Marcus and Vic welcome Kevin Holloran, Senior Director and head of the US Public Finance Healthcare Team at Fitch Ratings, to break down how credit ratings work in healthcare, why balance sheet strength outweighs short-term operating swings, and how margins shifted from steady pre-COVID levels through pandemic collapse, the 2021 rebound, and the post-2022 labor and inflation crunch. They cover Fitch’s focus on hospitals and life plan communities, the sector’s “trifurcation” between winners, rural strugglers, and those stuck in the middle, and the impact of July’s policy shifts—including Medicaid pressures, site-neutral payments, supplemental payment changes, tariffs, and 340B tensions. Kevin also outlines system strategy around scale and outpatient migration, risks for life plan residents, and why the sector’s near-term stability masks growing uncertainty for 2025–26.

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