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The Private Equity Stakeholder Project (PESP) supports Minnesota bill H.F. 2779, arguing that stronger oversight of private equity and hedge fund acquisitions is necessary to protect the financial stability of the state's health systems. PESP highlights a trend of private equity consolidation in U.S. healthcare, noting that buyouts reached a peak of 515 transactions valued at $151 billion in 2021. The organization claims that private equity tactics include looting safety net hospitals, stripping real estate, and cutting less profitable services. Furthermore, PESP reports a high correlation between private equity ownership and healthcare bankruptcies, stating that 21% of healthcare bankruptcies in 2024 involved private equity-owned companies, and 88% of the largest healthcare bankruptcies (liabilities over $500 million) in 2024 occurred at companies with a history of private equity ownership.

The Private Equity Stakeholder Project (PESP) supports Colorado Senate Bill 25-198 to increase transparency and oversight of healthcare and dental care transactions. PESP argues that private equity firms use strategies like leveraged buyouts and 'roll-ups' to consolidate markets, which often leads to higher prices and lower quality of care. In Colorado, PESP identifies at least 59 such deals since 2020, with significant activity in dental care and outpatient specialties. The testimony highlights the risks of high debt loads, including the closure of Johnstown Heights Behavioral Health and the anticompetitive behavior of U.S. Anesthesia Partners. PESP recommends lowering the monetary threshold for transaction notices to the Attorney General and implementing regulations on debt and investor liability.

The report argues that private equity firms continue to acquire US nursing homes despite industry claims to the contrary, often using complex ownership structures to avoid transparency. It highlights a pattern of high debt, real estate monetization through REITs, and private credit risks that correlate with increased patient mortality, reduced staffing, and facility bankruptcies. Case studies of companies like LaVie Care Centers and Gulf Coast Health Care illustrate 'harrowing conditions' and regulatory failures. The document concludes that federal deregulation under the Trump administration makes state-level legislation the most viable path for protecting patients and workers.

The Private Equity Stakeholder Project (PESP) argues that private equity's business model in the US healthcare sector—characterized by high leverage, sale-leasebacks, and dividend recapitalizations—prioritizes short-term investor returns over patient care. The document details how these strategies lead to increased healthcare costs, reduced staffing, and hospital bankruptcies, citing case studies of Prospect Medical Holdings, Steward Health Care, and Apollo Global Management's Lifepoint and ScionHealth. PESP advocates for state-level policy solutions including robust merger reviews, financial transparency requirements, and bans on debt-funded dividends to protect healthcare infrastructure.

The Private Equity Stakeholder Project (PESP) urges the Indiana State Senate to pass H.B. 1666, arguing that stronger oversight of private equity acquisitions in healthcare is necessary to protect patient safety and financial stability. PESP highlights systemic risks, including high bankruptcy rates among private equity-owned healthcare firms and specific failures in Indiana's intellectual and developmental disability (IDD) services sector. The testimony details quality-of-care deficiencies at Sevita and a fatal case of neglect at Help at Home, both of which are private equity-owned providers operating in Indiana.

The document argues that declining federal investment in US education has created opportunities for private equity firms to treat the sector as a "return-generating machine." It highlights the activities of firms like Leeds Equity Partners, which sought $1.8 billion for an education-focused fund in 2023, and notes that while these firms claim to improve outcomes through technology and personalized learning, there is no conclusive data proving that funding is more effective when directed to private-equity owned companies than to public school districts.

The Private Equity Stakeholder Project (PESP) urges the Connecticut General Assembly to pass HB 6873, arguing that private equity's business model—characterized by high debt and profit extraction—threatens healthcare stability. PESP cites the 2025 bankruptcy of Prospect Medical Holdings, which owns three Connecticut hospitals, as a primary example of how private equity ownership can lead to financial distress and diminished care quality. The testimony highlights that in 2024, 21% of healthcare bankruptcies involved private equity-owned companies. PESP supports HB 6873 because it would expand the 'notice of material change' statute to include joint ventures and sale-leaseback transactions, preventing firms from evading antitrust scrutiny or stripping assets through real estate deals.

The report argues that the private equity model of high leverage and short-term profit maximization is ill-suited for the US agricultural industry, which is characterized by fluctuating margins and a vulnerable migrant workforce. It highlights a trend of consolidation, citing that two private equity-owned firms control a majority of US fresh carrot production. The document details several case studies of bankruptcy and labor abuse, including Prima Wawona, Trinitas Farming, Windmill Farms, and Grimmway Farms. It further notes that the industry's reliance on H-2A visas and exemptions from the National Labor Relations Act exacerbates worker vulnerability, a situation further complicated by the Trump administration's mass deportation policies.

The report documents a shift in IDD services from non-profit providers to private equity-owned platforms, highlighting risks such as cost-cutting, financial extraction through dividend recapitalizations, and systemic quality failures. It provides case studies of companies like Sevita, Help at Home, and Broadstep Behavioral Health to illustrate patterns of abuse, neglect, and regulatory non-compliance.

The report argues that private equity firms are increasingly treating the US education sector as a "return-generating machine," leading to tuition hikes in childcare, the defunding of public schools through "school choice" vouchers, and the influence of corporate interests on classroom curricula. It highlights the role of firms like Leeds Equity Partners in owning companies across multiple stages of a child's education and calls for greater regulation and transparency to protect students and educators.

