Health Over Wealth Act
- Sponsor
- Sen. Markey, Edward J. [D-MA]
- Committees
- Finance Committee (primary)
- Last action
- Jul 23, 2026
Bottom line
This bill seeks to increase oversight and regulation of for-profit, particularly private equity, ownership in healthcare to protect patient access, quality, and safety, and to ensure the financial stability of healthcare providers.
What it actually does
The bill, titled the "Health Over Wealth Act," amends the Public Health Service Act to impose new transparency, risk mitigation, and accountability requirements on for-profit corporations, especially private equity funds, that own health care entities. It mandates extensive financial and operational reporting, prohibits certain real estate investment trust (REIT) transactions that weaken financial status or risk public health, and establishes a licensing regime for private equity firms investing in healthcare. Additionally, it amends bankruptcy law to prioritize withdrawal liability and requires hospitals to provide advance notice and mitigation plans for service discontinuation or closure.
Proponents argue
Proponents argue that the bill is necessary to address the negative impacts of private equity and corporate consolidation on healthcare, such as reduced quality of care, increased costs, understaffing, and facility closures. They contend that greater transparency and accountability will safeguard patient well-being and worker protections, ensuring healthcare remains focused on patient needs rather than profit maximization.
Opponents contend
Opponents might argue that the extensive reporting requirements and new regulatory burdens could stifle investment in the healthcare sector, particularly for struggling facilities that might benefit from private capital. They may contend that such regulations could lead to increased administrative costs, reduced efficiency, and potentially fewer healthcare options, especially in underserved areas, and that existing regulations are sufficient.
The bill is moderately complex, requiring careful reading to understand the detailed reporting requirements and regulatory mechanisms, which may exceed the time typically allotted for quick review.
Section 2, adding Title XXXIV, Sec. 3402 to the Public Health Service Act.
Required Reporting for Covered Firms
This section mandates that for-profit corporations owning healthcare entities ("covered firms") submit detailed annual reports to the Secretary of Health and Human Services (HHS). Covered firms controlled by private equity funds must report extensive financial data, including equity percentages, debt levels, fees collected, political spending, staffing levels, and facility closures. Other covered firms have similar, though slightly less extensive, reporting requirements. The data will be made public, audited, and used for annual reports to Congress on trends and impacts.
Supporters argue
Supporters argue this transparency is crucial to understand the financial practices and impacts of private equity in healthcare, which they contend often prioritize profit over patient care. It will allow policymakers and the public to identify problematic trends like understaffing or asset stripping.
Critics contend
Critics might argue that these extensive reporting requirements are overly burdensome, particularly for smaller healthcare entities, and could deter investment. They may also contend that some required information is proprietary and its public disclosure could harm competitive advantage.
Tradeoffs
Balances the public's right to know and regulatory oversight against the administrative burden on private entities and potential disclosure of sensitive business information.
Section 2, adding Title XXXIV, Sec. 3403(a) to the Public Health Service Act.
Mechanism to Ensure Risk Mitigation for Private Equity-Owned Firms
This section requires the Secretary of HHS to establish a mechanism to mitigate risks posed by private equity-controlled covered firms. This mechanism may include requiring these firms to establish escrow accounts sufficient to cover 5 years of operating and capital expenditures (including closure costs and supplemental funding for community providers), obligate minimum capital investments, or undertake other activities to ensure financial contributions mitigate impacts of potential closures, service reductions, or quality/safety declines.
Section 2, adding Title XXXIV, Sec. 3403(b) to the Public Health Service Act.
Prohibition on Harmful Real Estate Investment Trust Transactions
This section prohibits healthcare entities or covered firms from entering into sale-leaseback agreements with Real Estate Investment Trusts (REITs) if such terms would lead to long-term weakened financial status for the healthcare 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.
Section 2, adding Title XXXIV, Sec. 3403(c) to the Public Health Service Act.
Licensing Requirement for Private Equity Investment in Healthcare
This section requires private equity firms to obtain a license from the Secretary of HHS to invest in or purchase healthcare entities. The Secretary can deny or revoke licenses for non-compliance with the title's provisions, engaging in price gouging, understaffing, or access barriers. Revocation requires divestment from healthcare investments. Fees from licenses fund National Health Service Corps, community health centers, teaching health centers, and disproportionate share hospitals.
Section 2, adding Title XXXIV, Sec. 3404 to the Public Health Service Act.
Task Force to Monitor Private Equity and Consolidation, with Moratorium Authority
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 the role of private equity and consolidation. The Task Force will identify best practices, emerging trends, and develop legislative recommendations. Critically, the Secretary is granted authority to impose a moratorium on private equity funds purchasing or merging with covered firms until the Task Force determines whether abuses (like price gouging, understaffing, or access barriers) are occurring in specific sectors.
Section 5 of the bill, amending Section 1866 of the Social Security Act.
Hospital Closure and Service Discontinuation Notification and Mitigation Requirements
This section requires hospitals to notify the Secretary of HHS at least 90 days before discontinuing services or closing, prohibiting the discontinuation of "essential services" during this period unless there's a clear safety risk. Hospitals must submit mitigation plans if essential services are impacted, outlining how access will be preserved and employees supported. The Secretary conducts a public comment and review process, potentially developing an alternative mitigation plan. Non-compliant hospitals can be barred from Medicare enrollment for up to 3 years.
Elevates "withdrawal liability" (related to multiemployer pension plans) to a first-priority claim in bankruptcy proceedings and adds a new standard for confirming a bankruptcy plan for a "health care business," requiring courts to give substantial weight to the plan's ability to maintain regional health care access, quality, safety, and staff retention.
Section 4
Why it matters:This is standard legislative practice for amending existing federal statutes like the Bankruptcy Code. However, its placement outside the main body of the Public Health Service Act amendments could lead to it being overlooked by those primarily tracking healthcare legislation.
Case for: Proponents argue that these changes protect workers' pension benefits by giving them higher priority in bankruptcy and ensure that critical healthcare services are not summarily dismantled during financial distress, prioritizing community well-being over pure creditor recovery.
Case against: Opponents might argue that elevating withdrawal liability could complicate bankruptcy proceedings and reduce the recovery for other creditors, potentially making it harder for distressed businesses to reorganize. The new healthcare standard could be seen as an undue interference in the traditional financial focus of bankruptcy courts.
Estimated impact: Potentially significant for multiemployer pension plans and for communities reliant on healthcare businesses facing bankruptcy, altering financial outcomes and service continuity.
Amends the Internal Revenue Code to exclude rents received directly or indirectly from "qualified health care property" from being considered "rents from real property" for REIT qualification purposes, notwithstanding certain exceptions. This change would make it more difficult for entities that primarily derive income from healthcare property leases to qualify as REITs, potentially impacting their tax treatment.
Section 6
Why it matters:This is standard legislative practice for tax code amendments. Its technical nature means it's inherently "buried" for a general audience, but its placement at the end might suggest it's not the primary focus of the bill's public messaging.
Case for: Proponents argue this closes a loophole that allows certain entities to benefit from REIT tax structures while operating in the healthcare sector, ensuring that tax benefits are not misaligned with the public service nature of healthcare.
Case against: Opponents would contend that this change could disrupt the healthcare real estate market, making it harder for healthcare providers to access capital for facilities and potentially increasing their occupancy costs, ultimately passed on to patients.
Estimated impact: Potentially significant for the healthcare real estate investment market, affecting billions of dollars in assets and investment strategies.