Health Over Wealth Act
- Sponsor
- Rep. Jayapal, Pramila [D-WA-7]
- Committees
- Judiciary Committee (primary)
- Last action
- Jul 23, 2026
Bottom line
The Health Over Wealth Act seeks to increase transparency and accountability for for-profit and private equity ownership in the healthcare sector, aiming to safeguard patient access, care quality, and worker protections against profit-driven practices.
What it actually does
This bill establishes extensive new federal oversight and reporting requirements for for-profit corporations, particularly private equity funds, that own health care entities. It mandates transparency in financial dealings, implements risk mitigation strategies, and requires licensure for private equity firms investing in healthcare. Additionally, it amends bankruptcy law to prioritize worker claims and ensure regional health care access during insolvencies, and imposes new requirements on hospitals regarding service discontinuation or closure.
Proponents argue
Proponents argue that the bill is a necessary response to growing concerns about private equity's impact on healthcare quality, affordability, and worker conditions. They contend that increased financial leverage, asset stripping, and cost-cutting measures by for-profit entities often compromise patient safety and access to essential services. This legislation, they claim, will ensure that public health and community needs are prioritized over maximizing shareholder returns, providing critical data for ongoing oversight.
Opponents contend
Opponents might argue that the bill imposes excessive regulatory burdens and compliance costs on for-profit healthcare providers and private equity investors, potentially stifling innovation and necessary capital investment in the healthcare sector. They may contend that such stringent regulations could deter investment in struggling hospitals or rural areas, leading to unintended consequences like reduced access to care or facility closures, ultimately harming the very communities the bill aims to protect.
The bill is moderately complex due to its detailed definitions and multiple amendments to existing law, requiring a dedicated reading to grasp its full scope. The estimated reading time is appropriate for an informed reader.
Sec. 2, adding Title XXXIV, Sec. 3402 to the Public Health Service Act
Health Care Ownership Transparency
This provision requires for-profit corporations owning healthcare entities (covered firms) to submit detailed financial and operational reports to the Secretary of Health and Human Services (HHS). Covered firms owned by private equity funds face even more extensive reporting requirements, including information on debt levels, fees collected, political spending, staffing ratios, and facility closures. The data will be made public, audited, and used for annual reports to Congress on trends in healthcare ownership and its impact.
Supporters argue
Supporters argue that this provision is crucial for understanding the opaque financial structures and operational impacts of private equity and other for-profit entities in healthcare. They contend that greater transparency will enable policymakers to identify problematic trends, hold corporations accountable, and develop evidence-based policies to protect patient care and worker welfare.
Critics contend
Critics may argue that the extensive reporting requirements are overly burdensome, particularly for smaller healthcare entities, and could deter investment in the sector. They might also raise concerns about the disclosure of proprietary financial information, arguing it could put covered firms at a competitive disadvantage.
Tradeoffs
The provision balances the public's right to know about healthcare ownership and its impacts against the administrative burden on regulated entities and concerns about proprietary data. It also aims to provide data for policy decisions, which could lead to further regulation.
Sec. 2, adding Title XXXIV, Sec. 3403(a) to the Public Health Service Act
Risk Mitigation for Private Equity-Owned Healthcare Firms
This section directs the Secretary of HHS to establish a mechanism to mitigate risks posed by private equity-owned healthcare firms, especially concerning 'essential services.' This mechanism may require such firms to establish escrow accounts sufficient to cover 5 years of operating and capital expenditures, including funds for staff obligations and community support in case of closure or service reduction. It may also mandate minimum capital investments in affiliated healthcare entities or other activities to ensure financial stability and continuity of care.
Sec. 2, adding Title XXXIV, Sec. 3403(b) to the Public Health Service Act
Limitation on Real Estate Investment Trusts (REITs) in Health Care
This provision prohibits health care entities or covered firms from entering into sale-leaseback agreements with Real Estate Investment Trusts (REITs) if the terms would lead to long-term weakened financial status for the health care entity or place public health at risk. The Secretary of HHS is required to review such agreements and has litigation authority to enforce this prohibition. This is reinforced by Section 6, which amends the Internal Revenue Code to make it less advantageous for REITs to derive rents from qualified health care property.
Sec. 2, adding Title XXXIV, Sec. 3403(c) to the Public Health Service Act
Licensure for Private Equity Firms in Health Care
This provision requires private equity firms to obtain a license from the Secretary of HHS to invest in or purchase a health care entity. Licenses can be denied or revoked if the firm fails to comply with the title's provisions, engages in price gouging, understaffing, or creates access barriers. Revocation mandates divestment from all healthcare investments, and violations incur civil monetary penalties. Fees collected from these licenses will fund the National Health Service Corps, community health centers, teaching health centers, and disproportionate share hospitals (DSH).
Sec. 2, adding Title XXXIV, Sec. 3404 to the Public Health Service Act
Task Force Review and Moratorium on Private Equity Acquisitions
This section establishes a Task Force, chaired by the Secretary of HHS and co-chaired by a practicing healthcare provider, to monitor changes in the healthcare marketplace, specifically focusing on the role of private equity and consolidation. The Task Force will develop recommendations for limiting private equity's role and addressing adverse effects. Crucially, the Secretary may impose a moratorium on private equity funds purchasing voting securities of covered firms or on mergers/acquisitions that would give them control, until the Task Force has sufficient time to study potential abuses like price gouging or understaffing.
Sec. 4, amending Section 507(a) of title 11, United States Code
Priority of Claims for Withdrawal Liability in Bankruptcy
This provision amends the U.S. Bankruptcy Code to elevate 'withdrawal liability' (debts owed to multiemployer pension plans when an employer withdraws) to the first priority claim in bankruptcy proceedings. This means that such claims would be paid before most other unsecured claims, including administrative expenses and certain wages.
