Not-for-profit healthcare

The bankruptcy judge suggested Jackson Hospital and Clinic may be closed if it doesn't propose a plan of adjustment before the end of the calendar year.

Fitch Ratings cited the hospital's growing revenue and other factors in lifting the issuer's outlook.

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 Pennsylvania healthcare system is touting plans to grow its network as it funds an expansion for its largest hospital, in York.

While the cost of caring for older people can pressure municipal issuers, in states like Florida wealthy seniors can also contribute to economic vibrancy.

The outlook revision to negative for the Texas Biomedical Research Institute cited weakened liquidity and reliance on federal grants, the rating agency said.

Legacy Health, an eight-hospital Portland, Ore.-based healthcare system, that abandoned merger plans in May received a downgrade and negative outlook from Moody's Ratings.

"Rural hospitals were already uninvestible, in our mind," Columbia Threadneedle's Shannon Rinehart said. "What this has done is blow up any chance they have."

Hunt Memorial Hospital District's distressed finances led to downgrades to Ba3 by Moody's Ratings and B-plus by S&P Global Ratings, with both giving it a negative outlook.

Medicaid cuts and tariffs are expected to pressure already struggling small rural and urban hospitals, including 18 in California that borrowed from the state.