Pittsburgh is a city that built itself on steel. When that industry faltered, the city didn’t buckle. It reinvented itself with eds and meds — a new identity constructed around health care and the universities that train medical professionals.
That can feel safer than the fluctuations of manufacturing. History shows the rise and fall of products and industries as technologies emerge and new competitors take hold. Keeping people healthy is not something that can be outsourced to another state with better tax incentives or another country with cheaper labor.
Medicine as an industry, however, depends on people being able to afford the product.
The Bureau of Labor Statistics puts the number of health care providers and technicians in Pennsylvania at more than 422,000. That’s more than 7% of the state’s working population. That doesn’t even count the support staff who keep the doors open — records clerks, accountants, janitors, security guards and others.
But the need for hospitals as both providers and employers doesn’t change the fact that health care can be a complicated business.
Hospitals grow and change. They merge. They compete. They experience ups and downs. They deal with the challenges of private insurance and government programs.
A recent report from watchdog group Public Citizen identified 446 hospitals it said could be vulnerable because of financial pressures tied to changes in federal Medicaid and Children’s Health Insurance Program funding. UPMC Greene, UPMC McKeesport, UPMC Mercy and Highlands Hospital were among them.
The findings echoed a 2025 Pennsylvania Health Access Network analysis that identified 47 hospitals across the state that could be negatively affected by Medicaid cuts, including the same three UPMC facilities.
This isn’t shocking. Hospitals, ambulance services and other providers for years have lamented reimbursement rates from federal programs and the impact on the services they provide. It has been cited when hospitals see red ink and when they network together to share the burden. Excela Health, for example, merged with Butler Health System to create Independence Health System in 2023. A subsequent acquisition by West Virginia University Health System was announced in November.
UPMC shrugged off the Public Citizen report with language about “long-term stability” and “systemwide resources.” The nonprofit’s numbers support that, with revenues in the black for 2025, reversing losses from 2024. The system even is extending its reach into Ohio with the addition of Trinity Health System’s four hospitals.
That doesn’t mean concerns about Medicaid reimbursements or other government funding changes should be dismissed.
Hospitals rarely vanish overnight. More often, financial pressure shows up in smaller ways first — staffing shortages, longer waits, reduced departments, fewer specialists or cuts to services that may not generate revenue but remain critical to a community.
Western Pennsylvania understands better than most places what happens when foundational industries begin to strain. For a region built around eds and meds, paying attention to those pressures now is wiser than waiting for a crisis later.