October 22, 2024

Warren, Blumenthal Urge HHS To Take Action To Protect Wheelchair Users From Private Equity Abuses

Private equity’s expanding ownership of health care entities directly linked to declining standards of care for wheelchair users

Text of Letter (PDF)

Washington, D.C. – U.S. Senators Elizabeth Warren (D-Mass.) and Richard Blumenthal (D-Conn.) wrote to Department of Health and Human Services (HHS or the Department) Secretary Xavier Becerra, urging HHS to continue taking aggressive action to protect patients from the detrimental effects of private equity’s (PE) involvement in health care. The senators raised concerns about PE’s expanding ownership of health care entities and specifically highlighted the link between PE ownership and declining standards of care for vulnerable populations, such as wheelchair users.

Currently, the wheelchair supply market is largely controlled by two PE-owned companies — National Seating and Mobility (NSM) and Numotion — which fail to provide adequate support for timely repairs. For the nation’s roughly 5.5 million wheelchair users, repairs that take weeks are the norm, leading many to be trapped at home and at risk of other detrimental effects.

“PE’s involvement in health care markets has exacerbated problems related to surprise medical billing, inadequate staffing and training, and a lack of oversight and due process,” wrote the senators. “We appreciate the HHS action to make PE ownership of nursing homes more transparent, but we remain concerned about PE’s pervasive and expanding influence in other health care industries.”

Recent data provided by the industry shows that, on average, 60-82% of the total delay days for wheelchair repairs are due entirely to the industry’s inability to conduct timely in-home assessments and in-home repairs after all prior authorization has been obtained and all parts have been received. PE companies are structurally motivated to focus on selling wheelchairs rather than investing resources in repairs and customer service: companies make thousands of dollars in profit from the sale of modern wheelchairs, but lose money on repairs. The problems facing the wheelchair industry are illustrative of the negative impact of PE in health care overall, including PE’s use of anticompetitive practices to build up monopoly power, leading to a decline in quality of care and higher costs for patients.

“HHS can and must do more to help combat the misalignment of PE’s short-term profit incentives with the well-being of our nation’s most vulnerable populations,” the senators concluded.

The senators commended the Biden administration for initiating a cross-government inquiry on the impact of corporate greed in health care, and requested additional information from Secretary Becerra regarding HHS’s ability to address harms facing vulnerable populations as a result of PE’s expanding influence and what, if any, additional authorities the Department may need to further target PE ownership of health care entities.

Senator Warren has repeatedly called out the harms of private equity ownership on health care costs and quality of care, and advocated for Americans’ right to repair the items they own:

