for healthcare-related expenses or lost revenue attributable to COVID-19. Such payments are accounted for as government grants, and are recognized on a systematic and rational basis as other income once there is reasonable assurance that the applicable terms and conditions required to retain the funds will be met. Based on an analysis of the compliance and reporting requirements of the Provider Relief Fund and the impact of the pandemic on our operating results through the end of the second quarter, we recognized $822 million ($590 million net of tax), or $1.73 per diluted share, related to these general distribution funds, and these payments are recorded under the caption “government stimulus income” in our condensed consolidated income statements. The unrecognized amount of general distributions and targeted distributions are recorded under the caption “contract liabilities-deferred revenues” in our condensed consolidated balance sheet. We will continue to monitor compliance with the terms and conditions of the Provider Relief Fund and the impact of the pandemic on our revenues and expenses. If we are unable to attest to or comply with current or future terms and conditions our ability to retain some or all of the distributions received may be impacted. The CARES Act also provides for a deferral of payments until |
Revenues | Revenues Our revenues generally relate to contracts with patients in which our performance obligations are to provide health care services to the patients. Revenues are recorded during the period our obligations to provide health care services are satisfied. Our performance obligations for inpatient services are generally satisfied over periods that average approximately five days, and revenues are recognized based on charges incurred in relation to total expected charges. Our performance obligations for outpatient services are generally satisfied over a period of less than one day. The contractual relationships with patients, in most cases, also involve a third-party payer (Medicare, Medicaid, managed care health plans and commercial insurance companies, including plans offered through the health insurance exchanges) and the transaction prices for the services provided are dependent upon the terms provided by (Medicare and Medicaid) or negotiated with (managed care health plans and commercial insurance companies) the third-party payers. The payment arrangements with third-party payers for the services we provide to the related patients typically specify payments at amounts less than our standard charges. Medicare generally pays for inpatient and outpatient services at prospectively determined rates based on clinical, diagnostic and other factors. Services provided to patients having Medicaid coverage are generally paid at prospectively determined rates per discharge, per identified service or per covered member. Agreements with commercial insurance carriers, managed care and preferred provider organizations generally provide for payments based upon predetermined rates per diagnosis, per diem rates or discounted fee-for-service out-of-network During the second quarter of 2020, we requested accelerated Medicare payments as provided for in the CARES Act, which allows for eligible health care facilities to request up to six months of advance Medicare payments for acute care hospitals or up to three months of advance Medicare payments for other health care providers. After 120 days past receipt of the advance payments Our revenues are based upon the estimated amounts we expect to be entitled to receive from patients and third-party payers. Estimates of contractual adjustments under managed care and commercial insurance plans are based upon the payment terms specified in the related contractual agreements. Revenues related to uninsured patients and uninsured copayment and deductible amounts for patients who have health care coverage may have discounts applied (uninsured discounts and contractual discounts). We also record estimated implicit price concessions (based primarily on historical collection experience) related to uninsured accounts to record these revenues at the estimated amounts we expect to collect. Patients treated at our hospitals for non-elective Quarter 2020 Ratio 2019 Ratio Medicare $ 2,272 20.5 % $ 2,635 20.9 % Managed Medicare 1,488 13.4 1,595 12.7 Medicaid 564 5.1 416 3.3 Managed Medicaid 531 4.8 554 4.4 Managed care and insurers 5,631 50.9 6,425 50.9 International (managed care and insurers) 239 2.2 284 2.3 Other 343 3.1 693 5.5 Revenues $ 11,068 100.0 % $ 12,602 100.0 % Six Months 2020 Ratio 2019 Ratio Medicare $ 5,015 21.0 % $ 5,405 21.5 % Managed Medicare 3,314 13.8 3,184 12.7 Medicaid 978 4.1 763 3.0 Managed Medicaid 1,197 