[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 9910 Introduced in House (IH)]
<DOC>
119th CONGRESS
2d Session
H. R. 9910
To amend the Public Health Service Act to require the Secretary of
Health and Human Services to enforce certain requirements with respect
to for-profit corporations that own health care systems, and for other
purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
July 23, 2026
Ms. Jayapal (for herself, Mr. Deluzio, and Ms. Clarke of New York)
introduced the following bill; which was referred to the Committee on
Energy and Commerce, and in addition to the Committees on Financial
Services, Ways and Means, and the Judiciary, for a period to be
subsequently determined by the Speaker, in each case for consideration
of such provisions as fall within the jurisdiction of the committee
concerned
_______________________________________________________________________
A BILL
To amend the Public Health Service Act to require the Secretary of
Health and Human Services to enforce certain requirements with respect
to for-profit corporations that own health care systems, and for other
purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Health Over Wealth Act''.
SEC. 2. AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT.
The Public Health Service Act (42 U.S.C. 201 et seq.) is amended by
adding at the end the following:
``TITLE XXXIV--REQUIREMENTS RELATING TO PRIVATE OWNERSHIP IN HEALTH
CARE
``SEC. 3401. DEFINITIONS.
``In this title:
``(1) Affiliate.--The term `affiliate' means--
``(A) a person that directly or indirectly owns,
controls, or holds with power to vote, 20 percent or
more of the outstanding voting securities of another
entity, other than a person that holds such
securities--
``(i) in a fiduciary or agency capacity
without sole discretionary power to vote such
securities; or
``(ii) solely to secure a debt, if such
entity has not in fact exercised such power to
vote;
``(B) a corporation 20 percent or more of whose
outstanding voting securities are directly or
indirectly owned, controlled, or held with power to
vote, by another entity (referred to in this
subparagraph as a `covered entity'), or by an entity
that directly or indirectly owns, controls, or holds
with power to vote, 20 percent or more of the
outstanding voting securities of the covered entity,
other than an entity that holds such securities--
``(i) in a fiduciary or agency capacity
without sole discretionary power to vote such
securities; or
``(ii) solely to secure a debt, if such
entity has not in fact exercised such power to
vote;
``(C) a person whose business is operated under a
lease or operating agreement by another entity, or
person substantially all of whose property is operated
under an operating agreement with that other entity; or
``(D) an entity that operates the business or
substantially all of the property of another entity
under a lease or operating agreement.
``(2) Corporation.--The term `corporation' means--
``(A) a joint-stock company;
``(B) a company or partnership association
organized under a law that makes only the capital
subscribed or callable up to a specified amount
responsible for the debts of the association, including
a limited partnership and a limited liability company;
``(C) a trust; or
``(D) an association having a power or privilege
that a private corporation, but not an individual or a
partnership, possesses.
``(3) Covered firm.--The term `covered firm' means a for-
profit corporation that owns or is an affiliate of a health
care entity.
``(4) Health care entity.--The term `health care entity'
means an entity that consists of 1 or more of the following
health care providers:
``(A) A hospital.
``(B) A physician practice.
``(C) A skilled nursing facility.
``(D) A hospice facility.
``(E) A mental or behavioral health care provider.
``(F) An opioid treatment program.
``(G) A provider of services (as defined in section
1861(u) of the Social Security Act) or a supplier (as
defined in section 1861(d) of such Act) enrolled in the
Medicare program.
``(H) A supplier of durable medical equipment (as
defined in section 1861(n) of the Social Security Act).
``(I) Any other entity the Secretary determines
appropriate.
``(5) Private equity fund.--The term `private equity fund'
means--
``(A)(i) a person that would be considered an
investment company under section 3 of the Investment
Company Act of 1940 but for the application of
paragraph (1) or (7) of subsection (c) of such section
3;
``(ii) a venture capital fund, as defined in
section 275.203(l)-1 of title 17, Code of Federal
Regulations (or successor regulations); or
``(iii) a sovereign wealth fund; and
``(B) directly, or through an affiliate, acts as a
control person.
``SEC. 3402. HEALTH CARE OWNERSHIP TRANSPARENCY.
