With health care reform and the passage of the Affordable Care Act, the industry faces increasing uncertainty over how an organization will be able to manage with less robust revenue and accelerating consolidation, according to a new study by National Public Finance Guarantee Corp.

These factors pose challenges when addressing the long-term creditworthiness of the nonprofit health care sector, because hospitals are stuck between bad debt expenses and liquidity stress that came from the past recession, and conflicting court cases over health care reform in the coming years.

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