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The analysis models three policy scenarios for Southern New England, ranging from the adoption of California's Advanced Clean Trucks (ACT) rule to a more aggressive '100 x 40 ZEV + Clean Grid' scenario. The findings indicate that transitioning the M/HD fleet to zero-emission vehicles (ZEVs) would yield significant net societal benefits, including reduced premature deaths, lower greenhouse gas emissions, and long-term cost savings for fleets and electricity customers. While initial purchase costs for ZEVs are higher, the report projects lifetime cost parity with combustion vehicles by 2035. Macroeconomic analysis suggests the transition would result in national net job gains and increased GDP, with new jobs in electrical component manufacturing and infrastructure construction offering higher average wages than the jobs they replace.

The Transportation and Climate Initiative (TCI) is a regional program designed to reduce carbon emissions from the transportation sector by limiting total emissions and requiring fuel distributors to pay into a fund. This fund could generate an estimated $68 billion over ten years for participating states, including Connecticut, Delaware, the District of Columbia, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Vermont, and Virginia. The document highlights that rural residents, who drive more than 13,000 miles annually—over 20% above the regional average—stand to save up to twice as much per capita as urban residents by switching to electric vehicles (EVs). To support this transition, the author suggests higher purchase incentives for low- and moderate-income drivers, expanded rural charging infrastructure, and the growth of vanpools and paratransit services. Additionally, the document emphasizes the need for climate-resilient infrastructure, citing the damage caused by Tropical Storm Irene in Vermont as a precedent for the increasing intensity of storms in the region.

Rhode Island Treasurer Seth Magaziner informed Leonard Green & Partners that the Rhode Island pension system will not consider future investments with the firm. This decision follows the firm's management of Prospect Medical Holdings, which Magaziner asserts extracted value from hospitals—including St. Joseph’s Hospital and Our Lady of Fatima Hospital—at the expense of patients and employees, leading to reduced healthcare resources for vulnerable communities and the insolvency of a hospital pension fund.

The report alleges that Leonard Green & Partners extracted at least $658 million in fees and dividends from Prospect Medical Holdings while failing to meet capital investment commitments to safety net hospitals. It highlights a $457 million debt-financed dividend in 2018 that may have rendered the company technically insolvent. In Rhode Island, Prospect is accused of misleading regulators by counting operating losses and forgiven management fees as capital expenditures to secure tax breaks. The document also notes similar failures in New Jersey and Pennsylvania and questions the $10 million valuation of Leonard Green's majority stake sale to company management.

Members of Congress allege that Leonard Green & Partners destabilized Prospect Medical Holdings by extracting $658 million in fees and dividends, often funded by debt. The letter claims this financial strategy, combined with failures to meet capital commitments and pension obligations in Connecticut, Pennsylvania, and Rhode Island, left the hospital system vulnerable during the COVID-19 pandemic. The authors demand the return of these funds to ensure continuity of patient care.

RMI proposes a green stimulus strategy for the United States focused on four pillars: a national building retrofit program, the electrification and diversification of mobility, debt forgiveness linked to emissions reductions, and the creation of a federal Economic Recovery Facility to finance clean projects.

The report details how Leonard Green & Partners acquired Prospect Medical Holdings in 2010 and subsequently extracted between $570 million and $658 million in fees and dividends. This occurred despite a dramatic decline in EBITDA from $142 million in 2015 to $17 million in 2018 and the accumulation of $260 million in unfunded pension liabilities. The document highlights systemic failures, including the complete closure of the Nix Health system in Texas, 'immediate jeopardy' patient conditions in Connecticut, and legal disputes over pensions in Rhode Island and community funding in Pennsylvania. It concludes by urging the Pennsylvania Attorney General to block a change in ownership until Leonard Green returns the extracted funds to support hospitals during the COVID-19 pandemic.

The Private Equity Stakeholder Project argues that Leonard Green & Partners extracted $658 million in fees and dividends from Prospect Medical Holdings despite the hospital chain's declining financial health, poor quality ratings, and unfunded pension liabilities. The letter highlights a $457 million dividend paid in 2018 that allegedly contradicted commitments made to Rhode Island regulators. It also notes that Prospect sold hospital real estate to Medical Properties Trust to pay down $1.1 billion in debt and shut down all facilities in Texas. The author requests that California's Attorney General withhold approval for the ownership transfer to ensure resources are available for the COVID-19 response.

The Private Equity Stakeholder Project alleges that Leonard Green & Partners extracted $570 million to $658 million in fees and dividends from Prospect Medical Holdings while the hospital chain suffered from declining financial performance, poor quality ratings, and underfunded pensions. The document details systemic failures across hospitals in Texas, Connecticut, New Jersey, Pennsylvania, and Rhode Island, including the total closure of the Nix Health System in Texas and lawsuits from pensioners in Rhode Island. It highlights a $457 million dividend paid in 2018 that contradicted assurances given to Rhode Island regulators. The author contends that Leonard Green is attempting to exit its majority stake for a fraction of its acquisition cost, leaving behind a legacy of financial and operational distress in safety net hospitals.

