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Major swaths of the state’s health care system are now considered “high risk,” with the crisis largely fueled by a major backlog of patients waiting to be discharged from hospitals, the Massachusetts Health and Hospital Association said Monday.

MHA indicated the situation is exacerbated by serious financial challenges at Steward Health Care, which on Friday said it doesn’t plan to close any of its safety-net hospitals in Massachusetts but hinted some facilities may eventually come under new ownership.

The Department of Public Health elevated the risk level of two medical regions — the Boston metropolitan area and northeastern Massachusetts — to Tier 3 last week, a designation that could result in hospitals slashing “elective, non-urgent procedures and services,” MHA said. Hospitals with the designation must also meet frequently to discuss bed availability.

“It is indeed a crisis for those on the frontlines and the public can play a role in helping to alleviate the stresses hospitals are under,” Patricia Noga, MHA’s vice president of clinical affairs, said in the group’s newsletter Monday. “It’s imperative to seek the right care in the right place. Emergency departments will see any patient in need of care, but they are designed to handle severe illnesses and injuries that can’t be addressed in the primary or urgent care setting. Going elsewhere when appropriate saves you time and ensures that patients with true emergencies get the care they need, when they need it.”

The state makes its decisions about risk level tiering, using a scale of 0 to 4, based on risk factors such as a spike in certain diseases, staffing problems, emergency department usage and bed availability. DPH, in an alert sent to providers, said the new risk levels were being issued “in order to assure good situational awareness and rapid response for capacity constraints and workforce challenges.”

Other parts of the state, including southeastern Massachusetts and the Cape and Islands, have been assigned to Tier 3 since the start of 2023. The state in January outlined an agreement among hospitals, insurers and long-term care settings designed to more smoothly and efficiently move patients through hospitals.

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The capacity crunch at hospitals is “made even more precarious due to the unstable finances and uncertainty surrounding the Steward Health Care system,” MHA said.

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Touting the party as “in the strongest position we’ve seen in years,” MassGOP officials on Monday announced major fundraising success and plans to return operations to their former Boston headquarters.

State Republican Party Chairwoman Amy Carnevale, who took the reins just over a year ago with the party’s influence shrinking and finances in disarray, touted the MassGOP’s current footing as a marked improvement and said she is “determined to maintain this momentum” into the current election year.

Carnevale wrote in a message to supporters that the party’s finances have improved significantly since she started. In 2023, MassGOP raised about $770,000, she said.

“This is a huge number,” Carnevale wrote. “Raising money is never easy, especially during an off-year of the election cycle when the party does not have an elected statewide or federal official. Historically, the best comparison would be to 2007. After Governor [Mitt] Romney stepped down, the party was only able to raise approximately $494,000. We outperformed this benchmark, largely through the hard work of our event hosts, donors, and all of you.”

Carnevale said she served without pay in 2023 and kept party staff to a “bare minimum” to help control expenses. She said MassGOP so far paid down $200,000 of “inherited debt from previous leadership.”

The party repaid an unspecified number of vendors and remains in dispute with one other, according to Carnevale, who said MassGOP is still working through additional issues with state and federal political finance regulators.

“As we reported early last year, [the state Office of Campaign and Political Finance] identified $300,000 in misreporting in the 2022 cycle, and we are continuing to work through those issues,” Carnevale wrote. “Similarly, we entered a formal dispute resolution process with the [Federal Election Commission] over 2022 reporting issues. Our attorneys were able to negotiate the fine for this misreporting down to $6,450 while avoiding a full FEC audit of the committee. Additionally, the Party incurred a fine of $15,000 by the Attorney General for alleged campaign finance violations from the 2022 cycle, and this fine has been paid in full.”

Putting it closer to the hub of state government and political media, the party also plans to move its headquarters back to Boston after more than four years operating in Woburn.

Under former MassGOP Chairman Jim Lyons, who previously served as a state representative from Andover, the party in 2019 decamped its offices at 85 Merrimac St. in Boston for an office park in Woburn. Officials said at the time that the move would save nearly $350,000 over five years.

The party will transition operations back to Boston over the course of the month with plans to be fully operational in its old digs by the end of February, Carnevale announced Monday.

“This location is conveniently located near North Station with many public transportation options nearby. The move is paramount to our continued growth and connectivity to the heartbeat of the Massachusetts government where we can be on top of the many failed policies coming out of the Healey Administration and Beacon Hill,” Carnevale wrote, later adding, “With the new Boston location comes opportunities to hire interns, connect with elected officials, and promote conservative values from the epicenter of the state’s media apparatus. This move signifies that the Republican Party is back in the fight.”

It’s not clear exactly how long MassGOP had previously operated out of 85 Merrimac St. Former Lt. Gov. Kerry Healey, a Republican, used it as her campaign headquarters during her unsuccessful 2006 bid for governor.

