The Growing Access Barrier Facing Patients: Private Equity

By: Marcus J. Hopkins, Health Policy Lead Consultant, ADAP Advocacy

The acquisition of hospitals and healthcare practices by private equity (PE) firms has increased dramatically over the past two decades, with PE deals involving healthcare businesses tripling from 2009 to 2016, and acquisitions of healthcare-related operations reaching a staggering $79 billion in 2019 (Halabi et al., 2025). This explosive growth in acquisitions has resulted in astonishing profits for PE firms, slashed salaries for PE-owned employees, and worse outcomes for patients.

Photo Source: Purchaser Business Group on Health

According to the Private Equity Stakeholder Project (PESP), approximately 488 hospitals in the U.S. are owned by PE firms, including 8.5% of all private hospitals and 22.6% of all proprietary for-profit hospitals. At least 27.7% of PE-owned hospitals serve primarily rural patients, and nearly a quarter (22.6%) of PE-owned facilities are psychiatric hospitals (PESP, 2025b).

The healthcare sector is particularly attractive to PE firms as healthcare spending accounts for nearly one-sixth (18%) of the U.S. gross domestic product (GDP), growing 7.2% in 2024, and reaching $5.3 trillion or $15,474 per person (CMS, 2026). With spending at those levels, PE firms can very easily increase profitability, which they largely achieve by decreasing expenditures, particularly those related to salaries, and increasing the number of services provided and billed.

Research published in the Annals of Internal Medicine found that emergency department salaries were cut by 18.2% compared with control hospitals, by 15.9% in intensive care units (ICUs), and by 16.6% hospital-wide, reducing the number of full-time hospital employees by 11.6% (Kannan et al., 2025).

These cuts in staffing come with a cost. Using Medicare Part A and B claims and Cost Report data from 2009-2019, Kannan et al. found that, while there was no observable increase in ICU mortality rates, deaths in PE-owned emergency departments increased by 13.4%. In addition, patient transfers to other acute care hospitals from emergency departments increased by 4.2% and from ICUs by 10.6% (Kannan et al., 2025).

Photo Source: PESP Private Equity Hospital Tracker

A study published in Health Affairs found that claims billed by PE-owned hospitals to Medicare increased by 30.5% after acquisition, resulting in a 14.9% increase in Medicare spending per physician over five quarters. Similarly, patients at PE-acquired primary care practices saw a 12.9% increase in the number of services received, including an 11.1% increase in laboratory tests and an 11.3% increase in preventive and screening services (Singh et al., 2026).

These increases in services, when combined with significant decreases in salaries and staffing, result in huge profits for PE firms just from Medicare payments alone. It is harder, however, to quantify any increases in revenues related to the 340B drug pricing program at these practices or hospitals for a few of reasons:

• According to the Private Equity Stakeholder Project (PESP), some hospitals are operated by PE firms through complex ownership structures, often masking who owns, operates, or oversees them (PESP, 2025b).
• Some non-profit hospitals, while not directly owned by PE firms, are managed by companies that are owned by PE firms. Many of these arrangements are not publicly disclosed (PESP, 2025b);
• Providers are not currently required by either the Health Resources & Services Administration (HRSA), the Center for Medicare & Medicaid Services (CMS), or the Internal Revenue Service (IRS) to report annual 340B revenues to the public or on any tax documents.

That does not, however, mean that PE firms don’t have 340B in their sights. In May 2026, Quorum Health, based in Brentwood, TN, announced that they would be abandoning their for-profit business model and switching to a non-profit model under the pretense of ‘…deliver[ing] quality care in rural and mid-sized communities.” Quorum admits that doing so will result in $13 million in annual savings from tax exemptions alone, and that the expected acquisition of eligibility for the 340B Program will result in $11 million in additional revenues. While this shift must be approved by regulators, it’s expected to be approved by Fall 2026 (Van Alstin, 2026).

