...Stability Expected Despite Inherent Risk: While critical access hospitals (CAHs) are inherently vulnerable to shifts in reimbursement due to their limited revenue base, Fitch Ratings expects its rated portfolio to remain stable despite increasing revenue pressures. Those CAHs in Fitch's rated portfolio with investment-grade ratings demonstrate strong financial cushion against potential reimbursement pressure and operating uncertainty. As such, the majority of rating actions and outlooks in 2015 is expected to be affirmations at Stable. Strong Political Support: Fitch believes that CAHs enjoy strong bipartisan legislative support that will prevent significant changes to the reimbursement program over the near to medium term. Furthermore, Medicare expenditures in support of the CAH program comprise a very small percentage of the overall Medicare budget despite their relative proliferation across the country. For these reasons, Fitch does not consider fundamental or wholesale changes to the...
