Before Rick Jackson launched his surprise bid for the highest political office in Georgia earlier this year, some people in Alabama already knew his name.
He’d written an opinion article in one of the state’s biggest news outlets and addressed local leaders at Montgomery City Council meetings — all part of a large-scale and expensive effort to keep one of the city’s hospitals from closing its doors.
Leaders of the nonprofit hospital in Alabama’s capital blamed its collapse on financial pressures, including mounting debt, staffing shortages and Alabama’s refusal to expand Medicaid that would cover more of the state’s uninsured. Critics contend mismanagement was to blame.
At the time Jackson Hospital filed for bankruptcy last year, Rick Jackson’s medical staffing company was the facility’s second-largest creditor with nearly $10 million in unpaid bills.
“We called immediately — not to demand payment,” Jackson wrote in his op-ed. “But to ask how we could help the hospital make it through.”
That’s when Rick Jackson’s investment group offered a lifeline: a $35 million loan that gives Jackson’s company close control over the hospital and puts him first in line to be repaid.
“We call our approach venture philanthropy: we deploy capabilities and capital to solve structural problems in healthcare that traditional philanthropy or market-rate capital alone can’t fix,” he said.
Credit: Jason Getz/Atlanta Journal-Const
Credit: Jason Getz/Atlanta Journal-Const
Rick Jackson has no familial ties to Jackson Hospital — despite sharing its name — but the billionaire-turned-politician has a significant financial stake in its ability to remain open. Without the loan, the hospital told the court, it would be forced to close.
Some Montgomery residents wondered why Rick Jackson decided to step in.
“People were just kind of trying to speculate who is this guy,” said Robyn Hyden, executive director of nonprofit public policy organization Alabama Arise. Come to find out, she said, he’s launched a bid for governor in their neighboring state.
“To me, it does really show how interlinked our states are,” she said.
Like Georgia, Alabama has experienced a steady stream of hospital closures over the past decade, many of them in rural communities — though not all. The impact of Jackson Hospital’s potential closure could be compared to the loss of the Atlanta Medical Center in 2022, after which the city’s other facilities shouldered the burden of caring for its patients.
Both states already have high rates of uninsured residents, and those numbers are expected to continue to increase drastically following Congress’ decision to end federal pandemic-era subsidies under the Affordable Care Act.
Credit: HYOSUB SHIN / AJC
Credit: HYOSUB SHIN / AJC
“We have had a solution for a long time, just like Georgia has,” said Hyden. “States who have expanded Medicaid have experienced many fewer hospital closures by tremendous degree.”
But if elected, Rick Jackson says he would follow a line of Republican governors who are opposed to expansion in favor of programs with work requirements and federal grants to help ease the state’s healthcare woes.
“I will guarantee you that we will have the most cost-effective healthcare plan because I know how it works inside out,” he said Wednesday at the Georgia Chamber of Commerce luncheon in Athens.
Bottoms, Jackson spar over healthcare
The situation with the Alabama hospital puts a spotlight on the magnitude of Rick Jackson’s influence in the healthcare sphere and raises questions about what it could mean for Georgia to have a top industry executive running the state.
“The governor can really have a pretty profound impact on the healthcare system,” said Dr. Stephen Patrick, chair of the Department of Health Policy and Management at Emory University’s Rollins School of Public Health.
While they ultimately need legislative support to push their initiatives across the finish line, Patrick said, the office sets the trajectory for the state on the issue.
“They definitely set the priorities, they set the budget, and they appoint all of the high-level health agency leadership from the Department of Health to who runs Medicaid,” he said.
Rick Jackson’s Democratic opponent, former Atlanta Mayor Keisha Lance Bottoms, is campaigning on the promise to push for Medicaid expansion — and the Republican’s healthcare fortune is at the center of the Democrat’s attack lines.
Credit: Riley Bunch
Credit: Riley Bunch
“My opponent, who has a healthcare company in the state, who received a billion-dollar, no-bid contract for that healthcare company in 2020, does not want to expand Medicaid,” Bottoms told a crowd of supporters at a campaign stop in Brunswick last week.
Jackson has previously pledged to “unwind” his contracts with the state if elected and touts his industry experience as the missing link in addressing healthcare issues.
“Well, first of all, I understand how Medicaid works, and I do believe in an intelligent Medicaid expansion,” Jackson said when asked about her comments. If elected, Jackson said he’d seek a fixed block grant from the White House instead of open-ended federal matching.
“I’m not going to measure our state by how many people are on Medicaid,” he said. “I want to measure how many people are on commercial insurance, and the way to do that is reduce the cost of commercial insurance. And that’s what I want to do.”
