James R. Repetti (Boston College) presents Private Equity, Health Calamity: How Our Tax Laws Aid Private Equity Investment in Hospitals and Nursing Homes at Irvine, as part of its Graduate Tax Policy Colloquium:
The social welfare impact of investments by Private Equity funds (PEs) in various sectors of our economy is mixed due to the significant debt imposed on PE target companies and the short investment horizon of PE funds. With respect to PE investments in hospitals and nursing homes, however, most empirical studies suggest that PE investments significantly harm welfare. The large amounts of debt incurred by the targets of PE acquisitions increase the risk of default and contribute to excessive cost-cutting measures that harm patients.
Our tax system contains two features that significantly promote PE acquisitions. First, our tax system exempts gain realized by charitable organizations from the sale of their hospitals and nursing homes to for-profit purchasers. Theory predicts, and empirical evidence suggests, that tax-exempt sellers are willing to sell hospitals for less than a taxable seller would be due to this tax exemption. Given that these assets will no longer be deployed in the charitable sector, our tax system should not subsidize transfers to for-profit purchasers that reduce social welfare by exempting the gain from taxation. Even if the tax-exempt seller is not sharing its exemption with the for-profit buyer, policy considerations suggest that gain from such a sale should not be exempt. Since the tax-exempt seller has chosen to stop participating in the health-related activity, this is an appropriate time to return the foregone tax revenue to the government for a determination of its future best use, rather than allowing the tax-exempt to unilaterally make that decision.
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