5.0 1,167 4.6 Managed care and insurers 12,276 51.4 12,851 51.1 International (managed care and insurers) 531 2.2 581 2.3 Other 618 2.5 1,168 4.8 Revenues $ 23,929 100.0 % $ 25,119 100.0 % Revenues (continued) To quantify the total impact of the trends related to uninsured patient accounts, we believe it is beneficial to view total uncompensated care, which is comprised of charity care, uninsured discounts and implicit price concessions. A summary of the estimated cost of total uncompensated care for the quarters and six months ended June 30, 2020 and 2019 follows (dollars in millions): Quarter Six Months 2020 2019 2020 2019 Patient care costs (salaries and benefits, supplies, other operating expenses and depreciation and amortization) $ 9,916 $ 10,953 $ 21,258 $ 21,559 Cost-to-charges 12.6 % 12.2 % 12.2 % 12.0 % Total uncompensated care $ 6,729 $ 7,695 $ 14,602 $ 14,780 Multiply by the cost-to-charges 12.6 % 12.2 % 12.2 % 12.0 % Estimated cost of total uncompensated care $ 844 $ 938 $ 1,781 $ 1,774 The total uncompensated care amounts include charity care of $3.077 billion and $3.311 billion, respectively , respectively , |
Reclassifications | Reclassifications Certain prior year amounts have been reclassified to conform to the current year presentation. |
Basis of Presentation and Sig_3
Basis of Presentation and Significant Accounting Policies (Tables) | 6 Months Ended |
Jun. 30, 2020 | |
Accounting Policies [Abstract] | |
Schedule of Revenues from Third Party Payers, Uninsured and Other Payers | Our revenues by primary third-party payer classification and other (including uninsured patients) for the quarters and six months ended June 30, 2020 and 2019 are summarized in the following table (dollars in millions): Quarter 2020 Ratio 2019 Ratio Medicare $ 2,272 20.5 % $ 2,635 20.9 % Managed Medicare 1,488 13.4 1,595 12.7 Medicaid 564 5.1 416 3.3 Managed Medicaid 531 4.8 554 4.4 Managed care and insurers 5,631 50.9 6,425 50.9 International (managed care and insurers) 239 2.2 284 2.3 Other 343 3.1 693 5.5 Revenues $ 11,068 100.0 % $ 12,602 100.0 % Six Months 2020 Ratio 2019 Ratio Medicare $ 5,015 21.0 % $ 5,405 21.5 % Managed Medicare 3,314 13.8 3,184 12.7 Medicaid 978 4.1 763 3.0 Managed Medicaid 1,197 5.0 1,167 4.6 Managed care and insurers 12,276 51.4 12,851 51.1 International (managed care and insurers) 531 2.2 581 2.3 Other 618 2.5 1,168 4.8 Revenues $ 23,929 100.0 % $ 25,119 100.0 % |
Schedule of Estimated Cost of Uncompensated Care | A summary of the estimated cost of total uncompensated care for the quarters and six months ended June 30, 2020 and 2019 follows (dollars in millions): Quarter Six Months 2020 2019 2020 2019 Patient care costs (salaries and benefits, supplies, other operating expenses and depreciation and amortization) $ 9,916 $ 10,953 $ 21,258 $ 21,559 Cost-to-charges 12.6 % 12.2 % 12.2 % 12.0 % Total uncompensated care $ 6,729 $ 7,695 $ 14,602 $ 14,780 Multiply by the cost-to-charges 12.6 % 12.2 % 12.2 % 12.0 % Estimated cost of total uncompensated care $ 844 $ 938 $ 1,781 $ 1,774 |
Earnings Per Share (Tables)
Earnings Per Share (Tables) | 6 Months Ended |
Jun. 30, 2020 | |
Earnings Per Share [Abstract] | |
Schedule of Computations of Basic and Diluted Earnings Per Share | The following table sets forth the computation of basic and diluted earnings per share for the quarters and six months ended June 30, 2020 and 2019 (dollars and shares in millions, except per share amounts): Quarter Six Months 2020 2019 2020 2019 Net income attributable to HCA Healthcare, Inc. $ 1,079 $ 783 $ 1,660 $ 1,822 Weighted average common shares outstanding 337.760 342.170 338.001 342.513 Effect of dilutive incremental shares 3.839 6.203 4.847 6.821 Shares used for diluted earnings per share 341.599 348.373 342.848 349.334 Earnings per share: Basic earnings $ 3.20 $ 2.29 $ 4.91 $ 5.32 Diluted earnings $ 3.16 $ 2.25 $ 4.84 $ 5.22 |
Investments of Insurance Subs_2
Investments of Insurance Subsidiaries (Tables) | 6 Months Ended |
Jun. 30, 2020 | |
Investments, Debt and Equity Securities [Abstract] | |
Schedule of Investments | A summary of our insurance subsidiaries’ investments at June 30, 2020 and December 31, 2019 follows (dollars in millions): June 30, 2020 Amortized Unrealized Fair Gains Losses Debt securities $ 380 $ 30 $ — $ 410 Money market funds and other 59 — — 59 $ 439 $ 30 $ — 469 Amounts classified as current assets (105 ) Investment carrying value $ 364 December 31, 2019 Amortized Unrealized Fair Gains Losses Debt securities $ 359 $ 18 $ — $ 377 Money market funds and other 85 — — 85 $ 444 $ 18 $ — 462 Amounts classified as current assets (147 ) Investment carrying value $ 315 |
