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The report argues that Apollo Global Management's private equity model—characterized by high leverage and cost-cutting—has harmed patients and workers across its 220 hospitals. It documents specific instances of service cuts, poor quality ratings, and regulatory failures, while questioning the anti-competitive nature of the Lifepoint-ScionHealth spinoff.

The report details how private equity firm Cerberus Capital Management and real estate investment trust Medical Properties Trust (MPT) extracted significant capital from Steward Health Care through sale-leaseback transactions and dividends, contributing to a $9 billion liability and eventual Chapter 11 bankruptcy. It highlights a pattern of asset stripping, including the sale of hospital real estate to fund investor payouts, which left hospitals with unsustainable lease obligations. This financial distress manifested in severe patient care crises, including equipment repossessions, staffing shortages, and the closure of six hospitals, resulting in at least 2,650 layoffs. The document concludes with policy recommendations to increase financial transparency, limit debt-funded dividends, and regulate hospital change-of-ownership transactions.

The fact sheet contends that the traditional reliance on natural gas and LNG as a bridge to decarbonization in the Global South is outdated. It asserts that modern renewables and storage can meet reliability, speed, and cost requirements more effectively than gas. Citing IEA data, the document warns that gas-heavy strategies expose developing economies to higher consumer prices, price volatility, and technology lock-in, whereas a net-zero aligned approach could meet over 60% of their electricity needs via local renewables by 2050.

This document is a rebuttal by Amory B. Lovins of the Rocky Mountain Institute (RMI) to an article and subsequent response by Charles C. Mann in The Atlantic. Lovins argues that Mann ignores the role of efficiency and technological innovation in reducing oil demand and misrepresents the reliability and economic viability of renewable energy, specifically in Germany.

The report examines the economic viability of 'grid defection'—where customers use solar PV and battery storage to operate independently of the electric grid. It analyzes five U.S. geographies to determine when the levelized cost of electricity (LCOE) for these systems undercuts retail utility prices. The findings suggest that grid parity is already present in Hawaii and is imminent for millions of other U.S. customers, threatening to strand utility assets and trigger a 'utility death spiral' of rising prices and falling sales.

The document asserts that the Trump administration has systematically undermined scientific integrity and rolled back environmental and public health protections, exacerbating existing inequities for marginalized communities. It highlights a decrease in EPA criminal enforcement, the suppression of health data, and the erosion of social safety nets as key drivers of increased risk for low-income and minority populations.

The report identifies energy efficiency as the most cost-effective strategy for cutting U.S. carbon emissions, focusing on the industrial and building sectors which together account for two-thirds of U.S. carbon emissions. It details technical opportunities such as combined-heat-and-power (CHP) systems, building envelope improvements, and high-efficiency appliances. The document proposes a 'Blueprint' of policies—including efficiency standards, resource standards (EERS), and updated building codes—that could reduce total U.S. energy consumption by 29 percent by 2030. It highlights that while technical potential is high, barriers such as 'split incentives' and high up-front costs persist, requiring coordinated federal and state intervention.

The report argues that the United States can significantly reduce its reliance on fossil fuels by deploying a diverse mix of renewable energy sources, which have the technical potential to meet current electricity needs many times over. It highlights wind, solar, geothermal, bioenergy, and hydropower as key resources, noting that wind and geothermal are already competitive with new coal and natural gas plants in some cases. The document identifies critical barriers to this transition, including the need for a modernized transmission grid, streamlined siting processes, and sustainable biomass harvesting. It proposes a policy package featuring a national renewable electricity standard (RES) ramping up to 40% by 2030, extended tax credits, and increased R&D funding. While discussing carbon capture and storage (CCS) and advanced nuclear power as potential low-carbon supplements, the report notes significant cost uncertainties, infrastructure requirements, and safety risks associated with these technologies.

The document details the relationship between rising global temperatures and the formation of ground-level ozone, which is created when nitrogen oxides and volatile organic compounds react with heat and sunlight. It highlights that without strong climate policies, respiratory issues such as asthma attacks could increase by 11.8 million annual incidences by 2050. The text emphasizes the disproportionate impact on children, the elderly, and Latino populations in the U.S., noting that nearly half of the U.S. population lives in areas with unhealthy ozone levels.

The document outlines a supplemental analysis by the American Council for an Energy Efficient Economy (ACEEE) to quantify the impact of nine energy efficiency policies across residential, commercial, and industrial sectors. By 2030, these policies are projected to achieve cumulative end-use energy savings of 12.1 quadrillion BTUs, representing a 29 percent reduction in projected energy consumption compared to a reference case. The analysis estimates that annual policy costs will rise from $7.5 billion in 2020 to $13.4 billion in 2030, stimulating private investment of $113.6 billion by 2030. Key policies include federal appliance standards, an Energy Efficiency Resource Standard (EERS) for electricity and natural gas, updated building codes, and expanded R&D. The modeling utilizes the Energy Information Administration's NEMS model to determine effects on electricity generation, carbon dioxide emissions, and energy prices.

