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The report examines the growing influence of private equity in Michigan, where 10% of the private sector workforce is employed by private equity-controlled companies. It details how leveraged buyouts and aggressive cost-cutting strategies have led to increased bankruptcy rates, labor disputes, and reduced quality in essential services. Specific case studies highlight staffing shortages and poor rankings at Apollo-owned hospitals, rent spikes in Blackstone-owned student housing, and safety violations and child labor at Hearthside Food Solutions. The document also notes that Michigan has the second-highest number of private equity-owned manufactured home parks in the U.S., often characterized by predatory rent increases and neglected maintenance. Finally, it calls for the Michigan State Treasury and Retirement System to adopt responsible workforce and property management standards to protect public investments and residents.

The report examines the growth of private equity (PE) in the autism therapy sector, highlighting a pattern of aggressive acquisitions and debt-driven management. It argues that PE-backed providers often prioritize profit over patient care by using standardized treatment plans, pressuring parents for more therapy hours, and engaging in fraudulent billing. State audits in Massachusetts, Indiana, Wisconsin, and Colorado reveal millions of dollars in improper Medicaid payments and inadequate staffing. The document concludes with policy recommendations, including facility-level licensure and rules to ensure a high percentage of Medicaid payments go directly to care worker compensation.

The Private Equity Stakeholder Project (PESP) testified in support of Illinois bills S.B. 3118 and H.B. 4728, arguing that private equity ownership of intellectual or developmental disability (IDD) services prioritizes short-term profits over patient care. PESP highlights risks such as 'dividend recapitalization'—where firms like Centerbridge Partners and Vistria Group extracted over $737 million from providers Sevita and Help at Home—and the case of Bain Capital's Broadstep Behavioral Health, whose license to operate group homes in Illinois was revoked in July 2024 due to repeat quality standard violations.

The document provides case studies of Packers Sanitation (PSSI/Fortrex) and Hearthside Food Solutions to demonstrate the financial risks associated with poor labor practices. In both instances, child labor scandals and safety violations contributed to credit rating downgrades, loss of business, and eventual bankruptcy or restructuring, resulting in private equity investors losing their equity to lenders.

The Private Equity Bankruptcy Tracker reports that private equity firms were involved in 54% of the largest U.S. corporate bankruptcies (liabilities $\ge$ $1 billion) and 51% of large bankruptcies (liabilities $\ge$ $500 million) in 2025. The report argues that the private equity model, characterized by leveraged buyouts and aggressive value extraction, increases bankruptcy risks, particularly in the manufacturing, healthcare, and consumer discretionary sectors. These financial failures led to at least 36,802 layoffs across 13 PE-backed bankruptcies in 2025 and disrupted essential services, such as healthcare. The document also notes a trend toward 'distressed exchanges' to circumvent formal bankruptcy, with PE-backed firms accounting for 41% of these events according to S&P Global data.

In 2025, the Private Equity Stakeholder Project (PESP) tracked 1,029 private equity-backed healthcare deals in the U.S., including 151 leveraged buyouts, 664 add-on acquisitions, and 214 growth investments. The busiest subsectors were Health IT, dental care, and outpatient care. The report highlights a growing trend of private equity firms using joint ventures with nonprofit health systems to expand market access and evade antitrust scrutiny. It also notes significant expansion into pharmaceutical services, specifically clinical trial sites and institutional review boards, and home health/hospice care, where debt-driven models may divert Medicaid funds from patient care.

A review of fifteen large private equity evergreen funds reveals they significantly underperformed the S&P 500 and MSCI ACWI indexes in 2025 and over a three-year period, despite charging median expense ratios of 3.76% compared to 0.03% for the Vanguard S&P 500 ETF. The report notes that the private equity industry is seeking a regulatory safe harbor from the US Department of Labor to limit lawsuits as it targets 401K retirement savings, a shift occurring as global fundraising fell 11.0% in 2025 and several US state pension funds—including those in Alaska, Texas, and Ohio—reduced their private equity allocations due to dwindling returns and liquidity risks.

The Private Equity Manufactured Housing Tracker identifies 23 private equity firms and hedge funds owning over 1,900 manufactured home parks and 400,000 lots in the U.S. It argues that institutional investors capitalize on the limited mobility of residents to increase rents and fees, often with financing from Fannie Mae and Freddie Mac. The report details specific instances of rent hikes, poor maintenance, and unjust evictions, while calling for government intervention to preserve affordability and protect residents' rights.

The Private Equity Stakeholder Project outlines five categories of climate standards for private markets investors: alignment with science-based targets, disclosure of fossil fuel exposure and emissions, the requirement for portfolio-wide energy transition plans, integration of environmental justice and community protections, and transparency regarding political spending and climate lobbying. The framework recommends specific timelines, such as phasing out coal power by 2030 and achieving a 4:1 ratio of low-carbon energy supply investments relative to fossil fuel investments by 2030.

The West Contra Costa Unified School District (WCCUSD) has significantly increased its spending on outside contractors, with $14 million paid to three private equity-owned firms in 2024-2025, which the report argues undermines the stability and quality of support for students with disabilities.

