A new study reveals the states where private equity has the most influence on housing, health care, jobs and pensions
Housing rights activists and tenants protest against evictions and the poor condition of their apartments outside the offices the landlord Broadway Capital in Chelsea, Massachusetts on April 25, 2022.

For many years, Conemaugh Health System, a hospital chain in west central Pennsylvania, was a nonprofit entity, serving patients in the small communities of Johnstown, Hastings, Meyersdale and Roaring Spring. Today, it is a for-profit system owned in part by Apollo Global Management, one of the largest private-equity firms in the United States.

Since that ownership change in 2018, involving a hospital chain known as LifePoint Health, care at the health system has declined, three patients say. One is Paul Ricci, 53, who works at group homes for the intellectually disabled and in his spare time edits the Johnstown-based Allegheny Independent Media, "a non-fluff website for news and analysis of the Allegheny Region of Pennsylvania," as he calls it. Recently, he said, he and his father have experienced overnight waits in the emergency department and have had trouble getting through to someone who can answer billing questions.

That a big, New York City-based private-equity firm had stepped in at Conemaugh wasn't well-known when it happened, he told NBC News. "The same people were there at the hospital," he said. "I didn't know the care would be different."

Like many U.S. consumers, Ricci is beginning to learn about the impact that private-equity firms like Apollo can have on health care. Over the past decade, these firms have spent $1 trillion taking over health care companies across the nation, typically loading them with debt and hoping to sell them at a gain in three to five years. Critics say the drive to profit from the acquisitions of nursing homes, hospitals, physician practices and health care staffing companies conflicts with diligent patient care, and the firms and their purchases are coming under heightened scrutiny from legislators, anti-trust enforcers and patients.

LifePoint Health, for example, is one of the subjects of two Senate inquiries focused on whether financial deals like the company's may be harming patients. Apollo and LifePoint have said they welcome the scrutiny. Conemaugh did not respond to an email seeking comment.

In recent years, private-equity firms have taken over broad swaths of the nation's economy, extending well beyond health care. These purchases have involved supermarkets, child care, senior living centers, fast food operations, rental housing and pet care providers. Consumers are often unaware that private-equity firms own the companies they patronize because the firms don't put their names on the nursing homes, hospitals, veterinary practices and apartment buildings they own.

But these firms' involvement in different industries can be extensive — for example, NBC News recently estimated that 40% of the nation's emergency departments were operated by staffing companies owned by private-equity firms. And by 2030, according to a recent MetLife estimate, companies backed by private equity may own 40% of the nation's single-family homes, purchases that in many regions have already driven up housing costs for local renters, academics say.

New research by Private Equity Stakeholder Project, a nonprofit group that advocates for more transparency and regulation of the industry, aims to help consumers, legislators and regulators identify where private-equity firms dominate in four key economic areas: health care, housing, jobs and pensions. The analysis, called the Private Equity State Risk Index, details private equity's involvement in those arenas in all 50 states.

Arizona and Georgia, for example, rank high on the list for housing risks related to heavy private-equity purchases of rental homes; New Mexico and West Virginia place high for health care operations dominated by the financiers. Alabama and Massachusetts have an elevated impact on workers and jobs while Washington state, Louisiana and Michigan rank high in pension risk because of investments in private equity, the research states.

The index shows "the private equity threats in our own backyard and gives state leaders the tools to protect the people they serve," said Chris Noble, policy director at Private Equity Stakeholder Project. "By providing transparent data on the risks associated with private equity investments, we empower communities, working families, and policymakers to advocate for change and protect their states from the threats posed by unchecked private equity firms."