THE PRIVATE EQUITY interests negotiating over the fate of Steward Health Care’s Massachusetts hospitals are a bit more streamlined, but the state of the bankrupt health operation remains in flux heading into a week of hearings.

During Chapter 11 bankruptcy proceedings, attorneys for Steward said the company was moving briskly toward completing the sale of five of its seven Bay State hospital campuses.

But a four-times-delayed hearing on the sale of Steward’s assets is now set for Friday, the Boston Globe reported early Monday morning. 

Due to a lack of “qualified bidders” for Carney Hospital in Dorchester and Nashoba Valley Medical Center in Ayer, Steward announced its plans to close the two community hospitals by the end of the month. Over the weekend, rumblings emerged that a third Steward hospital may be in jeopardy – Holy Family Hospital in Haverhill.

“Basically, the state has said there’s nothing we can do, and so we’re going to let those two close,” John McDonough of the Harvard T.H. Chan School of Public Health said on an episode of The Codcast alongside Paul Hattis of the Lown Institute. Though the state Department of Public Health requires 120 days notice to close hospitals,“it looks like they are not going to agree to that,” McDonough said of recent Steward reports. “There’s not a lot that the state can do to stop them. So there’s a lot of concern in Dorchester and in the greater Ayer community.” 

About $80 million in state and federal money will be available over the next three years to help new ownership take over the struggling hospitals, Hattis noted. “Even if we can make these transactions happen, those hospitals are gonna need help from the state in order to make it financially,” he said.

The real estate investment trust investment company that owns the hospitals’ properties agreed to sell the Massachusetts sites to their mortgage lender, Apollo Global Management, last week. In theory, having fewer parties at the table should simplify negotiations, Hattis said.

Meanwhile, the state will hold hearings in Dorchester and Ayer this week to let the public weigh in on the anticipated closures. 

As the sale of Steward’s hospitals, land, and physician network roil the state health care systems, friction on Beacon Hill left the two-year session at a close without any new hospital safeguards in place.

Legislative gridlock tied up a number of major health care initiatives in the final hours of formal session, leaving bills by the wayside that would address hospital market oversight, the Massachusetts Health Policy Commission’s cost growth benchmark, prescription drug costs, long-term care, health equity, substance use disorder, overdose prevention centers, maternal health, and aid-in-dying. McDonough noted the larger economic development bill that stalled out also included provisions on licensing foreign-trained physicians to help address a serious physician shortage. 

Lawmakers have been huddling on an array of bills for the past week, expecting to reach resolutions in the various conference committees tasked with reconciling House and Senate versions of the legislation. As of Friday, the State House News Service reports, the most movement seems to be on legislation designed to improve maternal health outcomes.

“I think that people really kind of look at this and suggest that there’s some serious dysfunction in our great and general court, in terms of its process and in terms of the culture of how it’s working and operating,” McDonough said. “So maybe some of us are looking forward to the initiative of the state auditor that would allow her to do auditing and other kinds of oversight of how the Legislature actually functions and how it operates. Because there’s a need for some accountability that seems to not exist from any other quarter – not just on health care, but on the broader policy environment in the state.”

Hattis concurred with McDonough’s assessment of the legislative molasses. Several initiatives lawmakers left unpassed were designed to increase the transparency of health care organizations even outside of the private-equity-owned operations like Steward. But the hold-up between the chambers indicates some meaningful disagreement on the best final form of several bills, Hattis noted.

“In my mind,” he said, “a bad health care bill would’ve been worse than our current situation of no health care bill.”

He bristled at two proposals from the House. One would establish that the Health Policy Commission should not be bound by conflict of interest provisions and “therefore allow industry insiders to sit on the board and make decisions about parties and transactions that come through.” 

Additionally, Hattis took issue with the House version of a multi-year benchmark review process, where “the [Health Policy Commission] might have to sit on its hands for three or four years, even though a provider was having significant growth in its revenues above the benchmark,” he explained. “They wouldn’t be able to do anything until the three-plus year period elapsed, when the data was all in.” 

Both Hattis and McDonough said there is a need for better health planning to ensure equitable oversight, with a particular focus on shoring up under-resourced hospitals.

“I think that it is just terrible that we can hear the secretary of health and human services say ‘the market is spoken,’ and that’s sufficient,” McDonough said, referring to recent remarks by Kate Walsh. “There needs to be a state plan that says, ‘here are our values, here’s what matters to us, and here’s what we need to try to preserve, protect, and defend.’”