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The ratings agency cited low days cash on hand and operating losses at the system, which operates one of the leading academic medical centers in Kentucky.
The longer the shutdown of many federal government operations lasts, the worse it becomes for cities, states and other bond-issuing entities.
The county awarded $215 million of general obligation limited tax bonds for a jail project with uncertain future funding to lowest bidder BofA Securities.
The Howard Jarvis Taxpayers Association appealed to California's high court in a case challenging San Jose's plans to issue pension obligation bonds.
Bondholders say the insurers reneged on the bond insurance terms, which both firms deny in filings for the case, filed six years after the COFINA restucturing.