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    "text": "Fitch Ratings warns Trump policies could \"negatively affect\" the finances of state and local governments: \"While most issuers have the resources to handle revenue and cost stresses, those with less financial flexibility may experience ratings pressure.\"",
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          "alt": "Federal policies on tariffs and immigration, program and funding reductions effected through executive orders, and likely federal budget cuts could negatively affect U.S. public finance (USPF) and public infrastructure issuers’ operating environment and finances, Fitch Ratings says. While most issuers have the resources to handle revenue and cost stresses, those with less financial flexibility may experience ratings pressure.\n\nIf there is a significant reduction in the federal government’s share of Medicaid expenses in the pending reconciliation bill in Congress, states and not-for-profit (NFP) hospitals would be hit the hardest. Medicaid is an average of 20% of the payor mix for NFP hospitals. Lower revenues and higher unreimbursed expenses from self-pay patients would slow hospitals’ financial recovery, particularly for hospitals with a relatively large share of Medicaid patients and narrower margins.\n\nFederal revenues make up 30%-60% of most states’ total revenues, with approximately two-thirds coming from Medicaid funding. States are bound by federal statutory and regulatory Medicaid requirements but may reduce spending by lowering provider rates and limiting covered services. States generally have the fiscal capacity and flexibility to endure cuts and maintain financial performance, albeit with narrower margins and potential reserve draws.\n\nTariffs impacts depend on the severity and duration of the trade war. State and local governments with large agricultural and manufacturing sectors are particularly vulnerable to trade disruptions. NFP hospital supply costs would increase, although those with strong operating margins will be able to absorb costs without affecting their credit ratings. Academic hospitals face dual challenges from both tariffs and federal research funding recissions.\n",
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    "langs": [
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    "createdAt": "2025-05-08T15:19:45.812Z"
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}