These negative consequences have not gone unnoticed. The Private Equity Stakeholder Project—a Chicago-based non-profit watchdog organization founded in 2017 to monitor and address the growing impact of private equity and private fund managers in the climate & energy, workers & jobs, housing, healthcare, and detention & surveillance industries (PESP, n.d.)—began tracking hospitals owned by PE firms, creating an easily searchable list for public examination (PESP, 2025a) and an interactive map (PESP, 2025b).

Photo Source: Quartz

While nonprofit organizations and researchers are closely monitoring the impacts of PE firm ownership in the healthcare industry, state and federal legislators and regulators have struggled to keep pace with the pace of PE acquisitions. A recent article published in The American Journal of Managed Care has called on policymakers to “…pursue innovative regulatory solutions, including health care–specific PE law, alignment of state and federal oversight, adoption of alternative payment models, and strengthened patient protections against PE-associated clinical and nonclinical risks (Berman et al., 2026).

ADAP Advocacy echoes this call. Aside from the risks to patients, PE firms represent real and present dangers to the communities being served by the providers and hospitals they own and loot. They raid safety-net hospitals (O’Grady, 2022), bankrupt hospitals and sell off their property (DePillis, 2019), roll back or eliminate essential but less profitable services (Spegele, 2021), and leave communities with few, if any, options for accessing healthcare services. Those PE firms that have managed to worm their way into the non-profit provider sectors are also very likely reaping 340B revenues while patients suffer.

It’s time to curtail PE ownership in the healthcare sector, regardless of how much money it makes for owners and investors.

Disclaimer: All funders of the ADAP Advocacy Association are publicly listed on our website. 

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association; rather, they provide a neutral platform for the author to promote open, honest discussion of public health-related issues and updates.

References:

[1] Berman, M. E., Tamirisa, K., Rahim, F. O., Khachadoorian-Elia, H., & Witkowski, M. L. (2026, May 11). Regulating Private Equity in Health Care: A Strategic Policy Agenda. American Journal of Managed Care, 32(5), e138-e140. https://doi.org/10.37765/ajmc.2026.89938

[2] Centers for Medicare and Medicaid Services. (2026, January 14). National health expenditure data: Historical. Washington, DC: United State Department of Health and Human Services: Centers for Medicare and Medicaid Services: Data and Research: Statistics, Trends, and Reports: National Health Expenditure Data. https://www.cms.gov/data-research/statistics-trends-and-reports/national-health-expenditure-data/historical

[3] DePillis, L. (2019, July 29). Rich investors may have let a hospital go bankrupt. Now, they could profit from the land. Atlanta, GA: CNN: CNN Business: Economy. https://www.cnn.com/2019/07/29/economy/hahnemann-hospital-closing-philadelphia/index.html

[4] Halabi, S., Belani, S., & O’Hara, G. (2025). Private Equity and Non-Profit Status in the US Healthcare System. Akron Law Review, 58(4), 687-715. https://ideaexchange.uakron.edu/akronlawreview/vol58/iss4/4?utm_source=ideaexchange.uakron.edu%2Fakronlawreview%2Fvol58%2Fiss4%2F4&utm_medium=PDF&utm_campaign=PDFCoverPages

[5] Kannan, S., Bruch, J. D., Zubizarreta, J. R., Stevens, J., & Song, Z. (2025, September 23). Hospital Staffing and Patient Outcomes After Private Equity Acquisition. Annals of Internal Medicine, 178(11), 1,528-1,538. https://doi.org/10.7326/ANNALS-24-03471

[6] O’Grady, S. (2022, November). How Private Equity Raided Safety Net Hospitals and Left Communities Holding the Bag: A Case Study on Leonard Green & Partners’ Ownership of Prospect Medical Holdings. Chicago, IL: Private Equity Stakeholder Project: PESP Private Equity Hospital Tracker. https://pestakeholder.org/wp-content/uploads/2022/11/Prospect_Primer_Nov-2022.pdf

[7] Private Equity Stakeholder Project. (2025a, April). PE hospital tracker. Chicago, IL: Private Equity Stakeholder Project: PE Hospital Tracker. https://airtable.com/appZYwbt3vioNrb95/shricxhAQSjpv5ec8/tbl058jjL6qNMqzkM