Schedule of Maturities of Investments | Scheduled maturities of investments in debt securities at June 30, 2020 were as follows (dollars in millions): Amortized Fair Due in one year or less $ 14 $ 14 Due after one year through five years 114 122 Due after five years through ten years 180 197 Due after ten years 72 77 $ 380 $ 410 |
Financial Instruments (Tables)
Financial Instruments (Tables) | 6 Months Ended |
Jun. 30, 2020 | |
Derivative Instruments and Hedging Activities Disclosure [Abstract] | |
Schedule of Interest Rate Swap Agreements Designated as Cash Flow Hedges | The following table sets forth our interest rate swap agreements hedges Notional Maturity Date Fair Pay-fixed $ 2,000 December 2021 $ (40 ) Pay-fixed 500 December 2022 (24 ) |
Effect of Interest Rate on Results of Operations | The following table presents the effect of our interest rate swaps on our results of operations for the six months ended June 30, 2020 (dollars in millions): Derivatives in Cash Flow Hedging Relationships Amount of Loss Location of Loss Amount of Loss Interest rate swaps $ 51 Interest expense $ 6 |
Assets and Liabilities Measur_2
Assets and Liabilities Measured at Fair Value (Tables) | 6 Months Ended |
Jun. 30, 2020 | |
Fair Value Disclosures [Abstract] | |
Schedule of Assets Measured at Fair Value on Recurring Basis | The following tables summarize our assets and liabilities measured at fair value on a recurring basis as of June 30, 2020 and December 31, 2019, aggregated by the level in the fair value hierarchy within which those measurements fall (dollars in millions): June 30, 2020 Fair Value Measurements Using Fair Value Quoted Prices in Significant Other Significant Assets: Investments of insurance subsidiaries: Debt securities $ 410 $ — $ 410 $ — Money market funds and other 59 59 — — Investments of insurance subsidiaries 469 59 410 — Less amounts classified as current assets (105 ) (58 ) (47 ) — $ 364 $ 1 $ 363 $ — Liabilities: Interest rate swaps (Income taxes and other liabilities) $ 64 $ — $ 64 $ — December 31, 2019 Fair Value Measurements Using Fair Value Quoted Prices in Significant Other Significant Assets: Investments of insurance subsidiaries: Debt securities $ 377 $ — $ 377 $ — Money market funds and other 85 85 — — Investments of insurance subsidiaries 462 85 377 — Less amounts classified as current assets (147 ) (83 ) (64 ) — $ 315 $ 2 $ 313 $ — Interest rate swaps (Other) $ 3 $ — $ 3 $ — Liabilities: Interest rate swaps (Income taxes and other liabilities) $ 7 $ — $ 7 $ — |
Long-Term Debt (Tables)
Long-Term Debt (Tables) | 6 Months Ended |
Jun. 30, 2020 | |
Debt Disclosure [Abstract] | |
Schedule of Long-Term Debt | A summary of long-term debt at June 30, 2020 and December 31, 2019, including related interest rates at June 30, 2020, follows (dollars in millions): June 30, December 31, Senior secured asset-based revolving credit facility $ — $ 2,480 Senior secured revolving credit facility — — Senior secured 364-day — — Senior secured term loan facilities (effective interest rate of 2.8%) 3,698 3,725 Senior secured notes (effective interest rate of 5.1%) 13,850 13,850 Other senior secured debt (effective interest rate of 5.0%) 694 654 Senior secured debt 18,242 20,709 Senior unsecured notes (effective interest rate of 5.5%) 12,952 13,252 Debt issuance costs and discounts (252 ) (239 ) Total debt (average life of 9.4 years, rates averaging 5.0%) 30,942 33,722 Less amounts due within one year 163 145 $ 30,779 $ 33,577 |
Share Repurchase Transactions_2
Share Repurchase Transactions and Other Comprehensive Loss (Tables) | 6 Months Ended |
Jun. 30, 2020 | |
Federal Home Loan Banks [Abstract] | |
Components of Accumulated Other Comprehensive Loss | The components of accumulated other comprehensive loss are as follows (dollars in millions): Unrealized for-Sale Foreign Defined Change Total Balances at December 31, 2019 $ 14 $ (283 ) $ (187 ) $ (4 ) $ (460 ) Unrealized gains on available-for-sale 9 9 Foreign currency translation adjustments, net of $10 income tax benefit (71 ) (71 ) Change in fair value of derivative instruments, net of $15 income tax benefit (51 ) (51 ) Expense reclassified into operations from other comprehensive income, net of $2 and $1 income tax benefits, respectively 6 5 11 Balances at June 30, 2020 $ 23 $ (354 ) $ (181 ) $ (50 ) $ (562 ) |
Segment and Geographic Inform_2
Segment and Geographic Information (Tables) | 6 Months Ended |
Jun. 30, 2020 | |
Segment Reporting [Abstract] | |
