Private equity investment in health care facilities has grown substantially in the past decade. There have been hundreds of such acquisitions of health care facilities in the past decade, including physician practices, nursing home facilities, and hospitals involving hundreds of billions of dollars.

At its most basic, private equity investors take over a health care company with the intention of increasing its value and reselling it for a profit. Advantages of such a strategy can be more capital investment and management expertise. Downsides include the use of leveraged buyouts that could saddle the acquired company with high levels of debt. 

On this episode, we’re joined by Dr. Zuri Song, an associate professor of health care policy and medicine at Harvard Medical School, and an expert on the financial incentives, public policies, and private sector investment in the health care system. Dr. Song explained what research has found in studying private equity acquisitions in health care. On average, he said, these investments raise real concerns about both patient outcomes and access to care.

State legislatures are at the forefront of regulation in this area with much of the regulation focusing on increased transparency into these transactions. I talked with two state legislators to get their perspective: Senator Tyler Johnson, a Republican from Indiana who is also a physician, and Senator Cindy Friedman, a Democrat from Massachusetts. They each discussed the legislative action in their states and how they view private equity investment.

Resources

• The Evolving Landscape of State Health Care Transaction Laws, NCSL 
• Health Costs, Coverage and Delivery Database, NCSL 

Tribal households in this country pay more than the average for electricity, and members of tribes often face a higher energy burden--the percentage of household income spent on energy—than many people. Also, there also are about 17,000 homes on tribal land have no electricity, according to a 2023 U.S. Department of Energy report to Congress. The report also noted the critical need for electricity infrastructure on tribal lands, some of which has been addressed through federal grants, loans and technical assistance to tribes.

On this episode we discussed energy security and energy challenges in Indian Country with Daniel Cardenas Jr., the CEO, president and chairman of the board of the National Tribal Energy Association, and Trent Marlett, energy manager for the utility authority of the Choctaw Nation of Oklahoma.

Cardenas’ organization represents the four largest energy producing tribes. He noted that access to reasonably priced electricity is the greatest concern for tribal members and said the vast energy resources on tribal lands mean the future of energy is going to include them. Marlett explained how the Choctaw Nation works with their state energy generators to manage new projects and to try to stay up with the growth in the area and how folks in his state view energy security.

Resources

• Choctaw Nation of Oklahoma
• National Tribal Energy Association

There are more than 38 million people in the U.S. under 65 who have completed some college courses but did not receive a degree or certificate. Dozens of states have set ambitious post-secondary goals and part of reaching those goals includes bringing those back into the educational system. 

On this episode, we get the perspective from two people about how to bring those learners back into the system. Terah Crews is the CEO of ReUp Education, an focused on that population. Illinois Representative La Shawn Ford (D), who chairs the Appropriations Higher Education Committee in the Illinois House, has worked on programs to get people to re-enroll in college in his state. 

Crews discussed how ReUp is working with states to cast a wide net, not only for people close to finishing their degrees, but also for people who might need more support and alternative ways of taking classes, such as online courses. She also discussed some of the barriers people face and how states can help them get back on track to finishing their education. Ford explained that getting people back to school to finish a degree is key to upward mobility and legislation in Illinois is aimed at clearing some of the barriers people find to returning to school.

Resources

• NCSL Higher Education Task Force Report.
• Rep. La Shawn K. Ford Website
• ReUp Education

On this episode, we’re joined by Pev Squire, a political science professor at the University of Missouri and an expert on state legislatures. 

He's the author of several books on legislatures and government, and he joined the podcast to discuss his latest book, “Reforming Legislatures: American Voters and State Ballot Measures 1792- 2020.” The deep dive into about 1,500 ballot measures related to the operations of the legislature that were put to voters over more than 300 years provided Squire with a number of insights.

We discussed how voters view ethics, the qualities they want to see in their lawmakers and the healthy skepticism voters have about legislatures. Squire also explained what he learned about the notion that voters love their own lawmaker but hate the legislature.

