CHICAGO — Fitch Ratings and Moody’s Investors Service are maintaining their negative outlooks on the nonprofit health care sector, warning that the industry faces a slew of pressures ranging from risks associated with variable-rate debt to the uncertainty of national health care reform and the likelihood of state and federal reimbursement cuts over the next 12 to 18 months.

While still grappling with the market turmoil and economic recession of 2008, providers now face “one of the toughest environments in decades,” Moody’s said in a recent report.

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