Schedule of Geographic Distributions of Revenues, Equity in Earnings of Affiliates, Adjusted Segment EBITDA and Depreciation and Amortization | The geographic distributions of our revenues, equity in earnings of affiliates, adjusted segment EBITDA and depreciation and amortization for the quarters and six months ended June 30, 2020 and 2019 are summarized in the following table (dollars in millions): Quarter Six Months 2020 2019 2020 2019 Revenues: National Group $ 5,546 $ 6,444 $ 12,020 $ 12,761 American Group 5,103 5,626 10,847 11,221 Corporate and other 419 532 1,062 1,137 $ 11,068 $ 12,602 $ 23,929 $ 25,119 Equity in earnings of affiliates: National Group $ (4 ) $ (3 ) $ (3 ) $ (5 ) American Group (2 ) (11 ) (11 ) (22 ) Corporate and other 5 6 6 8 $ (1 ) $ (8 ) $ (8 ) $ (19 ) Adjusted segment EBITDA: National Group $ 1,485 $ 1,364 $ 2,700 $ 2,818 American Group 1,408 1,117 2,523 2,258 Corporate and other (227 ) (188 ) (357 ) (242 ) $ 2,666 $ 2,293 $ 4,866 $ 4,834 Depreciation and amortization: National Group $ 312 $ 283 $ 618 $ 548 American Group 295 270 582 551 Corporate and other 84 83 165 156 $ 691 $ 636 $ 1,365 $ 1,255 Adjusted segment EBITDA $ 2,666 $ 2,293 $ 4,866 $ 4,834 Depreciation and amortization 691 636 1,365 1,255 Interest expense 388 477 816 938 Losses (gains) on sales of facilities 27 (18 ) 20 (17 ) Losses on retirement of debt — — 295 — Income before income taxes $ 1,560 $ 1,198 $ 2,370 $ 2,658 |
Basis of Presentation and Sig_4
Basis of Presentation and Significant Accounting Policies - Additional Information (Detail) $ / shares in Units, $ in Millions | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2020USD ($)$ / sharesSurgery_CenterHospitalState | Jun. 30, 2019USD ($)$ / shares | Jun. 30, 2020USD ($)$ / sharesSurgery_CenterHospitalState | Jun. 30, 2019USD ($)$ / shares | |
Summary Of Significant Accounting Policies [Line Items] | ||||
Number of owned and operated hospitals | Hospital | 186 | 186 | ||
Number of freestanding surgery centers | Surgery_Center | 122 | 122 | ||
Number of facilities locations | State | 21 | 21 | ||
General and administrative expense | $ 76 | $ 94 | $ 172 | $ 180 |
Performance obligations for inpatient/ outpatient services satisfied period | Our performance obligations for outpatient services are generally satisfied over a period of less than one day. | |||
Charity care amount | 3,077 | 3,311 | $ 6,812 | 6,216 |
Estimated costs of charity care | 387 | $ 403 | 831 | $ 746 |
Government stimulus income | $ (822) | $ (822) | ||
Earning per share diluted | $ / shares | $ 3.16 | $ 2.25 | $ 4.84 | $ 5.22 |
CARES Act Provider Relief Fund [Member] | ||||
Summary Of Significant Accounting Policies [Line Items] | ||||
Government stimulus income | $ (822) | |||
Earning per share diluted | $ / shares | $ 1.73 | |||
Deferred payroll taxes | $ 220 | $ 220 | ||
Employee retention payroll tax credits | 60 | 60 | ||
Accelerated Medicare payments received | 4,400 | 4,400 | ||
General and targeted distributions recived | 1,400 | |||
Proceeds from general distribution fund | 922 | |||
General distribution fund value | 50,000 | 50,000 | ||
Proceeds from targeted distributions fund | 454 | |||
Government stimulus income net of tax | 590 | |||
Senior Secured Three Six Four Day Term Loan Facility [Member] | ||||
Summary Of Significant Accounting Policies [Line Items] | ||||
Maximum borrowing capacity | $ 2,000 | 2,000 | ||
Out of Network Services [Member] | ||||
Summary Of Significant Accounting Policies [Line Items] | ||||
Revenues | $ 55 | $ 86 | ||
Minimum [Member] | ||||
Summary Of Significant Accounting Policies [Line Items] | ||||
Percentage of income of federal poverty level eligible for charity care | 400.00% |
Basis of Presentation and Sig_5
Basis of Presentation and Significant Accounting Policies - Schedule of Revenues from Third Party Payers, Uninsured and Other Payers (Detail) - USD ($) $ in Millions | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2020 | Jun. 30, 2019 | Jun. 30, 2020 | Jun. 30, 2019 | |
Revenues From Third Party Payers [Line Items] | ||||
Revenues from third party payers | $ 11,068 | $ 12,602 | $ 23,929 | $ 25,119 |
Revenues ratio from third party payers | 100.00% | 100.00% | 100.00% | 100.00% |
Medicare [Member] | ||||
Revenues From Third Party Payers [Line Items] | ||||
Revenues from third party payers | $ 2,272 | $ 2,635 | $ 5,015 | $ 5,405 |
Revenues from third party payers, Ratio | 20.50% | 20.90% | 21.00% | 21.50% |
Managed Medicare [Member] | ||||
Revenues From Third Party Payers [Line Items] | ||||
Revenues from third party payers | $ 1,488 | $ 1,595 | $ 3,314 | $ 3,184 |
Revenues from third party payers, Ratio | 13.40% | 12.70% | 13.80% | 12.70% |
Medicaid [Member] | ||||
Revenues From Third Party Payers [Line Items] | ||||
Revenues from third party payers | $ 564 | $ 416 | $ 978 | $ 763 |
Revenues from third party payers, Ratio | 5.10% | 3.30% | 4.10% | 3.00% |
Managed Medicaid [Member] | ||||
Revenues From Third Party Payers [Line Items] | ||||
Revenues from third party payers | $ 531 | $ 554 | $ 1,197 | $ 1,167 |
