Analysts at S&P Global Ratings note that uncertainty around ACA intensifies risks for healthcare services providers. "We believe the healthcare services sector faces the greatest risk of downgrades when considering the trends now shaping the healthcare industry," a Dec. 15 S&P Global Ratings report notes. "Healthcare reform has been a hot topic for well over two decades, but it is now well-entrenched, and we do not envision a return to the days of old. The tumultuous political environment may call into question the path further reform will take, but in any reasonable scenario, the credit risk is greatest for health care services companies." Additionally, ratings in the pharmaceutical sector are also expected to remain strained largely due to the potential for increased M&A activity in the sub-sector, where companies may compromise the strength of their balance sheets to boost product pipelines or improve their competitive positions, S&P Global Ratings says.