Healthcare should serve Iowans, not Wall Street

As a retired firefighter and former state senator, I’ve remained passionate about healthcare affordability and bipartisan policy that works for everyone.

That’s why Sen. Chuck Grassley’s bipartisan report, titled “Profits Over Patients: The Harmful Effects of Private Equity on the U.S. HealthCare System,” caught my eye.

The investigation reviewed more than 1 million pages of documents and examined hospital finance and operations under private equity firms. The report found that private equity-owned operators from Wall Street failed to fulfill promises, while conditions deteriorated. The Senate investigation documented inadequate staffing, declining patient experiences, reduced care capacity and financial harm. It also found exorbitant management fees.

These business practices should concern every Iowan: millions of dollars flowing to Wall Street while local hospitals struggle to meet the needs of patients. Sen. Grassley put the issue plainly when the report was released: “Iowans deserve better.” I agree and support Sen. Grassley’s important work on this issue.

As a firefighter who provided emergency healthcare every day and a state senator who championed healthcare affordability and access, I learned first-hand that hospitals are more than just a building. It is where we’re born, get treated for everyday ailments and more chronic problems and where minutes can mean the difference between life and death in an emergency.

That is especially true in rural Iowa, where a hospital may be the community’s largest employer and the only nearby source of emergency care. Yet these essential institutions have increasingly become targets for private equity firms whose first obligation is not to patients, nurses or communities. It is to investors seeking large and rapid returns.

Wall Street raises money to buy businesses, increase profitability and sell them. In healthcare, that model can create dangerous incentives: cut staffing, eliminate less-profitable services, load facilities with debt, sell hospital real estate and lease it back, and charge patients more.

This dangerous dynamic is not only highlighted by investigations by our elected officials like Sen. Grassley but also citizen-led organizations. For instance, I saw that a group named Campaign for Accountability also published a report detailing similar issues with Wall Street rolling up critical healthcare providers and squeezing patients for profit.

It’s not just our lawmakers taking notice. Concerned citizens are also ringing the alarm bells.

Healthcare is an essential service, not an ordinary commodity. A patient experiencing a heart attack cannot comparison-shop. A family facing a cancer diagnosis cannot wait for a better deal. And a rural community cannot easily replace an emergency room, maternity ward or mental health service after it disappears.

Iowa policymakers should require full disclosure of healthcare ownership and financial arrangements, including management fees, debt, dividends and real estate transactions. Major acquisitions should receive meaningful review before they occur. Buyers should be required to show how they will protect staffing, essential services and long-term access to care. When promises are made to a community, they should be enforceable.

We should support Sen. Grassley and other federal leaders pursuing accountability. This should not be a partisan question. Republicans and Democrats should agree that the people who depend on a hospital matter more than the investors who profit from it.

Unfortunately, elected leaders at both state and federal levels seem to be barking up the wrong tree when it comes to healthcare policies. Most notably, they have been scrutinizing the role of pharmacy benefit managers – companies that negotiate drug prices with drugmakers before being dispensed to patients – and their ownership of retail pharmacies. While more transparency and guardrails may be warranted for PBMs, no law should result in regulating them to the point of forcing them to close hundreds of pharmacies. Red states like Arkansas and Tennessee have passed this misguided legislation. That’s why Rob Sand’s bipartisan approach to problem solving provides an opportunity to do the right thing for Iowans by rejecting these cookie cutter solutions.

When a pharmacy closes, the community loses access to everyday medications. When a hospital fails, a rural community can lose lives, jobs and its future growth opportunities.

Iowa’s health care system should be built around patients, caregivers and communities — not around extracting the highest possible return, while money and management simply fly over and fly away from Iowa when profits dry up. Our hospitals are not assets to strip and flip. They are the lifeblood of our communities, and we should treat them that way.