Revenues from third party payers, Ratio | 4.80% | 4.40% | 5.00% | 4.60% |
Managed Care and Other Insurers [Member] | ||||
Revenues From Third Party Payers [Line Items] | ||||
Revenues from third party payers | $ 5,631 | $ 6,425 | $ 12,276 | $ 12,851 |
Revenues from third party payers, Ratio | 50.90% | 50.90% | 51.40% | 51.10% |
International (Managed Care and Other Insurers) [Member] | ||||
Revenues From Third Party Payers [Line Items] | ||||
Revenues from third party payers | $ 239 | $ 284 | $ 531 | $ 581 |
Revenues from third party payers, Ratio | 2.20% | 2.30% | 2.20% | 2.30% |
Product and Service, Other [Member] | ||||
Revenues From Third Party Payers [Line Items] | ||||
Revenues from third party payers | $ 343 | $ 693 | $ 618 | $ 1,168 |
Other, Ratio | 3.10% | 5.50% | 2.50% | 4.80% |
Basis of Presentation and Sig_6
Basis of Presentation and Significant Accounting Policies - Schedule of Estimated Cost of Uncompensated Care (Detail) - USD ($) $ in Millions | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2020 | Jun. 30, 2019 | Jun. 30, 2020 | Jun. 30, 2019 | |
Accounting Policies [Abstract] | ||||
Patient care costs (salaries and benefits, supplies, other operating expenses and depreciation and amortization) | $ 9,916 | $ 10,953 | $ 21,258 | $ 21,559 |
Cost-to-charges ratio (patient care costs as percentage of gross patient charges) | 12.60% | 12.20% | 12.20% | 12.00% |
Total uncompensated care | $ 6,729 | $ 7,695 | $ 14,602 | $ 14,780 |
Multiply by the cost-to-charges ratio | 12.60% | 12.20% | 12.20% | 12.00% |
Estimated cost of total uncompensated care | $ 844 | $ 938 | $ 1,781 | $ 1,774 |
Acquisitions and Dispositions -
Acquisitions and Dispositions - Additional Information (Detail) $ in Millions | 6 Months Ended | |
Jun. 30, 2020USD ($)Hospital | Jun. 30, 2019USD ($)Hospital | |
Business Acquisition [Line Items] | ||
Number of hospitals purchased | Hospital | 1 | 7 |
Proceeds from sale of business | $ 39 | $ 41 |
Real Estate and Other Investments [Member] | ||
Business Acquisition [Line Items] | ||
Gain (loss) on sales of real estate | 3 | 18 |
Proceeds from sale of business | 39 | 16 |
Hospitals [Member] | ||
Business Acquisition [Line Items] | ||
Aggregate purchase price | 1,397 | |
Gain (loss) on sales of real estate | (23) | |
Hospitals [Member] | Discontinued Operations, Disposed of by Sale [Member] | ||
Business Acquisition [Line Items] | ||
Gain (loss) on sales of real estate | (1) | |
Proceeds from sale of business | 25 | |
Nonhospital Health Care [Member] | ||
Business Acquisition [Line Items] | ||
Aggregate purchase price | $ 107 | |
Hospital and other nonhospital health care entities [Member] | ||
Business Acquisition [Line Items] | ||
Aggregate purchase price | 346 | |
Fair value of identifiable net assets | $ 306 |
Income Taxes - Additional Infor
Income Taxes - Additional Information (Detail) - USD ($) $ in Millions | 3 Months Ended | 6 Months Ended | |||
Jun. 30, 2020 | Jun. 30, 2019 | Jun. 30, 2020 | Jun. 30, 2019 | Dec. 31, 2019 | |
Income Tax Contingency [Line Items] | |||||
Effective tax rate | 24.20% | 25.70% | 21.60% | 23.20% | |
Provision for tax benefits related to settlement of employee awards | $ 54 | $ 53 | |||
Provision for income taxes | $ 344 | $ 271 | 456 | $ 550 | |
Liability for unrecognized tax benefits | 513 | 513 | $ 550 | ||
Unrecognized tax benefits, accrued interest | 71 | 71 | 62 | ||
Unrecognized tax benefits that would impact effective tax rate | $ 164 | $ 164 | $ 160 |
Earnings Per Share - Schedule o
Earnings Per Share - Schedule of Computations of Basic and Diluted Earnings Per Share (Detail) - USD ($) $ / shares in Units, shares in Thousands, $ in Millions | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2020 | Jun. 30, 2019 | Jun. 30, 2020 | Jun. 30, 2019 | |
Earnings Per Share [Abstract] | ||||
Net income attributable to HCA Healthcare, Inc. | $ 1,079 | $ 783 | $ 1,660 | $ 1,822 |
Weighted average common shares outstanding | 337,760 | 342,170 | 338,001 | 342,513 |
Effect of dilutive incremental shares | 3,839 | 6,203 | 4,847 | 6,821 |
Shares used for diluted earnings per share | 341,599 | 348,373 | 342,848 | 349,334 |
Basic earnings | $ 3.20 | $ 2.29 | $ 4.91 | $ 5.32 |
Diluted earnings | $ 3.16 | $ 2.25 | $ 4.84 | $ 5.22 |
Investments of Insurance Subs_3
Investments of Insurance Subsidiaries - Schedule of Investments (Detail) - USD ($) $ in Millions | Jun. 30, 2020 | Dec. 31, 2019 |
Debt Securities, Available-for-sale [Line Items] | ||
Amounts classified as current assets | $ (105) | $ (147) |
Investment carrying value | 364 | 315 |
Amortized Cost | 439 | 444 |
Unrealized Amounts, Gains | 30 | 18 |
Fair Value | 469 | 462 |
Money Market Funds and Other [Member] | ||
Debt Securities, Available-for-sale [Line Items] | ||
