Private equity is already reshaping rural healthcare in Wyoming

Rural America has always been worth fighting for, and today one of its most essential lifelines — the local hospital — is under growing threat. As private equity firms expand across the healthcare system, rural communities need protections against investment and ownership models that can extract resources, weaken care, and leave entire regions with fewer options in an emergency. Investment is welcome in communities where capital can be scarce. But healthcare is different: When a hospital closes, lives are at risk. 

For Wyoming, this is not a distant or imaginary concern. Three of the state’s eight privately owned hospitals are now owned by private-equity firms — one of the highest proportions in the country. In a state where distance can turn a service reduction into a medical emergency, decisions made in corporate boardrooms can have immediate consequences for families hundreds of miles away.

For too long, private equity in healthcare has been treated like a story about Wall Street dealmaking. A new Campaign for Accountability report found that private equity-owned hospitals collected an average of $669 more per patient than hospitals operating under other ownership models, without a meaningful increase in the cost of delivering care. Much of the difference came from higher prices, particularly for privately insured patients. 

Since 2005, 197 rural hospitals have closed or converted to other uses. Roughly half are operating at a loss, and 418 are considered vulnerable to closure. In communities with so little margin for error, unstable ownership and rising costs can determine whether care remains available at all.

Every Wyoming resident should be concerned! 

In many small towns, the hospital is both a medical lifeline and one of its largest employers. When it’s weakened, patients face higher prices, reduced services, longer travel times and fewer options for emergency, maternity and behavioral healthcare, among others. 

And concerns about quality are not merely anecdotal. A 2023 study published in JAMA examining more than 660,000 hospitalizations found that hospital-acquired conditions — including patient falls and bloodstream infections — increased by 25% after private equity acquisition, even as those same harms were declining nationally. The consequences are measurable. 

As of 2023, private equity firms  owned at least 130 rural hospitals in at least eight states and had invested heavily in emergency department staffing, medical transport, behavioral health and hospital management companies. Yet a 2026 study in Annals of Surgery found that rural hospitals acquired by private equity experienced increases in postoperative mortality and complications compared with similar hospitals that were not acquired.

The risks extend well beyond hospital walls. Private equity backed firms now staff nearly a quarter of all U.S. emergency department visits. In emergency transportation, private equity companies control 64 percent of the Medicare helicopter air-ambulance market, and charge substantially higher rates than competing operators. In behavioral health — a critical service in areas with limited alternatives – private equity accounted for roughly 60 percent of all facility acquisitions between 2010 and 2021. For many rural communities, these services are not interchangeable. They are essential components of an already fragile healthcare network.

Access problems continue to worsen as well. Since the end of 2020, 139 rural labor-and-delivery units have closed, leaving fewer than half of rural hospitals still delivering babies. In that environment, any ownership model that prioritizes short-term returns over long-term stability should raise serious concerns.

Wyoming residents have come together and refuse to accept that decline. In 2018, Riverton community members created the nonprofit Riverton Medical District and began pursuing a locally governed hospital. Their new facility, now named RiverPeak Health, is scheduled for completion later this year. Plans include 13 inpatient beds, two labor-and-delivery rooms, emergency care and surgery available around the clock. 

None of this means that rural hospitals do not need investment. They do. Rural communities understand better than anyone the financial challenges these institutions face. But there is a profound difference between investors committed to strengthening hospitals in the long term and investors seeking to maximize short-term returns. 

Wyoming should establish its own safeguards before the next hospital or medical practice changes hands. Public officials should require full disclosure of hospital and acquisition-related debt, scrutinize real estate and management-fee arrangements and track whether maternity care, emergency services, behavioral health, surgery or local employment could be affected.

Rural hospitals are not financial assets to be traded. They are community lifelines that must remain intact. Wyomingites deserve a healthcare system built around care, stability, and accountability — not profit extraction.