ACHC vs HCA: Which Is the Better Buy in 2026?

Same yardstick, side by side (as of October 2026). Valuation lined up like this is most meaningful for two names in the same corner of the market, which these are. Figures are approximate; verify before investing.

The metrics above tell you which is the marginally better business. The bigger risk for most people is not picking the slightly worse stock, it is over-concentrating. ACHC and HCA share themes, so owning both, or adding either to what you already hold, can quietly push a large share of your portfolio into one bet.

This is the part a generic comparison page cannot answer, because it depends on what you own. Connect your brokerage and Walnut shows your real, combined ACHC and HCA exposure, flags overlap with your existing positions, and tells you if adding one would tip you past a concentration you are comfortable with, read-only by default, with your login staying at your broker. Walnut is not an investment adviser.

Acadia Healthcare (NASDAQ: ACHC) is the leading pure-play behavioral healthcare provider in the United States, operating roughly 277 facilities with more than 12,500 licensed beds across about 40 states and Puerto Rico as of the end of 2025. Its business spans four service lines: acute inpatient psychiatric hospitals (its largest and fastest-growing segment), specialty treatment facilities, comprehensive treatment centers for opioid-use disorder, and residential treatment centers. Revenue is heavily tied to government payors, with Medicaid at roughly 58 percent, commercial at about 25 percent, and Medicare near 14 percent, and no single facility contributing more than about 4 percent of total revenue.

Full ACHC guide

HCA Healthcare is the largest for-profit hospital system in the United States, operating a network of acute-care hospitals alongside surgery centers, urgent-care clinics, freestanding emergency rooms, and physician clinics. Its strategy centers on building dense local networks in growing Sun Belt and suburban markets, where controlling a large share of care lets it negotiate better rates with commercial insurers, recruit physicians, and spread fixed costs. In the first quarter of 2026 HCA reported revenue of about $19.1 billion, up roughly 4% year over year, with net income near $1.6 billion and diluted EPS of about $7.15, and it reaffirmed full-year 2026 guidance of roughly $76.5 billion to $80.0 billion in revenue and $15.55 billion to $16.45 billion in adjusted EBITDA. The second quarter, ended June 30, was stronger: revenue of about $20.2 billion, up roughly 9%, net income near $1.7 billion and EPS of $7.59 against a $7.50 estimate. Trailing twelve-month revenue now stands near $78 billion, with net income of about $6.8 billion.

Full HCA guide

Both fit overlapping themes, but they are not interchangeable. The useful comparison is which set of drivers and risks you want exposure to.

• ACHC drivers: Structural demand for behavioral health; Bed expansion and de novo growth.
• HCA drivers: Scale and local-market density; Outpatient and ambulatory expansion.

A faster-growing, richer-valued name usually swings harder, so it suits a longer horizon and a higher tolerance for volatility; a steadier, more cash-generative business suits a more conservative or income-minded investor. The honest test is which set of risks you could hold through a drawdown: Legal and regulatory exposure is the defining risk. For HCA, the dominant risk is reimbursement and health-care policy.

Growth-minded investors who believe the theme has years to run tend to accept the richer multiple for more upside; value-minded investors lean toward the cheaper forward earnings and steadier profile. Pick ACHC if you believe its drivers more; HCA if you believe its. Many investors hold both, but since they share themes, that is a concentrated bet, not diversification. Decide deliberately and check overlap. For the full detail, see the ACHC and HCA guides.

ACHC. Acadia closed at ~$30.52 on October 16, 2026, up ~114% year to date after the stock rebounded from a 52-week low near $11.43. It trades at about 16.5x forward EPS and ~10.3x EV/EBITDA, with analysts' mean target near $33.79 across 14 firms, so the market is still discounting legal and reimbursement uncertainty. Reported earnings remain depressed by the late-2025 impairment, legal and interest costs even as adjusted metrics grow.

HCA. At about $463 on October 16, 2026, HCA trades near 15.5x trailing and 14.5x forward earnings and about 10x EV/EBITDA, the multiple of a steady, cash-generative operator rather than a high-growth stock, so it reflects reimbursement stability and buyback-driven per-share growth more than rapid revenue expansion. Analysts expect 2026 EPS of about $29.48 rising to about $31.99 in 2027. The biggest variable is still policy: the 2026 guidance bakes in an ACA-subsidy and Medicaid hit that management is partly offsetting, so how those headwinds land in the October 27 report matters more than the headline multiple.

Headline figures (approximate, October 2026): ACHC shows revenue (ttm) ~$3.37B (Q2 2026 ~$866M), 2026 revenue guidance (spring) ~$3.37B to $3.45B, q2 2026 adj. eps ~$0.38 (vs ~$0.35 est.), net income (ttm) ~-$1.13B (late-2025 impairment); HCA shows revenue (ttm) ~$78.0 billion; Q2 2026 ~$20.2 billion, up ~9% year over year, net income (ttm) ~$6.8 billion, ~8.8% net margin, q2 2026 eps vs estimate $7.59 vs $7.50, full-year 2026 guidance (given with q1) Revenue ~$76.5 billion to $80.0 billion; adjusted EBITDA ~$15.55 billion to $16.45 billion.

ACHC and HCA are related but distinct: same themes, different businesses and risks. Neither wins in the abstract; the right pick is whichever thesis you actually believe, sized so you are not over-concentrated in one theme. Walnut can show your combined ACHC and HCA exposure against your real portfolio. It is not an investment adviser.