Fitch downgraded Ascension’s credit rating to “AA” from “AA+” despite the St. Louis-based system cutting its operating loss by $1.3 billion in fiscal 2025.
Ascension reported a $490.9 million operating loss (-1.6% operating margin) for the fiscal year ended June 30, an improvement from an operating loss of $1.8 billion (-6.3% margin) in 2024.
Fitch said in a Sept. 17 report that the downgrade reflects Ascension’s improving but still rebounding operating results. The ratings agency noted that Ascension’s performance materially improved in 2025 and is trending favorably, but not at the level it deems adequate for the higher rating.
Additionally, Fitch said it expects Ascension to issue up to $4.2 billion of additional debt, which will “constrain cash-to-debt to a level more consistent with a ‘AA’ rating.”
At the “AA” level, Ascension retains more financial flexibility as it restores operating margins and cash flows to levels in line with its historical performance, the report said.
“Fitch maintains that Ascension exhibits unique credit features found in only a few provider health systems, including national size and scale and a significant presence in key growth markets such as Texas, Florida, Tennessee and Indiana,” the report said.
The agency said it also views the system’s exit from lower-growth, underperforming markets as credit positive. It also views Ascension’s pending acquisition of ASC operator AmSurg as a “favorable opportunity to expand Ascension’s ambulatory strategy and geographic reach.”