[8] Private Equity Stakeholder Project. (2025b, April). PESP Private Equity Hospital Tracker. Chicago, IL: Private Equity Stakeholder Project. https://pestakeholder.org/pesp-private-equity-hospital-tracker/

[9] Private Equity Stakeholder Project. (n.d.). About us. Chicago, IL: Private Equity Stakeholder Project: About Us. https://pestakeholder.org/about-us/

[10] Singh, Y., Dixit, M. N., & Whaley, C. M. (2026, May 20). Private Equity Acquisitions In Primary Care: Changes In Utilization, Spending, And Workforce. Health Affairs, 45(6), 629-636. https://doi.org/10.1377/hlthaff.2025.01703

[11] Spegele, B. (2021, April 11). A City’s Only Hospital Cut Services. How Locals Fought Back. New York, NY: The Wall Street Journal: Health: Healthcare. https://www.wsj.com/health/healthcare/a-citys-only-hospital-cut-services-how-locals-fought-back-11618133400

[12] Van Alstin, C. (2026, May 24). Nationwide private-equity backed hospital chain announces shift to nonprofit business model. Providence, RI: Innovate Healthcare: Health Exec: Business Intelligence. https://healthexec.com/topics/healthcare-management/business-intelligence/nationwide-private-equity-backed-hospital-chain-announces-shift-nonprofit-business-model

HIV Advocacy: Why Stories Change More Than Hearts

By: Michelle Anderson, MA, Grassroots Advocacy & Patient Storytelling Consultant, ADAP Advocacy

**First-Person Perspectives**

I have been in advocacy for more than 20 years, and for years, I have sat in rooms where decisions were being made for people like me without including people like me in the conversation. I have listened to presentations filled with statistics, charts, and research findings that spoke completely over my head. I have listened to reports that described the disparities affecting Black women living with HIV, but those reports were not always an accurate depiction because they did not provide a complete narrative of Black women's experiences when faced with the systemic pressures that create risk for HIV beyond behavior. Although the data is important and research matters, something is still missing.

Photo Source: Narrative Power Institute

I often say that stories are more than personal experiences. They are a form of knowledge that speaks beyond what data cannot convey. They help us understand how policies, systems, and institutions impact real lives. They reveal the human reality behind data and create opportunities for change that numbers alone often cannot achieve because they connect the numbers to human impact.

For instance, when a Black woman living with HIV shares her experiences, it brings context to the conversation. It helps people understand that HIV is not a single issue. It is often connected to issues like poverty, trauma, housing insecurity, gender-based violence, lack of healthcare access, and systemic racism. These are realities that cannot be fully captured in a report because statistics only tell the story of the disproportionate impact of HIV.

Storytelling makes systems visible. It helps us move away from stigmatizing rhetoric that blames individuals and toward examining the conditions that shape people's realities. Instead of asking why someone did not make a different choice, storytelling helps us understand why the decision was made, given the options available to them and the conditions that shaped those options.

I have seen firsthand how stories can change a room. I have watched policymakers lean in when they hear someone describe the choice between paying rent and paying for healthcare. I have seen healthcare providers reconsider their assumptions after listening to a patient who may have fallen out of care due to transportation barriers. I have watched community members connect with issues they previously viewed as distant or unrelated to their own lived experiences. Stories create understanding, empathy, accountability, and, most importantly, they create movement.

Photo Source: ADAP Advocacy

That same principle is at the heart of the work currently underway through the "ADAP Saves Lives: End the Wait" campaign, which was launched in response to the reemergence of ADAP waiting lists and restrictions in some parts of the country. For those of us who have been in this fight nearly 20 years ago, the thought of people once again waiting for access to life-saving HIV medication is deeply concerning. Storytelling is an essential advocacy tool because behind every policy decision is a person whose health may be affected. By elevating the voices of persons living with HIV, storytelling helps policymakers and communities understand what is truly at stake when access to care is threatened.

