Moody's Investors Service affirmed Harris County (Texas) Hospital District's "A2" revenue bond rating, affecting $263 million of debt.
The district, which oversees three hospitals, also has $66 million of outstanding general obligation bonds that are unaffected by the action.
The rating reflects the essential role that Harris County Hospital District plays in the local market by offering a safety net hospital, teaching hospital and trauma service provider.
While the rating takes into account the district's significant property tax credits, the positive attributes are offset by a challenging payer mix that includes a large uninsured patient base.
The rating outlook is stable.