S&P Global Ratings revised its outlook to stable from positive and affirmed its 'A+' rating on Michigan Finance Authority's revenue debt, issued for MidMichigan Health (MidMichigan). The outlook revision to stable reflects MidMichigan's unexpectedly thin operating margin in fiscal 2018, which fell short of management's budgeted operating margin and represented considerably weaker performance than in the year before. Several factors contributed to the softer operating performance, including the systemwide electronic medical record (EMR) implementation and investment in new providers. While management has vigorously responded to these pressures and has seen improvement through the first half of unaudited 2019, in our view, MidMichigan's recent history of lighter performance and continued near-term headwinds, such as the completion of its EMR implementation, will
