Tenet Posts Q4 Results Above Expectations, Braces for $250M ACA Subsidy Fallout

Higher acuity and favorable payer mix positions Tenet for 2026, but the expiration of Affordable Care Act subsidies is projected to damper earnings.

Published on Feb. 24, 2026

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Tenet Healthcare reported strong fourth quarter 2025 financial results, with net operating revenues of $5.53 billion and net income of $371 million. However, the company warned that the expiration of enhanced Affordable Care Act (ACA) premium tax credits is expected to result in a $250 million hit to its 2026 adjusted EBITDA, primarily in the hospital segment, as ACA enrollment is projected to drop by 20%.

Why it matters

The expiration of ACA subsidies is a significant policy shift that will impact many healthcare providers, as exchange plan enrollment and revenues are expected to decline. Tenet's experience highlights the challenges facing the industry as it navigates this transition, and the importance of diversified business models to help offset such headwinds.

The details

Tenet's Q4 2025 results showed strong performance, with higher-acuity services and margin discipline driving growth. However, the company warned that the end of enhanced ACA premium tax credits will lead to a 20% drop in ACA enrollment, with 10-15% of people switching to alternate coverage. This is expected to result in a $250 million hit to Tenet's 2026 adjusted EBITDA, primarily in its hospital segment. Other major health systems have also projected significant losses due to the ACA subsidy lapse. To offset this, Tenet is focusing on growth in its ambulatory surgery arm, USPI, which has less exposure to exchange coverage.

  • Tenet reported Q4 2025 financial results on February 24, 2026.
  • The expiration of enhanced ACA premium tax credits is expected to impact Tenet's 2026 financial performance.

The players

Tenet Healthcare

A for-profit healthcare services company based in Franklin, Tennessee.

Sun Park

Tenet's Chief Financial Officer.

Saum Sutaria

Tenet's Chief Executive Officer.

United Surgical Partners International (USPI)

Tenet's ambulatory surgery arm, which continues to benefit from procedural growth and higher-acuity cases migrating to outpatient settings.

CommonSpirit Health

A healthcare system that Tenet recently completed a transaction with to regain full ownership of its revenue cycle management arm, Conifer Health Solutions.

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What they’re saying

“Clearly, there are a wide range of potential outcomes here, and we will continue to monitor enrollment levels and effectuation rates.”

— Sun Park, Chief Financial Officer (HealthLeaders Media)

“Tenet's diversified portfolio will help cushion the blow.”

— Saum Sutaria, Chief Executive Officer (HealthLeaders Media)

What’s next

Tenet will continue to monitor ACA enrollment levels and effectuation rates as it navigates the impact of the expiration of enhanced subsidies. The company's growth strategy will focus on expanding its ambulatory surgery platform, USPI, through acquisitions and new partnerships.

The takeaway

The expiration of ACA subsidies is a significant challenge facing the healthcare industry, as it will lead to declines in exchange plan enrollment and revenues. Tenet's experience highlights the importance of diversified business models and a focus on higher-acuity services to help offset such policy shifts and maintain financial performance.