Rick Jackson’s business capital is so large he debated purchasing the Jackson Hospital outright but ultimately told Alabama Gov. Kay Ivey that the cost to turn the facility around — between $250 million and $300 million — was too high of a price tag.
“There’s no way anybody could justify — certainly not us — to do that,” he said at a Montgomery City Council meeting in September 2025.
Credit: Hyosub Shin/AJC
Credit: Hyosub Shin/AJC
It’s not the first time he’s explored acquiring community hospitals. In 2008, Jackson Healthcare opened a business, Jackson Hospital Affiliates, with the objective of buying struggling healthcare facilities to turn around.
During the September city council meeting, Rick Jackson said he believes hospitals shouldn’t operate as nonprofits and offered a similar description as he does on the campaign trail when talking about how he’d approach running state government like a business.
“Our plan does include keeping (Jackson Hospital) as a nonprofit,” he said. “However, what you will see is that it will be done by the discipline of a for-profit mentality — as the Catholic (Health) Association says, ‘No margin, no mission.’”
His $35 million loan to the hospital comes with a 14% interest rate — that increases to 19% if payment is missed. The hospital also agreed to pay millions in other fees.
But even with the influx of Rick Jackson’s cash — and $80 million of public funding also being given to the hospital from the state, county and city — the fate of Jackson Hospital is uncertain.
“It’s fourth down on the 2-yard line, so we’ve got our last shot,” Stuart Memory, an attorney for the hospital, said during a recent bankruptcy hearing. “We are running out of money.”
When business meets public health
Today, the Alabama hospital’s doors remain open only due to a verbal agreement between the hospital and its investors and insurance powerhouse Blue Cross and Blue Shield — both sides locked in what U.S. Bankruptcy Judge Christopher L. Hawkins described as a “contentious” legal battle over reimbursement rates.
Meanwhile, local elected leaders describe the community as at the mercy of negotiations.
Credit: AP
Credit: AP
“We have made progress, but the challenge became the city and the county being caught between two giants: Jackson Healthcare and Blue Cross Blue Shield of Alabama,” Montgomery Mayor Steven Reed told the Atlanta Journal-Constitution.
Both sides, he said, have responsibility in finding a solution that serves residents.
“What we’ve tried to do is to keep the people the focus, and not so much so that it’s just about the bottom line,” Reed said. “Right now, we have a short-term solution to a long-term problem.”
The situation has also sparked debate about whether the kind of private investment, like Jackson’s massive bailout loan, has a place in healthcare management at all.
“There are two places where CEOs and businesses shouldn’t be in charge: and that’s law offices and doctors’ offices,” said Jane Adams, a healthcare consultant who previously worked with organizations advocating for Medicaid expansion.
When asked about Rick Jackson’s reasoning behind the decision to prop up the hospital, a spokesperson for his campaign said, “Improving healthcare is personal for Rick.”
“Rick is tackling issues at the core of our country’s healthcare challenges,” said Garrison Douglas, campaign spokesperson. “There are no simple solutions, but Rick will never stop fighting to make healthcare work better for everyone.”
Experts are also warning that the strain on struggling hospitals across the country like Jackson Hospital in Montgomery is only going to worsen after Congress cut Medicaid spending in the “Big, Beautiful Bill.”
According to KFF, an independent health policy research organization, the bill is expected to cut Medicaid spending by $911 billion over the next decade.
In Georgia, that could mean anywhere from $6 billion to $10 billion less in Medicaid funds.
“Cuts to federal healthcare spending of that magnitude are likely to have consequences for hospitals in general,” said Zachary Levinson, director of the KFF Project on Hospital Costs. “It could lead some to lay off staff, offer fewer services or close altogether.”
Credit: Hyosub Shin/AJC
Credit: Hyosub Shin/AJC
Georgia Republicans campaign on the need for a business mindset to address the state’s healthcare system failures.
Gov. Brian Kemp’s answer to the state’s high uninsured rate was the Pathways program, which partially expanded coverage to low-income Georgians who participate in an 80-hour-a-month work requirement.
On Wednesday in Athens, Kemp slammed Bottoms for advocating for expansion, saying that since he’s been in office, the state has spent an additional $2.2 billion on Medicaid — twice the normal rate of increase across the budget.
“I would hope that you all press the mayor on exactly what she’s wanting to do and how much it’s going to cost,” Kemp told reporters while standing alongside Jackson.
“All the Democrats want to do is just have government-run healthcare,” he said, adding that the issue needs “private sector solutions” and have government “get out of the way of healthcare.”
“This man knows how to fix that,” he said.
Staff reporter Thad Moore contributed to this report.
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