Moody's recently downgraged the outlook for non-profit hospitals in 2014 according to its recent study due the employers shifting commerically insured patients to the new, health insurance exchanges.  The study indicated that the downgrade is a result that the payments under many of the health insurance plans sold on the exchanges will have higher deductibles and copayments and lower rates.  With more out of pocket payments there is a risk of higher bad debt.  Also, Moody's report indicated that employers are moving to private exchanges not covered by the Affordable Care Act.  This could also have a similar impact on the hospitals as health insurance premiums for these plans become more competitive and hospital reimbursement is reduced.  The study which is available to subscribers is located at https://www.moodys.com/research/Health-Insurance-Exchanges-Are-A-Modest-Credit-Negative-for-Not-PBM_PBM159234   Even though there hospitals should be better off from more patients with insurance and fewer uninsured patients, Moody's focused on the timing of this transition having negative impact for 2014.