Key Takeaways
- • Six pending federal bills in the 119th Congress would regulate private equity in health care, ranging from an outright Medicare payment ban to disclosure, licensing, sale-leaseback, and antitrust tools, according to Health Affairs.
- • The Take Back Our Hospitals Act of 2026 (S. 4085/H.R. 7920), sponsored by Sen. Chris Murphy (D-CT) and Rep. Mary Gay Scanlon (D-PA), would bar PE-owned hospitals and skilled nursing facilities from receiving Medicare payment, phased in over three years.
- • PE firms have completed more than 6,000 health care acquisitions valued at over $750 billion, and at least 79 state bills addressing PE or investor-owned health care had been introduced across 25 states by early 2026.
- • The Health Affairs analysis argues for conduct-based regulation rather than ownership-based bans, citing definitional difficulty, an uneven playing field, and the unresolved question of what happens to existing PE-owned facilities, which account for an estimated one-quarter of private hospitals and one-fifth of nursing homes.
Summary
Health Affairs reports that Congress is debating how, rather than whether, to regulate private equity (PE) in health care. The debate was catalyzed by high-profile failures, including the 2025 bankruptcy of Prospect Medical Holdings, which closed Crozer-Chester Medical Center in Delaware County, Pennsylvania, and the 2024 bankruptcy of Steward Health Care, which was driven in part by a sale-leaseback arrangement with a real estate investment trust (REIT).
Six federal proposals are pending. The Take Back Our Hospitals Act would bar Medicare payment to hospitals and skilled nursing facilities owned or controlled by PE funds, REITs, or their affiliates. The Health Over Wealth Act of 2026 (S. 5112/H.R. 9910), reintroduced by Sen. Ed Markey (D-MA) and Rep. Pramila Jayapal (D-WA), would require HHS licensing before PE acquisitions, mandate disclosure of debt and executive pay, require escrow sufficient to fund five years of operations, and prohibit asset-stripping. The Stop Medical Profiteering and Theft Act of 2025 (S. 2989) targets sale-leaseback deals, while the Corporate Crimes Against Health Care Act of 2026 (S. 3829), from Sen. Elizabeth Warren (D-MA), would add criminal penalties of up to six years for executives whose looting contributes to a patient's death. The bipartisan Break Up Big Medicine Act of 2026 (S. 3822), from Warren and Sen. Josh Hawley (R-MO), would bar common ownership between insurers, pharmacy benefit managers, or wholesalers and providers, enforced through mandatory divestiture. Finally, Rep. Diana DeGette (D-CO) has pressed to attach provider ownership-disclosure requirements to H.R. 9393, the Lower Costs, More Transparency Act of 2026, with penalties of up to $5 million per violation for larger hospitals.
The article notes that evidence of harm includes higher hospital closure and bankruptcy risk, higher prices from physician practice rollups, and higher nursing home resident mortality after PE acquisition, although the picture varies by sector and deal structure. State legislatures have moved faster, with several enacting ownership-transparency requirements, sale-leaseback restrictions, and corporate-practice-of-medicine enforcement.
The author argues against a categorical ban. Health Affairs contends that PE is difficult to define because involvement often runs through REITs, management services organizations, and multi-tier holding companies, and that a narrow definition would push similar incentives into adjacent structures. It also notes limited comparative research showing PE-owned facilities are not systematically worse than other for-profit or nonprofit owners, and that ownership-based rules could distort markets. Finally, any ban would need to address the existing stock of facilities, where possible outcomes include closure, sales to scarce non-PE buyers, or mandated divestiture. The article concludes that regulation focused on specific conduct and harms, regardless of ownership type, is the more durable approach.
Six federal proposals are pending. The Take Back Our Hospitals Act would bar Medicare payment to hospitals and skilled nursing facilities owned or controlled by PE funds, REITs, or their affiliates. The Health Over Wealth Act of 2026 (S. 5112/H.R. 9910), reintroduced by Sen. Ed Markey (D-MA) and Rep. Pramila Jayapal (D-WA), would require HHS licensing before PE acquisitions, mandate disclosure of debt and executive pay, require escrow sufficient to fund five years of operations, and prohibit asset-stripping. The Stop Medical Profiteering and Theft Act of 2025 (S. 2989) targets sale-leaseback deals, while the Corporate Crimes Against Health Care Act of 2026 (S. 3829), from Sen. Elizabeth Warren (D-MA), would add criminal penalties of up to six years for executives whose looting contributes to a patient's death. The bipartisan Break Up Big Medicine Act of 2026 (S. 3822), from Warren and Sen. Josh Hawley (R-MO), would bar common ownership between insurers, pharmacy benefit managers, or wholesalers and providers, enforced through mandatory divestiture. Finally, Rep. Diana DeGette (D-CO) has pressed to attach provider ownership-disclosure requirements to H.R. 9393, the Lower Costs, More Transparency Act of 2026, with penalties of up to $5 million per violation for larger hospitals.
The article notes that evidence of harm includes higher hospital closure and bankruptcy risk, higher prices from physician practice rollups, and higher nursing home resident mortality after PE acquisition, although the picture varies by sector and deal structure. State legislatures have moved faster, with several enacting ownership-transparency requirements, sale-leaseback restrictions, and corporate-practice-of-medicine enforcement.
The author argues against a categorical ban. Health Affairs contends that PE is difficult to define because involvement often runs through REITs, management services organizations, and multi-tier holding companies, and that a narrow definition would push similar incentives into adjacent structures. It also notes limited comparative research showing PE-owned facilities are not systematically worse than other for-profit or nonprofit owners, and that ownership-based rules could distort markets. Finally, any ban would need to address the existing stock of facilities, where possible outcomes include closure, sales to scarce non-PE buyers, or mandated divestiture. The article concludes that regulation focused on specific conduct and harms, regardless of ownership type, is the more durable approach.
Go deeper than the headline
Research every firm in this story, track the ones that matter and get the daily briefing — free for 7 days.