Meaningful Involvement of People Living with HIV/AIDS (MIPA) recognizes that people living with HIV should be involved, utilizing our lived expertise as leaders, decision makers, and partners in shaping the policies and programs that impact our lives. When people share their experiences in legislative hearings, advisory boards, advocacy campaigns, and community discussions, they provide evidence-informed solutions grounded in real-time experiences. This is when narrative begins to build power.

Narrative power is the ability to shape how people understand an issue. It is the ability to influence systems by challenging stigma, exposing data gaps, and moving conversations beyond awareness to impact. By shifting the narrative, our stories change perspectives, influence policy, and become the power that shapes how systems operate and whose voices are valued within them.

Photo Source: ADAP Advocacy

I believe that the people closest to the issues are often closest to the solutions. Lived experiences belong at decision-making tables because stories are more than personal testimonies. They are tools for leadership, advocacy, and systems change. Stories do change hearts, but they also change how people understand issues, how policies are shaped, and how systems respond to the communities they serve.

Stories do change hearts, but the power does not stop there. They help people understand, in real time, the realities behind data and the impact systems have on people’s lives. When we share our stories, we are challenging stigma, educating communities, informing policy, and creating opportunities for change. We move beyond awareness and into action. We transform our lived experiences into narrative power. This month marks the beginning of ADAP Advocacy’s narrative power to combat the resurgence of those dreading AIDS Drug Assistance Program waiting lists. Patient’s lives depend on it!

Disclaimer: All funders of the ADAP Advocacy Association are publicly listed on our website. 

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association; rather, they provide a neutral platform for the author to promote open, honest discussion of public health-related issues and updates.

Gonorrhea is the Chink in DoxyPEP's Armor

By: Marcus J. Hopkins, Health Policy Lead Consultant, ADAP Advocacy

Recent studies have shown that DoxyPEP (doxycycline post-exposure prophylaxis) is becoming less effective against the bacterial sexually transmitted infection (STI) gonorrhea. Concerns are rising among certain public health groups, such as the Centers for Disease Control & Prevention and European counterparts, but Doxy-PEP remains regarded as a highly effective prevention method for high-risk groups.

Photo Source: Harvard Health Publishing

For the uninitiated, DoxyPEP is a post-exposure oral medication provided within 72 hours after a sexual encounter that reduces the likelihood of acquiring bacterial STIs, including syphilis, chlamydia, and gonorrhea. In the initial DoxyPEP trial, researchers found that the incidence of syphilis decreased by 87%, chlamydia by 88%, and gonorrhea by 55% (Dall, 2026). After this initial study, the Centers for Disease Control and Prevention (CDC) released clinical guidelines for its utilization in 2024 (Bachmann et al., 2024).

Even in the initial study, the reduced incidence of gonorrhea was modest, at best; subsequent studies have shown that a rapid increase in tetracycline-resistant strains of gonorrhea has greatly reduced or all but eliminated DoxyPEP’s efficacy against the infection.

Research published in JAMA Internal Medicine found that the incidence of STI cases of syphilis and chlamydia in San Francisco, CA, decreased significantly among Men who have Sex with Men (MSM) and transgender women against projected case numbers, while the incidence of gonorrhea increased significantly (Sankaran et al., 2025).

Another study published in Clinical Infectious Diseases suggests that widespread utilization of DoxyPEP may actually be contributing to the increase in tetracycline-resistant gonorrhea strains in King County, Washington state, which has resulted in the county health department revising its guidelines on the utilization of doxycycline to treat other bacterial issues, including skin and soft tissue infections and lower respiratory tract infections (Soge et al., 2025).

A third study published in The Lancet Infectious Diseases similarly suggests that widespread utilization of DoxyPEP may be inadvertently increasing the propagation of multidrug-resistant strains of gonorrhea in southern California (Yechezkel et al., 2026).

Photo Source: emedicinehealth.com

Drug-resistant strains of gonorrhea have been a concern in the United States for some time, and researchers have been sounding the call against overreliance upon DoxyPEP as a harm reduction tool against the STI for just as long. A correspondence published in the New England Journal of Medicine in 2025 warned that multidrug-resistant strains have been spreading globally, including strains that carry resistance to the antibiotic ceftriaxone (Helekal et al., 2025).

