Fitch downgrades Ascension Health to AA

Fitch Ratings downgraded Ascension Health’s issuer default rating and long-term revenue bond rating to AA from AA-plus, citing operating performance and expected debt.

The downgrade affects $5.5 billion in bonds. 

Fitch said Ascension had recovered to profitability after suffering $1.4 billion in losses in fiscal 2024 but the level of profits is inadequate to justify a AA-plus rating. 

The fiscal 2024 losses consisted of about $400 million associated with non-recurring activities and asset impairment and $1 billion stemming from a cybersecurity attack and a separate third-party patient claims clearinghouse incident. 

Through divesting acute and post-acute care assets that were losing money, Ascension eliminated over $575 million in operating losses and about $500 million in future capital spending. 

Fitch expects Ascension to issue up to $4.2 billion in additional debt, which “will constrain cash-to-debt to a level more consistent with a AA rating.”

In June Ascension signed an agreement to acquire AMSURG, the third largest developer and operator of ambulatory surgery centers in the United States. Ascension expects the transaction to close at the end of second quarter or beginning of third quarter of fiscal 2026 and to be immediately financially positive. 

Ascension is one of the largest Catholic non-profit healthcare systems in the United States. As of June 30 it operated 121 hospitals, 59 ambulatory surgery centers and 30 post-acute facilities. It operates in 16 states mainly in the Southeast, Southwest and Midwest and has its headquarters in St. Louis, Missouri. 

The revenue bonds are rated Aa2 with a negative outlook by Moody’s Ratings and AA with a stable outlook by S&P Global Ratings.

Repeated efforts to contact Ascension Health for a comment failed.