Sec. 4, amending Section 1129 of title 11, United States Code
Bankruptcy Plan Confirmation for Health Care Businesses
This provision adds a new subsection to the Bankruptcy Code, requiring courts, when confirming a bankruptcy plan for a health care business, to give 'substantial weight' to whether the plan would allow for the maintenance of regional health care access, quality and safety of care, and health care provider and staff retention regionally.
Sec. 5, amending Section 1866 of the Social Security Act
Requirements for Hospitals Discontinuing Services or Closure
This provision mandates that hospitals provide 90 days' notice to HHS before discontinuing services or fully closing, with exceptions for catastrophic events. During this 'notification period,' hospitals are generally prohibited from discontinuing 'essential services' (defined as those necessary for preserving access, quality, and safety). Hospitals must submit mitigation plans if essential services are impacted, which are subject to public comment and review. HHS can develop alternative mitigation plans and can prohibit non-compliant hospitals (and their ownership entities) from Medicare enrollment for up to three years.
The definition of 'affiliate' is exceptionally broad, encompassing direct or indirect ownership or control of 20 percent or more of voting securities, or operating a business under a lease or operating agreement. This ensures that the bill's requirements apply not just to direct owners but also to a wide network of related entities.
Sec. 2, adding Title XXXIV, Sec. 3401(1) to the Public Health Service Act
Why it matters:This is standard legislative practice to ensure comprehensive coverage and prevent evasion of regulatory intent. A broad definition of 'affiliate' is necessary to capture complex corporate structures common in private equity and large health systems.
Case for: Supporters would argue that a broad definition of 'affiliate' is essential to prevent private equity firms and other corporations from circumventing the bill's requirements through complex ownership structures or indirect control. It ensures that the spirit of the law, which is to regulate the full scope of influence over healthcare entities, is upheld.
Case against: Critics might argue that such a broad definition could inadvertently capture entities with minimal actual control or influence, imposing undue regulatory burdens on a wide range of investors or business partners who are not the primary target of the legislation. This could lead to overreach and unintended compliance costs.
Estimated impact: Significantly expands the universe of entities subject to reporting and regulatory oversight under the bill, ensuring that indirect and complex ownership structures are covered.
This provision specifies that fees collected from private equity firms for their mandatory licenses to invest in healthcare entities shall be deposited into a special account. These funds are then made available, without further appropriation, for the National Health Service Corps, community health centers, teaching health centers, and hospitals receiving disproportionate share hospital (DSH) payments.
Sec. 2, adding Title XXXIV, Sec. 3403(c)(3) to the Public Health Service Act
Why it matters:This is a common legislative technique to earmark funds for specific purposes, often related to the policy area being regulated. It ensures that the revenue generated from the new regulatory scheme directly supports related public health initiatives.
Case for: Proponents would highlight this as a direct benefit of the licensing program, arguing that it creates a sustainable funding stream for critical public health programs and safety-net hospitals. They would contend that firms profiting from healthcare should contribute to strengthening the broader health infrastructure.
Case against: Opponents might argue that these fees are essentially a tax on investment, which could be passed on to healthcare entities or patients. They might also contend that linking regulatory fees directly to specific programs creates an incentive for regulators to maximize fee collection rather than focusing solely on regulatory effectiveness.
Estimated impact: Creates a new, dedicated funding source for several key public health and safety-net programs, potentially increasing their financial stability and capacity.
This subsection clarifies that the new title does not supersede any State law that establishes, implements, or continues in effect any requirement or prohibition, except to the extent that such State law prevents the application of a requirement or prohibition of this title.
Sec. 2, adding Title XXXIV, Sec. 3406(c) to the Public Health Service Act
Why it matters:This is a standard legislative practice to define the scope of federal preemption. It's crucial for legal interpretation but often placed in a technical section.
Case for: Supporters would argue that this clause is essential to preserve the ability of states to enact and enforce stronger protections for healthcare access, quality, and patient safety. It ensures that the federal floor established by this bill does not inadvertently weaken existing or future state-level regulations.
Case against: Critics might argue that a lack of clear federal preemption could lead to a patchwork of conflicting state and federal regulations, increasing compliance costs and complexity for healthcare entities operating across state lines. They may contend that a uniform federal standard would be more efficient.
Estimated impact: Preserves the authority of states to implement more stringent regulations on healthcare ownership and operations, potentially leading to varied regulatory landscapes across the country.
This section mandates that the Secretary of HHS conduct or support research on various impacts of private equity investment in healthcare entities. Topics include effects on costs, access, clinical decision-making, recruitment/retention, labor organizations, worker pay/benefits, health outcomes, and disparities, as well as the effectiveness of state laws and compliance with transparency requirements.
Sec. 2, adding Title XXXIV, Sec. 3407 to the Public Health Service Act
Why it matters:This is a standard legislative practice to ensure ongoing study and evaluation of a policy area. It's not an immediate operational mandate but a directive for future evidence-gathering.
Case for: Proponents would argue that this research mandate is crucial for building a robust evidence base to understand the complex and evolving impacts of private equity in healthcare. They contend that data-driven insights are necessary to refine policies, identify best practices, and address unintended consequences effectively.
Case against: Critics might argue that while research is valuable, mandating such a broad scope of studies could be costly and divert resources from immediate regulatory implementation. They may also contend that the research topics are framed in a way that presumes negative impacts, potentially leading to biased findings.
Estimated impact: Establishes a comprehensive federal research agenda on private equity in healthcare, which could significantly shape future policy debates and regulatory actions.