``(a) Required Reporting.--
``(1) In general.--The Secretary shall require each covered
firm to submit to the Secretary, at such times as the Secretary
determines appropriate, through the infrastructure established
under paragraph (2), a report containing--
``(A) for a covered firm with respect to which
there is a private equity fund that is a control person
of the covered firm, the information described in
subsection (b); and
``(B) for a covered firm not described in
subparagraph (A), the information described in
subsection (c).
``(2) Reporting infrastructure.--The Secretary, in
consultation with the Secretary of the Treasury and the Federal
Trade Commission, shall establish infrastructure to collect the
data submitted under paragraph (1).
``(3) Public availability.--The Secretary shall make the
data submitted under paragraph (1) publicly available.
``(4) Auditing.--The Secretary shall periodically conduct
audits to verify the data submitted under paragraph (1).
``(5) Annual reports.--The Secretary shall submit to
Congress annual reports describing trends identified through
analysis of the data submitted under paragraph (1) relating
to--
``(A) the financial status of covered firms; and
``(B) how the type of ownership of health care
entities impacts access to health care, health care
quality, and patient safety.
``(b) Reports Submitted by Covered Firms Owned by or Affiliated
With Private Equity.--For purposes of subsection (a), and with respect
to a covered firm described in subsection (a)(1)(A) and each private
equity fund that is a control person of the covered firm, the
information described in this subsection is the following information
with respect to each year of the previous 10-year period:
``(1) The percentage of the equity of the private equity
fund contributed by--
``(A) the general partners of the fund; and
``(B) the limited partners of the fund.
``(2) The level of debt of the covered firm at the end of
the applicable year.
``(3) Information on the debt held by the private equity
fund, including--
``(A) the dollar amount of total debt;
``(B) the percentage of debt for which the creditor
is a financial institution in the United States;
``(C) the percentage of debt for which the creditor
is a financial institution outside of the United
States;
``(D) the percentage of debt for which the creditor
is an entity that is located in the United States and
is not a financial institution; and
``(E) the percentage of debt for which the creditor
is an entity that is located outside of the United
States and is not a financial institution.
``(4) The total amount of debt held by the covered firm
that is categorized as--
``(A) liabilities;
``(B) long-term liabilities; and
``(C) payment in kind or zero coupon debt.
``(5) The average debt-to-equity ratio of--
``(A) each covered firm with respect to the private
equity fund; and
``(B) the private equity fund.
``(6) The average debt-to-EBITDA (Earnings Before Interest,
Taxes, Depreciation, and Amortization) of each covered firm
with respect to the private equity fund.
``(7) The total number of covered firms with respect to the
private equity fund that experienced a default during the
applicable year, and the name of any such covered firm.
``(8) The total gross asset value of each covered firm with
respect to the private equity fund.
``(9) The gross performance of the private equity fund
during the applicable year.
``(10) The total dollar amount of aggregate fees and
expenses collected by the private equity fund, the manager of
the fund, or related parties from covered firms with respect to
the private equity fund, which shall--
``(A) be categorized by the type of fee; and
``(B) include a description of the purpose of the
fees.
``(11) Any transaction, monitoring, management,
performance, or other fees collected by the private equity fund
from the covered firm.
``(12) In dollars, the total amount of regulatory assets
under management by the private equity fund.
``(13) In dollars, the total amount of net assets under
management by the private equity fund.
``(14) With respect to the applicable year, the difference
obtained by subtracting the financial gains of the private
equity fund by the fees that the general partners of the fund
charged to the limited partners of the fund (commonly referred
to as the `performance net of fees').
``(15) Any management services agreements between the
covered firm and the private equity fund, including a
disclosure of fees paid through management services agreements.
``(16) Any other services procured by the covered firm from
the private equity fund or any other company owned by the
private equity fund.
``(17) Dividends paid by the covered firm to the private
equity fund.
``(18) The names of--
``(A) the limited partners of the private equity
fund;
``(B) the board members of the private equity fund;
and
``(C) the leadership of the covered firm.
``(19) All political spending by the covered firm,
including contributions, lobbying spending, and contributions
to groups that do not share their donor list.
``(20) All political spending by the private equity fund,
an affiliate of the fund, or an investment professional at the
fund, with respect to--
``(A) health care related issues; or
``(B) members of congressional committees with
oversight of health care.
``(21) Information on the extent to which the covered firm
entered into any sale lease back transactions with the private
equity fund.