Although Republicans have had some success winning the corner office, Democrats have long wielded veto-proof supermajority margins in the Massachusetts House and Senate.

The GOP flipped a Senate seat last year when Peter Durant of Spencer — who later delivered the party’s official response to Gov. Maura Healey’s State of the Commonwealth address — won a special election for the district vacated by Democrat Sen. Anne Gobi.

Durant’s House seat is now vacant, and no Democrats filed paperwork to run in the March 5 special election, according to POLITICO. 

“With the Democrats failing to field a candidate, we can confidently say that the MassGOP is poised to go 2-0 in our first two special elections under our new Chair,” Carnevale wrote Monday.

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Newton’s teacher strike — now resolved, with students back in the classroom Monday — may have been the longest in recent memory for Massachusetts, but it certainly was not an isolated event, and now school districts facing contract negotiations are concerned they could be next to see picket lines.

Teachers in the Bay State have been withholding their labor more in recent years — a trend that began in 2019, when educators in Dedham hit the picket lines. That strike marked the first of its kind in Massachusetts in 12 years.

Since 2022, there have been six teacher unions in the state to go on strike — Brookline, Malden, Haverhill, Woburn, Andover and Newton.

“Both in the private sector and in the public sector, there has been this burst of strikes, organizing, attempts to negotiate first contracts for new unions,” Boston University law professor Maria O’Brien said. “And it follows a period that I think would be fair to say was pretty dormant and quiet for many years before that.”

O’Brien specializes in labor matters, and said that the success of other strikes can spark more.

“If you look over to your right and you see someone else that’s done it and had success with it, yeah, I suspect there’s kind of a marginal effect there that that influences the next unhappy group of employees to say, ‘Well, they did it. Let’s study that. Let’s think about that. And consider following in their footsteps,’” O’Brien said.

She suspects that the current economic conditions are fueling the fire as she tracks growing labor activity.

“My gut tells me that it’s somehow connected to the kind of unpleasant period of inflation that we’ve all been living through these last couple years since the pandemic,” O’Brien said. “And I think inflation at least partly explains it because inflation eats away at your purchasing power with whatever you’re making.”

Vice President of the Massachusetts Teachers Association Deb McCarthy told NBC10 Boston that she’s seen firsthand the financial struggles that some educators face.

“We have schools that are not receiving the funding or the resources that we need,” she said. “And that’s why I think you are seeing this pattern of educators withholding their labor.”

What’s more, McCarthy said, the job itself has drastically changed since the pandemic.

“I believe our students are in an emotional crisis,” she said. “We hear time and time again that students aren’t feeling safe. Educators aren’t feeling safe, and that we have prioritized the wrong things in our classrooms.”

In Massachusetts, it’s illegal for public employees like teachers to go on strike. But in many instances, these strikes have pressed on in the face of court injunctions and steep fines.

McCarthy backs proposed legislation to legalize teacher strikes if good faith negotiations go on for more than six months.

“I mean, it’s a no brainer,” she said. “We should not be in a system that is seeking to punish a gendered profession who loves children by trying to hit them with exorbitant fines.”

In some cases, though, those fines end up waived when an agreement is met. That’s certainly not always the case, however. In Haverhill, the teacher’s union there had to pay $110,000 in fines after four days on the picket line, and also had to reimburse the city $200,000.

Tom Scott, executive director of the Massachusetts Association of State Superintendents, said there is a real financial burden to districts and municipalities dealing with these strikes.

“You have a lot of nonprofessional people who still come to work,” Scott said. “You have a lot of security costs. So when you have a strike, you have lots of police details that are provided. You’ve got a lot of food insecurity issues that need to be addressed.”

NBC10 Boston reached out to five communities that have seen educator strikes to learn the cost associated, but we haven’t heard back yet.

Beyond the cost, Scott added that these strikes can lead to student learning loss, as well as damage the relationship between administrators and teachers for long after an agreement is met.

“The animosity, the distrust, the relationships that are broken, the way in which unions unify and sort of almost become cult-like in terms of how they kind of connect with one another, which didn’t happen before that strike,” Scott said.

And yet, whether it’s teaching students, service coffee or shipping packages, labor unions all over the country have been connecting in an effort to get more from their employers.

“Budget statements are value statements,” McCarthy said. “Public education is the foundation of our democracy, and currently our schools are underfunded here in Massachusetts.”

Scott said the number of strikes recently has been enough to leave district leaders across the state cautious about what’s to come.

“I think, you know, every superintendent right now who’s looking down the barrel of a negotiation this year or next year, obviously, in the back of their mind is, you know, could this, ‘Could this be us next?’”

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