You may think you know the story: Private equity firms buying up healthcare businesses and sticking it to payers.

I must be talking about nursing homes, right?  After all, the ownership of nursing homes appears to be the Biden administration’s number one healthcare obsession.

But I’m not. For one thing, regardless of its ownership, a nursing home can’t jack up prices because its prices are fixed by government payments, largely Medicaid. Instead, I am talking about private equity reportedly buying healthcare staffing agencies or, as was detailed in a thorough recent Washington Post investigation, monopolizing anesthesiology practices.

The Post investigation was revealing, reporting on “private-equity funds acquiring hundreds of physician practices across America and, according to multiple academic studies, raising prices while returning billions to investors.”

Where is the administration’s outcry over this development? Instead of acting, its Federal Trade Commission is slumbering. It may be that to acknowledge the incentives toward anti-competitive consolidation unleashed by the Affordable Care Act would be to admit that the ACA falls somewhere short of perfection. In fact, according to Bureau of Labor Statistics’ data, the inflation rate for medical care in the last half of 2022 was twice as high as it was in the last half of 2013, the first year the ACA was fully operational. It was only because the Inflation Reduction Act dumped an extra $20.9 billion into health insurers’ pockets for 2022 alone that ACA marketplace health insurance premiums didn’t skyrocket. 

This assistance was cunningly extended through the 2024 presidential election with another barrowful of $20.9 billion, after which the boom can be lowered. It still did not prevent individual market rate increases of as high as 16% from being approved in Washington, considered a progressive state for healthcare.

Because the sentimental part of me still yearns for an idealistic view of government, a favorite movie is “The American President.” In that movie, the fictional president Andy Shephard, played by Michael Douglas, discusses his adversary, Sen. Bob Rumson, played by Richard Dreyfus, and says: “We have serious problems to solve, and we need serious people to solve them. And whatever your particular problem is, I promise you, Bob Rumson is not the least bit interested in solving it. He is interested in two things and two things only: making you afraid of it and telling you who’s to blame for it.”

That blame game, singularly aimed at nursing home care, has been abundantly on display during the Biden administration, but it, too obscures serious problems in the entire healthcare system. I am by no means suggesting that nursing homes owned by private equity are beyond reproach, but they cannot be painted with a broad brush, any more than the massive settlements paid out in progressive states like Massachusetts or New Jersey somehow define state-run nursing home care.

In fact, if the Biden administration is so concerned about private equity investors acquiring nursing homes, it could mitigate that possibility by not rubber-stamping Medicaid State Plan Amendments that objectively fail to pay care costs — leaving only deeper pockets with a tolerance for risk, and ability to ride things out until a hoped-for brighter future, able to sustain nursing home operations.

It would also not impose an unfunded staffing mandate that would be yet another crippling blow for a sector looking to rebuild its workforce, and potentially force sales of even more facilities that cannot weather any more financial pain — pain that would, ironically, further force them into the cruel embrace of staffing agencies owned by private equity.

To paraphrase President Biden’s fictional counterpart, we have serious problems in healthcare.  But to fixate on bludgeoning nursing home care is to ignore them.

Brendan Williams is the president & CEO of the New Hampshire Health Care Association.