The document argues that private equity firms have systematically exploited the No Surprises Act's independent dispute resolution (IDR) process to increase healthcare costs. It details how private equity-backed groups lobbied for the arbitration provision via dark money campaigns and subsequently dominated the IDR process as both providers filing claims and certified entities arbitrating them. This has resulted in an estimated $5 billion in additional costs over three years, which the report suggests will lead to higher insurance premiums for patients.

The Private Equity Stakeholder Project and a group of residents are calling on Brookfield Asset Management to implement strict standards for resident protections—including a 3% annual rent cap and the allowance of window A/C units—should it acquire Yes! Communities. The letter highlights a pattern of rent hikes and poor maintenance at Yes! Communities parks in Michigan, Florida, Tennessee, Indiana, Iowa, and Texas, and expresses concern over the management record of RHP, a previous Brookfield partner, citing issues in New York, Colorado, and North Carolina.

The report finds that WCCUSD's spending on outside vendors more than doubled between 2019 and 2025, with over $14 million spent on three private equity-owned firms in the 2024-2025 school year alone. This shift has resulted in higher costs for taxpayers and reduced student support, including a loss of 40 hours of service per student with a disability compared to in-house staffing. The document highlights the role of firms like Leonard Green & Partners and Vistria Group, noting a pattern of labor violations and a preference for virtual services over in-person care.

The 2025 State Healthcare Policy Review tracks a national trend of state-level efforts to regulate private equity in healthcare. It categorizes legislative approaches into transparency and reporting, approval and enforcement authority, targeted prohibitions, and Corporate Practice of Medicine (CPOM) enforcement. The report details laws passed in states like Massachusetts, California, Indiana, Oregon, New Mexico, Washington, and Maine, while also tracking pending and failed legislation in other states.

The report argues that KKR's use of leveraged buyouts (LBOs) often leads to financial instability and labor abuses in its portfolio companies. It documents a pattern of health and safety violations, anti-union activities, and wage theft across various sectors, including healthcare and landscaping. The document also highlights KKR's role in high-profile bankruptcies, such as Toys "R" Us and Envision Healthcare, and alleges that the firm has engaged in antitrust violations by obscuring information from the US government during mergers and acquisitions.

Private equity firms have invested nearly $200 billion in data center-related industries since January 2022, driving a strategy of acquiring vertically integrated retail energy utilities and fossil fuel power plants to secure power for AI infrastructure. BlackRock's Global Infrastructure Partners (GIP) has acquired ALLETE Inc. and is pursuing a $38 billion takeover of AES, while Blackstone has invested in the Potomac Energy Center and is seeking to acquire TXNM Energy. The report argues that this expansion risks creating stranded high-emitting assets if AI demand is overestimated, while already causing increased electricity costs for ratepayers—rising up to 267% in some data center hubs—and significant environmental degradation. Organized community resistance has already delayed or blocked $64 billion in data center projects across 24 U.S. states.

Between 2021 and 2025, rents in the United States' workforce housing sector—the lowest-rent market-rate housing—increased by over 20%, more than double the 9.2% increase seen in 'discretionary' housing. The report finds that in most of the 94 analyzed markets, rent increases for low-income tenants outpaced those for high-income tenants, with the most significant regional increases occurring in Florida (26.8%), the Northeast (25.3%), and the Pacific Northwest (23.2%). The analysis suggests that investor landlords, including private equity firms, target this sector as a reliable profit source due to high demand and a captive renter class. The report warns that these increases are likely to drive higher rates of eviction and self-eviction and calls for policy interventions such as price controls and eviction protections.

The report analyzes the role of private equity in the $30 billion U.S. outpatient surgery market, highlighting a trend of 'stealth consolidation' where smaller, unreported deals bypass regulatory review. It finds that private-equity-owned ambulatory surgery centers (ASCs) often increase prices by nearly 50% within a few years without improving patient outcomes. The document identifies specific examples of consolidation involving firms like KKR, Bain Capital, and TowerBrook Capital, and calls for stronger antitrust oversight and disclosure rules to prevent rising costs and reduced healthcare choices.

The report examines how private equity (PE) firms consolidate the ambulatory surgery center (ASC) market through leveraged buyouts and 'roll-up' strategies, often increasing prices by nearly 50% within five years. It details a 'second wave' of consolidation where corporate giants like UnitedHealth and non-profit systems like Ascension acquire these PE-built networks, potentially bypassing antitrust scrutiny. Case studies on AmSurg, Regent Surgical Health, and Surgery Partners illustrate risks including high debt burdens, operational opacity, and pressures on clinical staffing and revenue.

The report finds that rents for the lowest-cost unsubsidized market-rate housing (workforce housing) increased by 20.2% nationally between 2021 and 2025, more than double the 9.2% increase for luxury (discretionary) housing. This trend is most pronounced in the Sunbelt region, where corporate landlords, including private equity firms, target workforce housing as a low-risk, high-cash-flow investment. The document highlights a crisis of evictions and 'self-evictions' driven by these price hikes and argues that government-sponsored enterprises (GSEs) like Fannie Mae and Freddie Mac facilitate this corporate takeover by providing easy financing with few tenant protections. It recommends policy interventions such as rent control, just cause eviction laws, and the adoption of investment standards for public pension funds.