In 2024, the Private Equity Stakeholder Project (PESP) tracked 1,049 private equity-backed healthcare deals in the US, a 7.6% decrease from 2023. While overall activity was subdued due to high interest rates and regulatory scrutiny, dental care saw a 10.3% increase in deals. The report highlights the prevalence of 'add-on acquisitions'—which accounted for nearly 60% of deals—as a strategy to avoid antitrust scrutiny. PESP notes risks associated with this model, including higher prices, reduced quality of care, and increased bankruptcies in physician practice management. The document also identifies a growing trend of private equity firms using joint ventures with nonprofit health systems to expand market access. It concludes by urging state and federal policymakers to lower reporting thresholds for mergers and acquisitions and implement robust change-of-ownership regulations.

The executive summary describes the private equity (PE) business model as one of 'legalized looting,' where firms use aggressive cost-cutting, excessive fees, and debt-funded dividends to extract short-term value from acquired companies. It highlights that these practices increase bankruptcy risks and are subsidized by a tax code that provides loopholes, such as carried interest, which benefit wealthy executives while burdening workers and the environment.

In 2024, private equity-backed companies were overrepresented in U.S. corporate bankruptcies, particularly among large filings with liabilities exceeding $500 million. This trend is attributed to the private equity model's preference for short-term profit and the use of leveraged buyouts, which saddle companies with unsustainable debt. These bankruptcies led to at least 65,850 layoffs and significant disruptions in the healthcare and consumer sectors. The report also highlights the use of 'distressed exchanges' as an out-of-court restructuring tool and notes that private equity firms often remain profitable through management fees and dividends despite the collapse of their portfolio companies.

The document argues that private equity ownership of hospitals, specifically Apollo Global Management's ownership of Lifepoint Health, prioritizes short-term profits over patient care. It highlights a decline in CMS star ratings and poor clinical outcomes across several Lifepoint hospitals in North Carolina, including high mortality rates for heart failure and pneumonia, and significant issues with catheter-associated urinary tract infections. The report also details Lifepoint's use of joint ventures with academic and nonprofit entities to expand its market reach.

The Private Equity Stakeholder Project (PESP) supports a Department of Justice lawsuit against six major U.S. landlords, including private equity-owned firms Blackstone, Greystar Real Estate Partners, and Cortland Management, for allegedly using RealPage pricing algorithms to coordinate rents. PESP highlights Blackstone's role as the nation's largest landlord and cites a report showing that Blackstone increased rents by 38% in San Diego properties acquired in 2021, significantly exceeding the market average of 20%.

The Private Equity Stakeholder Project (PESP) asserts that private equity is deeply integrated into the U.S. medical debt crisis, which affects 14 million people and totals at least $220 billion. PESP identifies 113 private equity-owned revenue cycle management (RCM) companies, representing 28.5% of a comprehensive industry list, and argues that these firms profit from high-interest medical credit cards and aggressive debt collection. The document refutes claims by the American Investment Council (AIC) that private equity investment in RCM is limited, citing contradictions in AIC's own data and evidence of majority equity investments in providers like AccessOne. Furthermore, the text cites multiple academic studies from 2020 to 2023 indicating that private equity ownership in hospitals, nursing homes, and physician practices is associated with increased patient costs and higher charges for services.

The report examines a range of legislative and regulatory efforts to address private equity's role in the US healthcare system, highlighting a shift toward increased oversight of mergers and acquisitions at the state level. It details successful laws in Illinois, Indiana, New Mexico, and New York, while noting failures in states like California and Massachusetts. Federally, it discusses proposed acts to penalize corporate looting and increase transparency, alongside CMS rules on staffing and spending. The document also tracks antitrust and fraud enforcement actions and concludes with policy recommendations to curb financialization through stricter transparency, debt limits, and joint liability.

The report argues that private equity firms prioritize high returns (at least 15%) over short timelines (3-5 years), leading to deferred maintenance and increased tenant instability. It proposes a toolkit of interventions, including rental registries with beneficial ownership disclosure, just cause eviction protections, landlord licensing with portfolio caps, and right of first refusal legislation. The document also examines federal legislative attempts to curb consolidation through tax penalties and transfer taxes, while highlighting the challenge of state preemption of local housing justice measures.

The report details how private equity firms profit from the detention and sheltering of immigrants in the United States through contracts for facility management, healthcare, telecommunications, and biometrics. It highlights specific instances of fiscal mismanagement and poor conditions in facilities managed by private equity-backed companies, such as DocGo and GardaWorld. The document also examines the expansion of surveillance through biometric systems like HART and the role of private equity in border militarization and deportation logistics.

The article examines the impact of private equity ownership on US hospitals, specifically detailing how leveraged buyouts, dividend recapitalizations, and sale-leaseback transactions with real estate investment trusts (REITs) drain resources from healthcare operations. Using Steward Health Care and Prospect Medical Holdings as primary examples, the author illustrates how these financial tactics lead to understaffing, reduced quality of care, and bankruptcy. The document calls for increased state and federal regulation, including joint liability for private equity firms and restrictions on debt-funded dividends, alongside healthcare worker organizing.