Resources

• Pev Squire Bio

On this episode, we dive into geothermal energy, a process that involves tapping into underground reservoirs of heat and steam and using that heat either directly or to generate electricity. Geothermal is attracting the attention of state lawmakers who are looking for additional clean energy sources, new techniques to generate geothermal energy by pumping water into heated layers of the Earth, make geothermal an option in areas of the country where the underground reservoirs of hot water have disappeared. 

Joining the podcast to explain the issue are Sarah Jewett, vice president for strategy at Fervo Energy, and Alex McWard, who tracks energy issues for NCSL. 

Jewett had explained the history of the geothermal industry, how new techniques have changed the outlook for geothermal and the role she thinks this energy sector will play as demand increases sharply for electricity. McWard pointed to a few states that have taken legislative action to encourage geothermal development and why some state lawmakers are excited about the potential of geothermal. 

Resources

• Fervo Energy
• Webinar: “Heating Up: The Emergence of Geothermal Energy,” NCSL

On this episode, two legislative staffers offer some advice to people new to working at the legislature. 

Kate Wolf, a legislative aide in the Nebraska Legislature, and Morgan Hall, a fiscal analyst in the Georgia House budget office talked about surprises early in their careers, what attracted them to legislative service and what they wish they'd known before they started their jobs.

Resources

• Legislative Staff Resources, NCSL

On this episode we sat down with Zach Rausch, the chief researcher at the Tech and Society Lab at NYU, and the lead researcher for “The Anxious Generation,” by Jonathan Haidt, which was published last year. 

The core thesis of the book is that we've been overprotecting children in the real world and underprotecting them in the online world. The book points to data about Gen Z, the generation born from the mid-’90s to about 2010 showing significant increases in anxiety, depression and suicide. The book goes further and makes the case that it is the combination of the smartphone and social media apps that are the root of the problem.

We recorded this interview on the sidelines of NCSL’s Legislative Summit in Boston where he appeared on a panel with other experts discussing young people, social media and public policy.

Resources

• After Babel Substack
• Social Media and Children, 2025 Legislation, NCSL
• Zach Rausch website

This is our third podcast from NCSL’s Legislative Summit in Boston where the organization is celebrating its 50th anniversary.

Joining today's show with some some international perspective are Mark Daly, the chair of the Irish Senate, and Ruth Bajada, the deputy chief of mission for the European Union delegation to the U.S. 

On Monday and Tuesday I spoke with current and incoming presidents and staff chairs for NCSL. You can check those out wherever you get your podcasts. 

Resources

• Celebrating 50 years of NCSL
• NCSL's Legislative Summit

We're coming to you again today from NCSL’s Legislative Summit in Boston where the organization is celebrating its 50th anniversary.

Today's guests are Illinois Rep. Marcus Evans Jr., the incoming president of NCSL, and Lonnie Edgar, deputy director for Mississippi’s Joint Legislative Committee on Performance Evaluation and Expenditure Review and the incoming NCSL staff chair. They will both assume their new positions on Wednesday at the NCSL Business Meeting.

Resources

• Celebrating 50 years of NCSL
• NCSL's Legislative Summit

For today's episode, we're podcasting from NCSL’s Legislative Summit in Boston where the organization is celebrating its 50th anniversary.

We're positing podcasts Aug. 4, 5 and 6 with some voices from the Summit. Today our guests are  Utah Sen. Wayne Harper, the president of NCSL,  and John Snyder, the Transportation Committee staff administrator for the Kentucky Legislative Research Commission and the NCSL staff chair. 

Tomorrow, joining us will be Illinois Rep. Marcus Evans Jr., the incoming president of NCSL, and Lonnie Edgar, deputy director for Mississippi’s Joint Legislative Committee on Performance Evaluation and Expenditure Review and the incoming NCSL staff chair.

And on Wednesday, we'll sit down with two international visitors to get their perspective on the Summit and why working with state lawmakers is important for their nations.

Resources

• Celebrating 50 years of NCSL
• NCSL's Legislative Summit