RE: “John Oliver on U.S. For-Profit Hospice Care: Too Important to Just Hope the Free Market Fixes It,” the issues raised are not new—and Oliver’s piece failed viewers by not referencing the hard work underway now and over the past two years by many policymakers and advocacy organizations—including the one I lead, which represents nonprofit providers—on a wide range of potential reforms, including Congressman Earl Blumenauer’s draft Hospice Care, Accountability, Reform and Enforcement (CARE) Act of 2024.

The rise of for-profit ownership and an accompanying shift in focus to earnings growth have changed the sector. While hospices of any profit status can and do provide quality care, hospice is strongly rooted in its founding by volunteer and community-focused nonprofits. The current payment and oversight structure together create an environment ripe for fraud, as Mr. Oliver highlighted, as well as profiteering. As a result, a wealth of consumer trust built over almost half a century of hospice activity in the U.S., and the legacy of nonprofit, mission-driven hospice providers, many of whom are members of our association, are under direct threat.

Change is needed, which we have been working toward—and, done right, will ensure hospice remains a sustainable and trustworthy benefit for those needing care and services.

America’s population is rapidly aging. Our mission-driven members know how to serve older adults. In hospice, and other settings, nonprofits are innovators in aging services, setting standards in quality of care and service. But without proper payment incentives, oversight, and targeted enforcement to ensure Medicare funds are spent as intended—solely for the benefit of those voluntarily electing hospice care without misinformation—greed will prevail and sadly, more Americans will find themselves living—and dying—without quality services and care they need.