``(22) Every asset purchased by the covered firm during the
applicable year.
``(23) Information that is similar to the information
required to be contained in a notification filed pursuant to
the rules under subsection 7A(d)(1) of the Clayton Act.
``(24) Data related to real estate, mortgage, and lease
payments.
``(25) Interest expenses and payments made by the private
equity fund and each covered firm with respect to the private
equity fund to comply with tax receivable agreements.
``(26) Average interest rate paid on secured and unsecured
lines of credit by the private equity fund and each covered
firm with respect to the private equity fund.
``(27) For the private equity fund and each covered firm
with respect to the private equity fund, a list of--
``(A) all transactions with the 10 largest vendors
or service providers; and
``(B) any new vendors or service providers.
``(28) For the private equity fund and each covered firm
with respect to the private equity fund, the number of payments
to staffing firms.
``(29) For the covered firm, the staffing of each health
care provider owned by such covered firm, disaggregated by
position and ratio of staff to patients.
``(30) For the covered firm, the staff retention rates,
number of job postings, and vacancy rates, disaggregated by
position, with respect to each health care provider owned by
such covered firm.
``(31) For a covered firm that owns 1 or more hospitals,
the number of beds in use and the capacity of each such
hospital.
``(32) For the covered firm, the number of health care
facilities or providers owned by such covered firm that have
closed during such year.
``(33) For the covered firm, health care costs charged to
patients and public and private health plans.
``(34) For the covered firm, the percentage and number of
non-patient care areas in health care facilities owned by such
covered firm that have been converted into patient care areas.
``(35) For the covered firm, reductions in the wages or
benefits of health workers employed by health care providers
owned by such covered firm.
``(36) For the private equity fund and each covered firm
with respect to the private equity fund, complaints of, or
citations for violations of, State or Federal worker protection
laws, including charges of unfair labor practices, complaints
of violations of State or Federal antidiscrimination laws,
complaints of violations of wage and hour laws, and
whistleblower complaints.
``(37) For the private equity fund and each covered firm
with respect to the private equity fund, disclosure of any
agreement or arrangement with a labor relations consultant or
other independent contractor or organization for which a report
is required to be filed under section 203(a)(4) of the Labor-
Management Reporting and Disclosure Act of 1959.
``(38) Any other information that the Secretary determines
relevant for evaluating the impact of private equity ownership
of health care entities on the provision of health care, health
care quality, and safety.
``(c) Information Submitted by Covered Firms Not Owned by Private
Equity.--For purposes of subsection (a) and with respect to a covered
firm described in subsection (a)(1)(B), the information described in
this subsection is the following information with respect to each year
of the previous 10-year period:
``(1) The level of debt of the covered firm at the end of
the applicable year.
``(2) The total amount of debt held by the covered firm
that is categorized as--
``(A) liabilities;
``(B) long-term liabilities; and
``(C) payment in kind or zero coupon debt.
``(3) The average debt-to-equity ratio of the covered firm.
``(4) The average debt-to-EBITDA (Earnings Before Interest,
Taxes, Depreciation, and Amortization) of the covered firm.
``(5) Whether the covered firm experienced a default during
the applicable year.
``(6) The total gross asset value of the covered firm.
``(7) Dividends paid by the covered firm.
``(8) The names of the leadership of the covered firm.
``(9) All political spending by the covered firm, including
contributions, lobbying spending, and contributions to groups
that do not share their donor list.
``(10) Every asset purchased by the covered firm during the
applicable year.
``(11) Information that is similar to the information
required to be included in a notification filed pursuant to the
rules under subsection 7A(d)(1) of the Clayton Act.
``(12) Data related to real estate, mortgage, and lease
payments.
``(13) Interest expenses and payments made to comply with
tax receivable agreements.
``(14) Average interest rate paid on secured and unsecured
lines of credit.
``(15) A list of--
``(A) all transactions with the 10 largest vendors
or service providers; and
``(B) any new vendors or servicer providers.
``(16) The number of payments to staffing firms.
``(17) The salaries of the executives of the covered firm
and each health care entity owned by such covered firm.
``(18) The board membership of the covered firm and each
health care entity owned by such covered firm.
``(19) The staff retention rates, number of job postings,
and vacancy rates, disaggregated by position, with respect to
each health care provider owned by the covered firm.