ISRG's US Procedure Growth Slows: Is ACA Headwind a Temporary Concern?

Intuitive Surgical ISRG has faced a moderation in U.S. procedure growth during the first half of 2026, but management’s commentary suggests the slowdown is more likely a temporary demand-timing issue than evidence of a structural deterioration. U.S. da Vinci procedures grew 12% in the second quarter, down from 14% in the first quarter. da Vinci procedure growth was 17% in the fourth quarter of 2025.

Management pointed to a modest adverse impact from the expiration of enhanced ACA premium subsidies. Customer feedback indicated that changes in insurance coverage and premium dynamics affected the timing of patient visits, particularly for procedures that can be postponed.

Intuitive Surgical also stated that the underlying disease burden remains unchanged, implying that deferred benign procedures should eventually return as patients re-enter the healthcare system. Management also noted that the procedure moderation likely reflected a combination of ACA-related effects and the “law of large numbers,” rather than a single factor. The distinction between deferrable and non-deferrable procedures was particularly important, with the former showing greater moderation.

For the second half, investors should nevertheless expect some pressure on reported growth. Intuitive Surgical maintained its 2026 da Vinci procedure growth forecast of 13.5-15.5%, expecting performance toward the midpoint. Management flagged tougher U.S. comparisons in the third quarter, alongside seasonal effects internationally, while incorporating ACA-related patient behavior into its outlook.

At this stage, the slowdown does not appear structural. U.S. utilization still increased 3%, while system placements rose 24%, and management said ACA concerns had not affected the capital pipeline. Strong adoption of da Vinci 5 continues to support upgrades and capacity expansion. The key risk is the duration of deferred procedures, rather than weakening underlying demand for robotic surgery.

Peer Updates

Globus Medical’s GMED robotic platform faced a softer Enabling Technologies quarter, with revenues declining 26% year over year to $26.1 million. The company attributed the decline primarily to its shift toward greater flexibility in capital acquisition, rather than explicitly citing ACA premium-subsidy changes.

Despite lower capital revenues, demand for Excelsius technology remained healthy. EGPS and eHub units deployed through sales, leases or rentals rose 25% year over year, while robotic utilization surpassed 137,000 procedures. Management also acknowledged tougher second-half comparisons and remained cautious on its outlook because of Enabling Technologies’ strategy shift and Nevro integration.

Stereotaxis’ STXS robotic business continues to face commercialization and procedure-related headwinds, but management did not specify any headwind from ACA premium subsidy expiration. Revenues declined 13% year over year to $7.7 million, partly because no robotic system was delivered during the quarter.

Management also cited “general pressure on procedures” as the company transitions from Johnson & Johnson and ramps up its own catheter manufacturing. Catheter supply constraints remain a bigger near-term bottleneck as demand exceeds available production, limiting shipments despite customer orders. STXS’ robotic growth is currently constrained more by product availability, hospital adoption, and procedure volumes than by any clearly identified impact from ACA subsidy changes.

ISRG’s Price Performance, Valuation and Estimates

Shares of ISRG have lost 29.2% so far this year compared with a 6.8% decline of the industry.

Image Source: Zacks Investment Research

From a valuation standpoint, Intuitive Surgical trades at a forward price-to-earnings ratio of 34.95X, above the industry average. But it is significantly lower than its five-year median of 69.05X. ISRG carries a Value Score of D.

Image Source: Zacks Investment Research

The Zacks Consensus Estimate for Intuitive Surgical’s 2026 earnings implies a 20.3% rise from the year-ago period’s level.

Image Source: Zacks Investment Research

The stock currently carries a Zacks Rank #3 (Hold). You can see the complete list of today’s Zacks #1 Rank (Strong Buy) stocks here.

Beyond Nvidia: AI's Second Wave Is Here

The AI revolution has already minted millionaires. But the stocks everyone knows about aren't likely to keep delivering the biggest profits. AI’s second wave is moving from infrastructure to implementation and these companies are at the forefront of this transition, positioned to become what Amazon and Google were to the internet era.

Want the latest recommendations from Zacks Investment Research? Today, you can download 7 Best Stocks for the Next 30 Days. Click to get this free report

This article originally published on Zacks Investment Research (zacks.com).

Zacks Investment Research