Amortized Cost | 59 | 85 |
Fair Value | 59 | 85 |
Debt Securities [Member] | States and Municipalities [Member] | ||
Debt Securities, Available-for-sale [Line Items] | ||
Amortized Cost | 380 | 359 |
Unrealized Amounts, Gains | 30 | 18 |
Fair Value | $ 410 | $ 377 |
Investments of Insurance Subs_4
Investments of Insurance Subsidiaries - Schedule of Maturities of Investments (Detail) $ in Millions | Jun. 30, 2020USD ($) |
Investments, Debt and Equity Securities [Abstract] | |
Due in one year or less, Amortized Cost | $ 14 |
Due after one year through five years, Amortized Cost | 114 |
Due after five years through ten years, Amortized Cost | 180 |
Due after ten years, Amortized Cost | 72 |
Amortized Cost, Total | 380 |
Due in one year or less, Fair Value | 14 |
Due after one year through five years, Fair Value | 122 |
Due after five years through ten years, Fair Value | 197 |
Due after ten years, Fair Value | 77 |
Fair Value, Total | $ 410 |
Investments of Insurance Subs_5
Investments of Insurance Subsidiaries - Additional Information (Detail) | 6 Months Ended |
Jun. 30, 2020 | |
Investments, Debt and Equity Securities [Abstract] | |
Available for sale securities expected maturity of debt securities | 5 years 3 months 18 days |
Available for sale securities average scheduled maturity | 9 years 9 months 18 days |
Financial Instruments - Schedul
Financial Instruments - Schedule of Interest Rate Swap Agreements Designated as Cash Flow Hedges (Detail) - Pay-Fixed Interest Rate Swaps [Member] $ in Millions | 6 Months Ended |
Jun. 30, 2020USD ($) | |
Maturity Date, 2021 [Member] | |
Derivative Instruments, Gain (Loss) [Line Items] | |
Notional Amount | $ 2,000 |
Fair Value | $ (40) |
Maturity Date | 2021-12 |
Maturity Date, 2022 [Member] | |
Derivative Instruments, Gain (Loss) [Line Items] | |
Notional Amount | $ 500 |
Fair Value | $ (24) |
Maturity Date | 2022-12 |
Financial Instruments - Additio
Financial Instruments - Additional Information (Detail) $ in Millions | 6 Months Ended |
Jun. 30, 2020USD ($) | |
Derivative Instruments and Hedging Activities Disclosure [Abstract] | |
Estimated amount reclassified from other comprehensive income and be included in interest expense | $ 36 |
Estimated termination value | $ 65 |
Financial Instruments - Effect
Financial Instruments - Effect of Interest Rate Swaps on Results of Operations (Detail) $ in Millions | 6 Months Ended |
Jun. 30, 2020USD ($) | |
Derivative Instruments, Gain (Loss) [Line Items] | |
Amount of Loss Recognized in OCI on Derivatives, Net of Tax | $ (51) |
Interest Rate Swaps [Member] | |
Derivative Instruments, Gain (Loss) [Line Items] | |
Amount of Loss Recognized in OCI on Derivatives, Net of Tax | 51 |
Interest Rate Swaps [Member] | Reclassification out of Accumulated Other Comprehensive Income [Member] | |
Derivative Instruments, Gain (Loss) [Line Items] | |
Interest rate swaps | $ 6 |
Assets and Liabilities Measur_3
Assets and Liabilities Measured at Fair Value - Schedule of Assets Measured at Fair Value on Recurring Basis (Detail) - USD ($) $ in Millions | Jun. 30, 2020 | Dec. 31, 2019 |
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Assets, Fair Value Disclosure | $ 469 | $ 462 |
Less amounts classified as current assets | (105) | (147) |
Investments of insurance subsidiaries, noncurrent | 364 | 315 |
Interest Rate Swaps [Member] | ||
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Derivative Asset | 3 | |
Derivative Liability | 64 | 7 |
Money Market Funds and Other [Member] | ||
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Assets, Fair Value Disclosure | 59 | 85 |
Debt Securities [Member] | ||
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Debt Securities, Available-for-sale Securities | 410 | 377 |
Quoted Prices in Active Markets for Identical Assets and Liabilities (Level 1) [Member] | ||
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Assets, Fair Value Disclosure | 59 | 85 |
Less amounts classified as current assets | (58) | (83) |
Investments of insurance subsidiaries, noncurrent | 1 | 2 |
Quoted Prices in Active Markets for Identical Assets and Liabilities (Level 1) [Member] | Money Market Funds and Other [Member] | ||
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Assets, Fair Value Disclosure | 59 | 85 |
Significant Other Observable Inputs (Level 2) [Member] | ||
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Assets, Fair Value Disclosure | 410 | 377 |
Less amounts classified as current assets | (47) | (64) |
Investments of insurance subsidiaries, noncurrent | 363 | 313 |
Significant Other Observable Inputs (Level 2) [Member] | Interest Rate Swaps [Member] | ||
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Derivative Asset | 3 | |
Derivative Liability | 64 | 7 |
