HCA is stealing its workers’ pay to fund a $10 billion buyback.
Esther Reyes cleans the rooms where patients recover at HCA’s Las Palmas hospital in El Paso. She earns $16.80 an hour. She is a single mother of three. “Sometimes I need to decide, maybe this month I pay the water bill, then another pay for gas,” she has said. “I’m struggling. I struggle a lot. If they gave us the raise we want, it would be a huge blessing.”
The workers are asking for a pathway to $25 an hour. That is not a demand for a windfall. It is a request that a floor exist under the work that produces the profit.
Here are the numbers. HCA reported $6.8 billion in profit in 2025, up 17.8 percent from the year before. In early 2026, its board authorized $10 billion to buy back the company’s own shares. A buyback is a corporation spending cash to purchase its stock, concentrating the remaining value among shareholders. It is not weather. It is a decision.
HCA employs more than 300,000 people across the United States and the United Kingdom. About 22,000 workers are involved in the current contract negotiations. A $10-an-hour raise for all of them, at full-time hours, would cost about $457 million a year — under 7 percent of one year’s profit. The $10 billion authorization would cover twenty-two years of that raise.
The company could pay the workers, keep the buyback, and still report record profits. It chooses not to.
Sam Hazen, HCA’s chief executive, received more than $26.5 million in total compensation in 2025. That was 420 times the company’s reported median employee pay of $62,955. Put the three receipts side by side: the profit, the buyback, the executive compensation. The money is all there. The question the company has answered is where the money goes.
The public pays at both ends. At $16.80 an hour, a family of Reyes’s size can qualify for SNAP — the food-assistance program once known as food stamps — the earned-income tax credit, a federal wage subsidy for low-income work, and subsidized health coverage. HCA’s revenue also includes payments made through Medicare and Medicaid for the care its hospitals provide. The taxpayer helps finance the care, then helps support the workers HCA will not pay enough to live on. The shareholders take the middle.
That is wage suppression externalized onto the public. It requires no leverage at all. The cost simply moves off the company’s books and onto workers, families, and taxpayers. Privatized profits. Socialized losses.
The operating metrics can look fine while the extraction sits somewhere else. It lives in the financing activities — the section of the cash-flow statement where the buyback appears — not in the line reporting the hospital’s day-to-day operations. The worst extraction is often not on the income statement at all.
A wage is taxed as income when it is paid. A buyback is treated differently. If the shareholder holds the appreciated stock, the owner can borrow against it; a loan is not income. At death, the tax basis resets to market value, erasing the lifetime gain for income-tax purposes. SEC Rule 10b-18 has provided buybacks a safe harbor from market-manipulation charges since 1982. The code makes the choice cheap. Paying a worker triggers withholding. Returning the same cash through a buyback triggers nothing at the point of transfer.
The hospital system that cannot afford $25 an hour can afford $10 billion returned to shareholders. The difference is not an accounting accident. It is a transfer the tax code subsidizes.
HCA’s workers have taken the fight public. There was a rally outside Sunrise Hospital in Las Vegas on August 6 and informational pickets at more than a dozen hospitals across California, Texas, Nevada, and Florida. The pattern is the same one that sent 31,000 Kaiser Permanente health workers to the picket lines in January: wages and staffing are not separate disputes when understaffing is part of the business model.
Jody Domineck, a pediatric nurse with more than twenty years at HCA Sunrise in Las Vegas, has described walking away from a parent whose child was having a procedure. The parent was crying alone in a hallway. Domineck had other patients who needed her.
The relationship between nurse staffing and patient mortality is among the most replicated findings in health-services research. A staffing ratio is the number of patients assigned to each nurse. It is also a hiring commitment. A raise is a line item. A ratio changes the staffing model that produces the profit.
The workers sought binding nurse-to-patient ratios in statute. Nevada’s legislature sent a safe-ratio bill to Governor Joe Lombardo in 2025. He vetoed it. When the public route was blocked, the workers carried the guarantee to the bargaining table.
HCA’s statement says that “portraying this as a patient safety issue is inaccurate” and that “the outstanding issues are about compensation.” Read that statement again. It concedes that compensation is outstanding. What it asks is that the staffing question be classified out of the dispute.
That is the intellectual-laundering operation in the company’s own words: reduce the fight to money so the staffing model stays off the table. The demand is read as an expense. The consequence is removed from view.
The company’s history explains why this matters. Private equity took HCA private in 2006 in what was then the largest leveraged buyout in American history — a transaction in which acquisition debt was loaded onto the hospitals themselves — and took it public again in 2011. The buyback is the mature form of that arrangement: value routed to the owners of capital while the people doing the work are priced at the margin and the public backfills the difference.
California has set nurse-to-patient ratios by statute for two decades. Its hospitals did not close, as the industry predicted. A $25-an-hour floor for the people cleaning patient rooms is a rounding error against a $10 billion authorization. What is missing is not arithmetic. It is the willingness to allocate the money toward the people who produce the care.
The 2022 law placed a 1 percent excise tax on stock buybacks by publicly traded companies. On HCA’s $10 billion repurchase, that charge would be roughly $100 million — barely more than a rounding error against $6.8 billion in profit. The Joint Committee on Taxation scored the provision at $74 billion over ten years. The direction of policy is clear: raise the charge until choosing a living wage over a buyback is no longer free. The buyback economy was manufactured by a rule. It can be unmade by a price.
A baseline is not a forecast. It states what current choices produce.
These are the current choices: $10 billion authorized for shareholders, $16.80 an hour for the rooms, and a veto where a safe ratio might have been law.
The company says the outstanding issues are about compensation. That is the one true sentence in its statement. The wages are outstanding. The buyback is authorized. The parent cried in the hallway alone.