Since 2010, Leonard Green & Partners and other owners collected $658 million in dividends and fees from Prospect Medical Holdings, despite the company facing severe operating challenges, underfunded pensions, and low quality ratings from the Centers for Medicare and Medicaid Services. A significant $457 million debt-financed dividend paid in 2018 contradicted previous assurances given to Rhode Island regulators that no further distributions were planned. During the same period, Prospect's EBITDA fell from $142 million in 2015 to $17 million in 2018, and its pension fund funded ratio dropped from 68.3% in 2016 to 60.7% in 2018.

The report examines performance incentive mechanisms (PIMs) designed to motivate US utilities to implement strategic demand reduction (SDR)—a combination of energy efficiency and demand response that optimizes the electricity system. Analyzing seven state case studies, the authors find that while PIMs are effective, the potential for cost-effective load flexibility remains largely untapped. Most current PIMs focus on 'shape' (long-term demand adaptation) and 'shed' (peak demand reduction) services, with limited focus on 'shift' (moving demand between times of day) or 'shimmy' (real-time grid balancing). The report argues that durable, long-term incentives with periodic updates, supported by complementary policies like decoupling and time-varying rates, are most effective at aligning utility business models with public interest and decarbonization goals.

The document outlines the technical approaches used to estimate children's exposure to chlorpyrifos and PFAS, the process for tracking children's product recalls, and the use of EPA Regulatory Impact Analyses to quantify the health benefits lost when air pollution standards were weakened or repealed.

The report details how Leonard Green & Partners extracted $570.44 million in fees and dividends from Prospect Medical Holdings while the health system faced widespread operational failures, including facility closures in Texas, quality rating declines in Connecticut, and legal disputes over pensions and taxes in Rhode Island and Pennsylvania. By November 2019, Leonard Green sought to sell its 61% stake to minority owners for $12 million, a fraction of its original investment, leaving behind a legacy of financial distress and deteriorating care at several safety net hospitals.

The 2019 Rhode Island Greenhouse Gas Reduction Study finds that the state can feasibly reduce emissions by 70-80% by 2030, 2040, or 2050 by focusing on electrification, efficiency, and transitioning the power grid to renewables. The report updates previous 2016 baseline estimates, finding that 2017 emissions were approximately 45% higher than previously thought due to updated science on methane leakage and its short-term global warming potential. While substantial reductions are possible, the study notes that pathways stall at around 4 million metric tons of carbon dioxide equivalent, leaving a 20-30% gap that requires further research into industrial decarbonization and carbon sequestration.

The report finds that Rhode Island can feasibly reduce its greenhouse gas emissions by 70-80% by 2030, 2040, or 2050 by focusing on electrifying transportation and heating, improving energy efficiency, and transitioning the electricity grid to renewables. A critical finding is that updated science on methane leakage from natural gas infrastructure reveals that 2017 emissions were approximately 45% higher than previously estimated in 2016. While the 2050 pathway is relatively low-cost, the 2030 pathway requires a significant spending spike, resembling a 'Green New Deal' approach. The study emphasizes that reaching net-zero requires the complete phase-out of natural gas and further research into industrial decarbonization and carbon sequestration.

The analysis finds that Latino, Asian American, and African American residents in the Northeast and Mid-Atlantic are exposed to significantly higher levels of vehicle-related PM2.5 pollution than white residents. The report highlights that white residents comprise 85% of those in the lowest pollution areas, while people of color are overrepresented in the most polluted census tracts, often located near major highways in urban centers. The document argues for targeted investments in clean transportation, such as electric vehicles and buses, to reduce these environmental inequities.

The document argues that electric utilities are critical partners in the transition to electric medium- and heavy-duty vehicles. It recommends three primary investment models—make-ready, end-to-end ownership, and rebate incentives—and suggests restructuring commercial rates to eliminate or reduce demand charges. The guide emphasizes prioritizing disadvantaged communities burdened by air pollution and implementing 'managed charging' to optimize grid stability and integrate renewable energy.

The document details the economic and environmental impact of transitioning to clean transportation in Rhode Island. It estimates that a total investment of nearly $14 billion by 2050 will yield nearly $19 billion in returns, resulting in a cumulative net benefit of over $5 billion. Key drivers of this transition include vehicle electrification, improved fuel efficiency, and low-carbon fuels, which together are projected to avoid 38.7 million metric tons of CO2 and reduce fossil-based liquid fuel use by 4 billion gallons by 2050.

The report argues that traditional quasi-judicial regulatory processes are inadequate for the scale of current electricity system transformations and proposes a four-stage framework—initiation, vision communication, conduction, and delivery of outcomes—to achieve more successful reforms.

The document argues that Northeast and Mid-Atlantic states can significantly reduce CO2 pollution and consumer fuel spending by transitioning to electric vehicles and low-carbon fuels. It highlights specific targets for emissions cuts and emphasizes the need for equitable investments that prioritize polluted communities and marginalized populations.