The document advocates for immediate action to combat climate change using existing technologies. It identifies fossil fuel combustion and deforestation as the primary drivers of CO2 increase and proposes five 'common sense' solutions: increasing vehicle fuel efficiency, modernizing the electricity system with renewables, improving energy efficiency in buildings, protecting forests, and increasing federal R&D for clean energy. It emphasizes that these steps would reduce emissions while saving consumers money and enhancing energy security.

The document contains interview transcripts with executives from Denbury Resources, Exxon Mobil, NRG Energy, TECO Energy, and Waste Management (ConocoPhillips participated but declined to be quoted). The interviews explore corporate stances on climate science, the physical risks of climate change to business operations, mitigation efforts, and the funding of political or policy-oriented organizations. Findings reveal a spectrum of responses: some companies acknowledge the risks and invest in clean energy or efficiency, while others avoid taking official positions on climate science or deny that physical climate impacts currently affect their operations.

The document details the construction of the EW3 database, which integrates 2008 Energy Information Administration (EIA) data with NREL and Argonne National Laboratory water coefficients to estimate freshwater withdrawals and consumption. It describes the process of mapping cooling systems to specific generators, using Google Earth to verify cooling types, and applying the Water Supply Stress Index (WaSSI) to identify watersheds where electricity generation significantly increases water stress. The methodology also covers the projection of water use through 2036 using the Regional Energy Deployment System (ReEDS) model and the calculation of water and carbon intensities for the top 15 U.S. electricity providers.

The U.S. electricity system relies heavily on freshwater, with cooling power plants accounting for 41 percent of all freshwater withdrawals. This dependence creates a 'collision' where energy production competes with municipal, agricultural, and ecosystem needs, a situation exacerbated by global warming. The report details regional risks—such as hydropower instability in the Northwest and cooling water shortages in the Southeast—and highlights low-water alternatives like wind, solar photovoltaic, and dry-cooling systems.

The report provides a state-by-state breakdown of progress toward 2020 Clean Power Plan benchmarks, noting that some states have exceeded 500% of their goals while others show 0% progress. It highlights the role of energy efficiency, renewable energy standards, and regional initiatives in achieving these targets.

The Great Plains region has experienced increasing average temperatures and shifting precipitation patterns, with winter temperatures in northern states rising by more than 6°F over the last 30 years. Climate change is projected to exacerbate the depletion of the High Plains (Ogallala) aquifer, particularly in the southern region where unsustainable water use and extreme heat are already prevalent. Agriculture and livestock are highly vulnerable; rising temperatures are expected to shift crop zones, increase pest prevalence, and reduce livestock yields, with a projected 10% decline in cow/calf and dairy operations under higher emissions scenarios. Ecosystems, specifically prairie potholes and playa lakes, face threats from altered evaporation and recharge rates, which impacts migratory birds and aquifer replenishment. The document also highlights the vulnerability of 65 Native American tribes on rural lands facing water quantity and quality issues.

The Southwest is projected to warm by 4-6°F under lower-emissions and 7-10°F under higher-emissions scenarios by the end of the century. The region faces severe water scarcity, expanding deserts, and reduced runoff, particularly in the Colorado River system. Public health risks include increased heat-related deaths in Los Angeles and worsening air quality. Economic threats include reduced yields for California specialty crops, diminished ski resort profitability due to snowpack loss, and reduced aircraft freight capacity at high-altitude airports like Phoenix and Denver. Biodiversity is critically threatened, especially in the Madrean Pine-Oak Woodlands, while mountain ecosystems face range reductions and reproductive failures in wildflowers due to earlier snowmelt and spring frosts.

The report examines the ecological and economic importance of southern US forests, noting they provide 18% of global pulpwood despite covering only 2% of world forest area. It details a historical net decline of 40% in forest extent since European settlement and projects that suburban development will convert 19 million acres of forest between 2020 and 2040. The document highlights that 87% of these forests are privately owned, making the implementation of market-based incentives—such as carbon sequestration payments and conservation easements—critical for future sustainability, though current adoption of these measures remains mixed.

Climate change increases human health risks in the U.S. through more intense heat waves, prolonged wildfire seasons, and severe flooding that compromises water quality. Specific examples include the increased likelihood of drought conditions similar to those seen in Texas in 2011 and the lengthening of allergy seasons.

The document defines Renewable Electricity Standards (RES) as policies requiring a minimum percentage of electric power to come from eligible renewable sources. It details how these standards create market demand for clean energy, the types of eligible resources, and the potential for business opportunities through the sale of electricity or renewable energy credits (RECs). The text also outlines the state-level adoption of RES in the U.S. as of 2008 and discusses the legislative history and arguments surrounding a proposed national RES.