Sexual health advocates have been heralding DoxyPEP as one of the first effective methods for preventing STIs transmission since the findings of the initial study, including those at the American Sexual Health Association (ASHA, 2025). There is no doubt that DoxyPEP has clearly been shown to be effective against syphilis and chlamydia; however, ADAP Advocacy recommends that organizations begin having realistic conversations about its efficacy against, as well as the continued increase in propagation of, multidrug-resistant strains of gonorrhea.

These conversations need not be “sex-negative,” focusing on fear and shame-based representations of sexual activity; they do, however, need to be realistic.

Disclaimer: All funders of the ADAP Advocacy Association are publicly listed on our website. 

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association; rather, they provide a neutral platform for the author to promote open, honest discussion of public health-related issues and updates.

References:

[1] American Sexual Health Association. (2025, May 09). Learn More About Doxy PEP from Three People Who Take It. Research Triangle Park, NC: American Sexual Health Association. https://www.ashasexualhealth.org/learn-more-about-doxy-pep-from-three-people-who-take-it/

[2] Bachmann, L. H., Barbee, L. A., Chan, P., Reno, H., Workowski, K. A., Hoover, K., Mermin, J., & Mena, L. (2024, June 06). CDC Clinical Guidelines on the Use of Doxycycline Postexposure Prophylaxis for Bacterial Sexually Transmitted Infection Prevention, United States, 2024. Morbidity and Mortality Weekly Report Recommendations and Reports, 73(2): 1-8. http://dx.doi.org/10.15585/mmwr.rr7302a1

[3] Dall, C. (2026, May 11). Study shows doxyPEP’s diminished effectiveness against gonorrhea. Minneapolis, MN: University of Minnesota: Research and Innovation Office: Center for Infectious Disease Research and Policy: Antimicrobial Stewardship. https://www.cidrap.umn.edu/antimicrobial-stewardship/study-shows-doxypep-s-diminished-effectiveness-against-gonorrhea

[4] Helekal, D., Mortimer, T. D., & Grad, Y. H. (2025, July 09). Expansion of tetM-Carrying Neisseria gonorrhoeae in the United States, 2018–2024. New England Journal of Medicine, 393(2), 198-200. https://doi.org//10.1056/NEJMc2504010

[5] Sankaran, M., Glidden, D. V., Kohn, R. P., Nguyen, T. Q., Bacon, O., Buchbinder, S. P., Gandhi, M., Havlir, D. V., Liebi, C., Luetkemeyer, A. F., Nguyen, J. Q., Roman, J., Scott, H., Torres, T. S., & Cohen, S. E. (2025, January 06). Doxycycline Postexposure Prophylaxis and Sexually Transmitted Infection Trends. JAMA Internal Medicine, 185(3), 266-272. https://doi.org/10.1001/jamainternmed.2024.7178

[6] Soge, O. O., Thibault, C. S., Cannon, C. A., McLaughlin, S. E., Menza, T. W., Dombrowski, J. C., Fang, F. C., & Golden, M. R. (2025, June). Potential Impact of Doxycycline Post-Exposure Prophylaxis on Tetracycline Resistance in Neisseria gonorrhoeae and Colonization With Tetracycline-Resistant Staphylococcus aureus and Group A Streptococcus. Clinical Infectious Diseases, 80(6), 1,188-1,196. https://doi.org/10.1093/cid/ciaf089

[7] Yechezkel, M., Helekal, D., Kapadia, B., Hong, V., Pomichowski, M. E., Reyes, I. A. C., Davis, G. S., Müller, N. F., Grad, Y. H., Tartof, S. Y., & Lewnard, J. A. (2026, May 07). Durability of doxycycline effectiveness against gonorrhoea after implementation of post-exposure prophylaxis in southern California, USA: a retrospective, test-negative, observational study. The Lancet Infectious Diseases. https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(26)00123-4/fulltext