On October 10, 2024, Senator Elizabeth Warren reintroduced the Stop Wall Street Looting Act, comprehensive legislation to fundamentally reform the private equity industry and level the playing field by forcing private investment firms to take responsibility for the outcomes of companies they take over, empowering workers and protecting investors.
On October 3, 2024, Senator Elizabeth Warren sent a letter to John Deere accusing the company of undermining its own “right-to-repair” agreements and evading its responsibilities under the Clean Air Act by failing to grant its customers the right to repair their own agricultural equipment.
On September 30, 2024, Senators Elizabeth Warren and Ed Markey, along with Representative Jake Auchincloss and Representative Stephen Lynch, sent a letter to the CEO of Rural Healthcare Group raising concerns over its proposed acquisition of Steward Health Care’s physician group, Stewardship Health.
On September 26, 2024, Senator Elizabeth Warren sent two letters regarding the costly restrictions imposed on the Department of Defense that bar the military from repairing its own military equipment and instead force it to pay billions of dollars extra to military contractors.
On September 4, 2024, Senator Warren urged the IRS to crack down on Real Estate Investment Trusts (REITs) squeezing the health care industry.
On August 8, 2024, Senators Warren and Markey requested information from private equity firm Apollo Global Management (Apollo) on the company’s role in Steward’s bankruptcy, and urged Apollo to work in good faith to facilitate the sale of Steward’s Massachusetts hospitals.
In July 2024, Senator Elizabeth Warren included a provision in the Senate Fiscal Year 2025 NDAA that would require contractors to provide DoD with “fair and reasonable” access to repair materials.
On July 3, 2024, Senators Warren and Markey wrote to Medical Properties Trust and Macquarie Infrastructure Partners, owners of Steward’s eight Massachusetts hospitals, urging them to offer lease concessions to keep the hospitals open and viable.
On June 11, 2024, Senators Warren and Markey introduced the Corporate Crimes Against Health Care Act of 2024 to root out corporate greed and private equity abuse in the health care system, specifically preventing what happened with Steward from happening again.
On June 5, 2024, Senator Warren wrote to the DOJ, FTC, and HHS calling out high health care costs due to vertically-integrated insurers, private equity companies, and pharmaceutical companies that are driving health care consolidation.
On June 3, 2024, Senators Warren, Brown (D-Ohio), and Markey wrote to the Director of the U.S. Trustee Program (USTP), calling for USTP to move to appoint a Chapter 11 trustee to run the company in place of Steward’s current management, and to monitor the hospitals’ bankruptcy proceedings to protect patients and local communities.
On May 24, 2024, Senator Warren sent a letter to the U.S. Department of Health and Human Services and the U.S. Centers for Medicare & Medicaid Services, urging them to support communities and health care providers affected by the crisis caused by Steward’s financial mismanagement.
On April 19, 2024, Senators Warren and Senator Markey sent a letter to six private credit funds that are holders of Steward’s debt, asking them a series of questions about their loans and calling on them to offer loan modifications that could potentially help keep the hospitals afloat.
On April 16, 2024, Senators Warren and Markey called out Medical Properties Trust and Macquarie Infrastructure Partners for exploiting Steward Hospitals, and urged them to help keep the hospitals open.
On April 8, 2024, Senators Warren, Markey, and the rest of the MA delegation urged the FTC and DOJ to closely scrutinize UnitedHealth Group’s proposed acquisition of Steward Health Care’s physician group, Stewardship Health.
On April 3, 2024, Senator Warren delivered remarks at a Senate hearing in Boston titled, “When Health Care Becomes Wealth Care: How Corporate Greed Puts Patient Care and Health Workers at Risk,” which centered on Steward Health Care’s Massachusetts hospitals.
On April 2 Senators Warren and Ed Markey called out private equity firm Cerberus Capital Management (Cerberus) for its role in creating Steward Health Care’s financial challenges, following Cerberus’s reply to the Massachusetts congressional delegation’s February 2024 probe.
On February 9, 2024, Senator Warren slammed UnitedHealth Group for leveraging NaviHealth’s unregulated artificial intelligence algorithm to unlawfully deny health care to seniors with severe injuries.
On March 26, 2024, Senator Warren released a statement about Steward’s plan to sell its physician group Stewardship Health to UnitedHealth Group’s subsidiary Optum.
On March 26, 2024, Senators Warren and Markey sent a letter to Steward CEO and Chairman Dr. Ralph de la Torre, calling on him to testify at a congressional hearing in Boston.
On March 8, 2024, Senators Warren and Markey sent a letter to Dr. de la Torre, blasting him for years of financial mismanagement, private equity schemes, and executive profiteering that have led to Steward Health Care’s financial crisis.
On February 15, 2024, Senators Warren and Markey, along with all nine members of the Massachusetts congressional delegation, sent a letter to Cerberus seeking answers from the private equity firm for its role in creating the current financial challenges at Steward hospitals.
On January 29, 2024, Senator Warren released a statement about Steward’s financial situation and allegations of patient neglect at Steward facilities.
On January 23, 2024, Senator Warren led the Massachusetts congressional delegation in a letter to the CEO of Steward Health Care pressing the company to brief them on Steward’s financial position, the status of their Massachusetts facilities, and their plans to ensure the communities they serve are not abandoned.
On August 22, 2023, Senator Elizabeth Warren and Ed Markey (D-Mass.), celebrated the U.S. Department of Transportation’s National Highway Traffic Safety Administration reversing course and allowing enforcement of Massachusetts’ pro-consumer Right-to-Repair law.
On June 16, 2023, Senator Elizabeth Warren and Ed Markey (D-Mass.) called on the National Highway Traffic Safety Administration to reverse its course after it sent a recent letter to auto manufacturers, advising them not to comply with Massachusetts’ Right to Repair law.

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