Samantha Liss
On the heels of a scuttled hospital merger between rivals in Terre Haute, Indiana, a state senator introduced a bill that will forbid comparable mergers sooner or later.
Last yr, nonprofit Union Health tried to amass the one different acute care hospital in Vigo County by leveraging a state legislation it helped create that permits hospital monopolies. Now, Sen. Ed Charbonneau, a key architect of the 2021 law, which permits what is called a “Certificate of Public Advantage,” or COPA, desires to repeal it.
“I didn’t think I was doing 100% the right thing last time,” the Republican, who chairs the Senate well being committee, mentioned of co-authoring Indiana’s 2021 COPA legislation. “I do think I am this time.”
Indiana is one in all 19 states which have COPA legal guidelines, which permit hospital mergers that the Federal Trade Commission in any other case considers unlawful as a result of they scale back competitors and sometimes create monopolies.
In trade for permitting these offers, the merging hospitals sometimes agree to satisfy a lot of circumstances imposed by the state to mitigate the harms of a monopoly. But well being care economists and the FTC have mentioned that state oversight can’t change competitors and that these mergers finally hurt sufferers.
The public and the FTC pressured Indiana health regulators to dam Union’s merger with its rival, Terre Haute Regional Hospital. Just days earlier than a December deadline for the state to situation a call on whether or not to approve the deal, Union Health and Terre Haute Regional Hospital pulled their application.
Union Health and Tennessee-based HCA Healthcare, which owns Terre Haute Regional, declined to reply questions on what prompted the choice to scuttle the deal. In a November statement, Union mentioned it deliberate to submit a brand new software.
In 2021, Union Health leaders had been instrumental within the passage of Indiana’s COPA legislation. They provided draft language for the invoice, in accordance with legislative testimony, and Union Health CEO Steve Holman testified earlier than lawmakers that the merger would enhance Vigo County’s poor public well being rankings.
But Charbonneau’s invoice would forestall such offers and make Indiana the sixth state to repeal its COPA legislation.
In 2023, Maine ended its COPA after heeding warnings from the FTC in regards to the dangerous results of such mergers. Minnesota, Montana, North Carolina, and North Dakota have additionally repealed such legal guidelines.
In comments to Indiana regulators, the FTC referenced KFF Health News’ reporting on Ballad Health, a 20-hospital monopoly in Tennessee and Virginia, as a cautionary story towards such mergers.
COPAs, such because the one underneath which Ballad operates, “have proven unwieldy,” are “difficult to manage,” and “have failed to protect local communities from the harmful effects of anticompetitive hospital mergers,” the FTC mentioned in its feedback on the proposed Union-Regional merger.
Ballad declined to answer KFF Health News inquiries relating to the FTC’s feedback.
Since Ballad launched in 2018 and have become the nation’s largest state-approved hospital monopoly, it has not lived up to a few of its guarantees, KFF Health News has reported. It has fallen in need of high quality and charity care targets, in accordance with annual studies from Ballad and the Tennessee Department of Health. After years of problems and complaints from patients, the state is now attempting to carry Ballad more accountable for its high quality of care.
In a November interview with KFF Health News, Ballad Health CEO Alan Levine attributed the quality-of-care droop to covid-19 and workforce challenges. He mentioned these points are unrelated to the COPA merger and the monopoly it created.
In Indiana, Republican Gov.-elect Mike Braun has mentioned tackling well being care points will likely be a top policy priority. Braun’s coverage agenda to “protect Hoosiers from consolidation” requires rooting out rules that “promote consolidation” and pose a “barrier” to competitors.
Republicans management the state legislature. Charbonneau, a high-ranking senator, has co-authored a number of payments to fight consolidation, together with by means of restricting noncompete agreements for major care physicians and requiring hospitals and different well being care companies to inform Indiana’s lawyer basic of pending mergers and acquisitions.
If Charbonneau’s invoice to repeal Indiana’s COPA legislation passes throughout the legislative session starting Jan. 8, it could forestall Union from buying Regional. Union would wish to submit a brand new software and get it accepted earlier than Charbonneau’s invoice would take impact July 1. Both Union and HCA declined to touch upon the proposed invoice and their future software plans.
KFF Health News is a nationwide newsroom that produces in-depth journalism about well being points and is likely one of the core working applications at KFF—an impartial supply of well being coverage analysis, polling, and journalism. Learn extra about KFF.
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