HCA Healthcare's (HCA) Q2 results were largely in line with the company's pre-release but Health Insurance Exchange headwinds offsetting a $540 million benefit from a Florida program recognized in the quarter, RBC Capital Markets said in a note emailed Monday.

RBC said it was not surprised by HCA Healthcare's resetting of its core earnings before interest, taxes, depreciation, and amortization growth expectations for this year, to "more in line with with the long-term historical 4-6% target" amid the Affordable Care Act headwind as well as "softness" in surgical volumes.

The investment firm said that HCA Healthcare's management confirmed that the main drivers of the increased full-year Health Insurance Exchange headwind estimate were two assumptions that did not happen: that about 15% to 20% of people losing exchange coverage would move to employer-sponsored insurance and also that newly uninsured people would show lower hospital utilization.

Meanwhile, HCA Healthcare's surgical volume was hit by the disenrollment from Health Insurance Exchange and consumer weakness, RBC said, adding the company saw same-facility inpatient surgeries down 2.3% and outpatient surgeries decreasing 3.4% in the quarter. Also, elective inpatient surgeries fell 6% year-to-date versus a 2% drop last year, RBC said.

The investment firm noted, however, that HCA Healthcare's insured volumes, excluding exchanges, rose 3.2% in Q2 and 2.2% year-to-date, which indicates "durable underlying demand."

RBC reiterated HCA Healthcare's outperform rating and $435 price target.

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