How do we deliberately shift patients, workforce, money, and legal advantages toward non-profit and public providers, and away from investor-owned firms in healthcare

Federal Government:

Increase and multi-year-stabilize the Community Health Center Fund (CHCF) and Section 330 grants – Make it easier for new community-governed clinics (especially in “primary care deserts”) to become FQHCs or “look-alikes.”
Expand public / quasi-public insurance options that favor non-profits – Use standardized benefit designs and aggressive cost controls – Prefer or contract primarily with non-profit plans and safety-net providers.
Adjust Medicare and Medicaid payment rules so that (FQHCs, rural health clinics, public hospitals) receive enhanced, predictable reimbursement) with broadening of more complex care and strict assurance of quality and efficiency. And so that participation incentives in value-based models are stronger for non-profits — designed to reward healthcare providers for delivering quality care and achieving better patient outcomes while reducing costs – Quality Measures tracking – Cost Benchmarking – Pay-for-Performance – Accountable care Organizations – Patient Centered Medical Homes.
Targeted tax incentives for genuinely community-governed non-profits (e.g., FQHC-style boards, public representation).

State Governments:

Use Medicaid managed care procurement to favor non-profits – Explicitly bar or limit for-profit HMOs in Medicaid or other publicly funded markets – Score Medicaid MCO bids more favorably if the plan is Non-profit or public or Strongly contracted with FQHCs, public hospitals, and rural health clinics.
Design network rules that require safety-net / non-profit inclusion – For all state-regulated plans (Marketplace, small group, individual, sometimes large group), mandate that networks include: At least a threshold percentage of “essential community providers”—FQHCs, Ryan White clinics, safety-net hospitals, rural health clinics – Adequate participation from public hospitals and county clinics.
When new hospitals, outpatient centers, or beds are proposed, prefer non-profit or public applicants in CON decisions – Attach conditions to approvals that Require non-profit status.
Control hospital conversions and private-equity acquisitions – Restrict future sale to for-profit or private-equity owners – Require that distressed hospitals first be offered to public entities or community non-profits – Impose strong ongoing conditions on any for-profit acquisitions (minimum charity care, service lines, reinvestment requirements).
Create state public hospital authorities able to acquire failing private hospitals and convert them to public or non-profit status.

Local Governments:

Invest in and expand public hospital systems and their outpatient networks.
Use city/county capital budgets and bonds to – Build new primary-care and behavioral-health clinics – Acquire and reopen failing private hospitals as public/non-profit entities.
Use local public-health grant-making authority to: Fund community health centers, free clinics, and hospital-based outreach, requiring that funded partners be non-profit or public organizations.

Non-profit Organizations:

Scale up non-profit providers and innovative care models – Open new sites in areas saturated by high-price providers but underserved for low-income patients.
Lobby for CHC Fund reauthorization, Medicaid expansions, and public-option designs favorable to non-profit providers – Publish data on cost, access, and quality to argue for channeling more public dollars to the safety net.
Create or re-energize non-profit or mutual health plans (like the original BCBS model) that have broad networks including safety-net providers and reinvest surpluses in care infrastructure rather than shareholders.

Others:

Foundations – Endow non-profit clinics and hospitals, especially in distressed regions – Provide operating subsidies during transitions from for-profit to non-profit ownership.
Large purchasers (unions, public employers, universities) – Design benefit plans that prioritize non-profit/public networks and avoid high-price for-profit systems unless absolutely necessary – Negotiate value-based contracts with non-profit systems and direct employees toward FQHCs and public clinics for primary care.
Citizens, patient groups, and local organizations – Advocate for keeping hospitals and clinics non-profit or public during ownership changes – Support ballot initiatives or local ordinances that require public referenda before selling public hospitals – Strengthen requirements for community representation on hospital boards – Discourage private equity and venture capital acquisitions – Urge politicians to favor public or community-non-profit alternatives.

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