Significant Other Observable Inputs (Level 2) [Member] | Debt Securities [Member] | ||
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Debt Securities, Available-for-sale Securities | $ 410 | $ 377 |
Assets and Liabilities Measur_4
Assets and Liabilities Measured at Fair Value - Additional Information (Detail) - USD ($) $ in Millions | Jun. 30, 2020 | Dec. 31, 2019 |
Fair Value Disclosures [Abstract] | ||
Estimated fair value of long-term debt | $ 34,000 | $ 37,026 |
Carrying amounts of long-term debt | $ 31,194 | $ 33,961 |
Long-Term Debt - Schedule of Lo
Long-Term Debt - Schedule of Long-Term Debt (Detail) - USD ($) $ in Millions | Jun. 30, 2020 | Dec. 31, 2019 |
Debt Instrument [Line Items] | ||
Senior secured debt | $ 18,242 | $ 20,709 |
Net debt issuance costs | (252) | (239) |
Total debt (average life of 8.8 years, rates averaging 4.7%) | 30,942 | 33,722 |
Less amounts due within one year | 163 | 145 |
Long-term debt | 30,779 | 33,577 |
Senior Secured Asset-Based Revolving Credit Facility [Member] | ||
Debt Instrument [Line Items] | ||
Long-term line of credit | 0 | 2,480 |
Senior secured 364-day term loan facility [Member] | ||
Debt Instrument [Line Items] | ||
Senior secured debt | 0 | 0 |
Senior Secured Term Loan Facilities [Member] | ||
Debt Instrument [Line Items] | ||
Senior secured debt | 3,698 | 3,725 |
Senior Secured Notes [Member] | ||
Debt Instrument [Line Items] | ||
Senior secured debt | 13,850 | 13,850 |
Other Senior Secured Debt [Member] | ||
Debt Instrument [Line Items] | ||
Other senior secured debt | 694 | 654 |
Senior Unsecured Notes [Member] | ||
Debt Instrument [Line Items] | ||
Senior unsecured notes | 12,952 | 13,252 |
Senior Secured Revolving Credit Facility [Member] | ||
Debt Instrument [Line Items] | ||
Long-term line of credit | $ 0 | $ 0 |
Long-Term Debt - Schedule of _2
Long-Term Debt - Schedule of Long-Term Debt (Parenthetical) (Detail) | 6 Months Ended |
Jun. 30, 2020 | |
Debt Instrument [Line Items] | |
Total debt average term | 9 years 4 months 24 days |
Total debt average rate | 5.00% |
Senior Secured Term Loan Facilities [Member] | |
Debt Instrument [Line Items] | |
Effective interest rate | 2.80% |
Senior Secured Notes [Member] | |
Debt Instrument [Line Items] | |
Effective interest rate | 5.10% |
Other Senior Secured Debt [Member] | |
Debt Instrument [Line Items] | |
Effective interest rate | 5.00% |
Senior Unsecured Notes [Member] | |
Debt Instrument [Line Items] | |
Effective interest rate | 5.50% |
Long-Term Debt - Additional Inf
Long-Term Debt - Additional Information (Detail) - USD ($) $ in Millions | 1 Months Ended | 3 Months Ended | 6 Months Ended | ||||
Feb. 29, 2020 | Jun. 30, 2020 | Dec. 31, 2019 | Jun. 30, 2019 | Jun. 30, 2020 | Jun. 30, 2019 | Dec. 31, 2020 | |
Debt Instrument [Line Items] | |||||||
Pretax loss on retirement of debt | $ 0 | $ 0 | $ 295 | $ 0 | |||
Secured Debt [Member] | |||||||
Debt Instrument [Line Items] | |||||||
Pretax loss on retirement of debt | $ 295 | ||||||
6.25% Senior Notes Due 2021 [Member] | |||||||
Debt Instrument [Line Items] | |||||||
Early Repayment of Senior Debt | $ 1,000 | ||||||
Debt Instrument, Redemption Price, Percentage | 6.25% | ||||||
7.50% Senior Notes Due 2022 [Member] | |||||||
Debt Instrument [Line Items] | |||||||
Early Repayment of Senior Debt | $ 2,000 | ||||||
Debt Instrument, Redemption Price, Percentage | 7.50% | ||||||
Senior Unsecured Notes [Member] | |||||||
Debt Instrument [Line Items] | |||||||
Debt instrument, principal amount | $ 2,700 | ||||||
Debt instrument, stated interest | 3.50% | ||||||
Debt Instrument, Interest Rate, Effective Percentage | 5.50% | 5.50% | |||||
Senior Secured Three Six Four Day Term Loan Facility [Member] | |||||||
Debt Instrument [Line Items] | |||||||
Maximum borrowing capacity | $ 2,000 | $ 2,000 | |||||
Debt Instrument, Interest Rate, Basis for Effective Rate | LIBOR rate plus 2.50% | ||||||
Debt Instrument, Interest Rate, Effective Percentage | 2.50% |
Share Repurchase Transactions_3
Share Repurchase Transactions and Other Comprehensive Loss - Additional Information (Detail) - USD ($) $ / shares in Units, shares in Thousands, $ in Millions | 3 Months Ended | |||
Mar. 31, 2020 | Jun. 30, 2020 | Jan. 31, 2020 | Jan. 31, 2019 | |
Share repurchase program authorized amount | $ 2,000 | $ 2,000 | ||
Repurchase of common stock, shares | 3,287 | |||
Repurchase price of common stock, per share | $ 134.18 | |||
Board of Directors Chairman [Member] | ||||
Share repurchase program authorized amount | $ 4,000 | $ 2,000 | ||
Share repurchase program, remaining authorized repurchase amount | $ 2,800 |
Share Repurchase Transactions_4
Share Repurchase Transactions and Other Comprehensive Loss - Components of Accumulated Other Comprehensive Loss (Detail) $ in Millions | 6 Months Ended |
