Intuitive on Thursday said growth in the number of U.S. procedures performed with its da Vinci surgical robots slowed in the second quarter, partly because enhanced Affordable Care Act premium subsidies expired at the end of 2025 and Congress didn’t extend them.
The lapse prompted enrollment declines and shifts to higher-deductible insurance policies, according to the company. “In our customer conversations, some have said that changes in patient coverage and premium structures may be affecting when patients seek care and move forward with treatment,” CEO Dave Rosa said on Intuitive’s earnings call.
Shares dropped in Friday morning trading, to $354.26.
Da Vinci procedure growth in the U.S. was 12% in the quarter, moderating from recent trends and from the company’s own expectations at the start of the year.
The slowdown was most visible in procedures patients can postpone.
Slower growth in deferrable procedures
Outside the U.S., da Vinci procedures grew 20% during the same period. The contrast highlights how the subsidy expiration is a domestic issue tied to the U.S. insurance market.
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The pattern of patients delaying elective care after coverage changes isn’t new — it mirrors what happened in other health sectors after past insurance disruptions, though the scale here is tied to a specific federal policy change.
Despite the sluggish U.S. procedure volume, Rosa said system placements were strong, reflecting continued demand for Intuitive’s newer da Vinci 5 platform. It reiterated its forecast for worldwide 2026 da Vinci procedure growth of about 13.5% to 15.5%, predicting it will be closer to the midpoint of that range.
Analysts weigh the impact and the pipeline
Citi Research analyst Joanne Wuensch called the outlook “tricky” in a report to clients, noting prior concerns about the impact of ACA subsidy cuts have now materialized.
“While the update was somewhat tempered by continued strength in the global capital purchasing environment and several updates on the pipeline, it will likely weigh on [Intuitive’s] shares (at least near term),” Wuensch wrote.
Intuitive has submitted “multiple innovations” for Food and Drug Administration clearance, including a flexible robotic endoscope system for use in the gastrointestinal tract, Rosa said. It has submitted a 510(k) application for a noncommercial version of the device.
Other early-stage R&D programs are targeting new disease states. It also recently received regulatory clearance for the da Vinci 5 robot in India.
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The robotic surgery leader, which helped create the market more than two decades ago, now faces competition from companies launching new systems, including Medtronic, CMR Surgical, Distalmotion and Moon Surgical.
New market entrants in the U.S. are trying to gain ground at ambulatory surgery centers, which traditionally haven’t had robotic surgery programs.
Intuitive executives said on the call that the company is selling more refurbished older-model da Vinci systems to ASCs in the U.S. and to customers in cost-constrained countries. Another initiative, aimed at reducing procedure costs, focuses on extending the life of certain instruments used with its systems.
CFO Jamie Samath highlighted cardiac and nipple-sparing mastectomy procedures as promising long-term opportunities that are now in early stages. Procedure growth in both markets accelerated sharply in the second quarter, he said. It is investing in development of cardiac-specific instruments and more clinical evidence to support the mastectomy procedure.
Overall, Intuitive maintains a dominant competitive position with little sign of erosion, said BTIG analyst Ryan Zimmerman in a note after the call. “Emerging opportunities in cardiac, GI, and the ASC setting represent compelling incremental growth vectors, and we continue to view the current procedure softness as transitory rather than a signal of structural demand deterioration,” the analyst said. The company sees opportunities to sup.