Jun. 30, 2020USD ($) | |
Equity [Abstract] | |
Unrealized gains on available-for-sale securities, beginning balances | $ 14 |
Unrealized gains on available-for-sale securities | 9 |
Unrealized gains on available-for-sale securities, ending balances | 23 |
Foreign currency translation adjustments, beginning balances | (283) |
Foreign currency translation adjustments | (71) |
Foreign currency translation adjustments, ending balances | (354) |
Defined benefit plans, beginning balances | (187) |
Defined benefit plans, expense reclassified into operations from other comprehensive income | 6 |
Defined benefit plans, ending balances | (181) |
Change in fair value of derivative instruments, beginning balances | (4) |
Change in fair value of derivative instruments | (51) |
Change in fair value of derivatives instruments, expense reclassified into operations from other comprehensive income | 5 |
Change in fair value of derivative instruments, ending balances | (50) |
Accumulated other comprehensive income (loss), net of tax, beginning balances | (460) |
Unrealized gains on available-for-sale securities, net of income taxes | 9 |
Foreign currency translation adjustments | (71) |
Change in fair value of derivative instruments, net of income tax benefit | (51) |
Expense reclassified into operations from other comprehensive income, Total | 11 |
Accumulated other comprehensive income (loss), net of tax, ending balances | $ (562) |
Share Repurchase Transactions_5
Share Repurchase Transactions and Other Comprehensive Loss - Components of Accumulated Other Comprehensive Loss (Parenthetical) (Detail) $ in Millions | 6 Months Ended |
Jun. 30, 2020USD ($) | |
Equity [Abstract] | |
Unrealized gains on available-for-sale securities, income tax expense | $ 3 |
Foreign currency translation adjustments, income tax benefit | 10 |
Change in fair value of derivative instruments, income tax benefit | 15 |
Defined benefit plans, Expense reclassified into operations from other comprehensive income, Income tax benefits | 2 |
Change in fair value of derivative instruments, Expense reclassified into operations from other comprehensive income, Income tax benefits | $ 1 |
Segment and Geographic Inform_3
Segment and Geographic Information - Additional Information (Detail) | 6 Months Ended |
Jun. 30, 2020Hospital | |
Segment Reporting Information [Line Items] | |
Number of geographically organized groups | 2 |
Number of owned and operated hospitals | 186 |
Reorganization Group [Member] | National Group [Member] | |
Segment Reporting Information [Line Items] | |
Number of owned and operated hospitals | 96 |
Reorganization Group [Member] | American Group [Member] | |
Segment Reporting Information [Line Items] | |
Number of owned and operated hospitals | 84 |
Reorganization Group [Member] | Corporate and Other [Member] | |
Segment Reporting Information [Line Items] | |
Number of owned and operated hospitals | 6 |
Segment and Geographic Inform_4
Segment and Geographic Information - Schedule of Geographic Distributions of Revenues, Equity in Earnings of Affiliates, Adjusted Segment EBITDA, Depreciation and Amortization and Assets (Detail) - USD ($) $ in Millions | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2020 | Jun. 30, 2019 | Jun. 30, 2020 | Jun. 30, 2019 | |
Segment Reporting Information [Line Items] | ||||
Revenues | $ 11,068 | $ 12,602 | $ 23,929 | $ 25,119 |
Equity in earnings of affiliates | (1) | (8) | (8) | (19) |
Adjusted segment EBITDA | 2,666 | 2,293 | 4,866 | 4,834 |
Depreciation and amortization | 691 | 636 | 1,365 | 1,255 |
Interest expense | 388 | 477 | 816 | 938 |
Losses (gains) on sales of facilities | 27 | (18) | 20 | (17) |
Losses on retirement of debt | 0 | 0 | 295 | 0 |
Income before income taxes | 1,560 | 1,198 | 2,370 | 2,658 |
National Group [Member] | ||||
Segment Reporting Information [Line Items] | ||||
Revenues | 5,546 | 6,444 | 12,020 | 12,761 |
Equity in earnings of affiliates | (4) | (3) | (3) | (5) |
Adjusted segment EBITDA | 1,485 | 1,364 | 2,700 | 2,818 |
Depreciation and amortization | 312 | 283 | 618 | 548 |
American Group [Member] | ||||
Segment Reporting Information [Line Items] | ||||
Revenues | 5,103 | 5,626 | 10,847 | 11,221 |
Equity in earnings of affiliates | (2) | (11) | (11) | (22) |
Adjusted segment EBITDA | 1,408 | 1,117 | 2,523 | 2,258 |
Depreciation and amortization | 295 | 270 | 582 | 551 |
Corporate and Other [Member] | ||||
Segment Reporting Information [Line Items] | ||||
Revenues | 419 | 532 | 1,062 | 1,137 |
Equity in earnings of affiliates | 5 | 6 | 6 | 8 |
Adjusted segment EBITDA | (227) | (188) | (357) | (242) |
Depreciation and amortization | $ 84 | $ 83 | $ 165 | $ 156 |