Union Health is making a new offer to Indiana regulators to buy its rival hospital on the ground high while the door seems ready to conclude such offers.
The non -profit health system is trying to take advantage of an existing state law to acquire the regional high earth hospital, the only other active care hospital in the county of Vigo. After having withdrawn his initial request in November in the middle of the decline, Union moved his argument to underline what he describes as a “decreased position” of the region while offering more concrete promises, such as the limits of price increases.
Union submitted its new application On February 5, while Indiana legislators tried not to have these mergers in their state. The legislators then watered down a bill which threatened to completely prohibit the Union Agreement, the modified legislation now prohibiting the mergers sought on February 15, leaving an opening for the Union. This means that the proposed merger will then be confronted with a confrontation with the administration of the new Governor of Indiana, which reported the opposition to such agreements.
Indiana is among the last states to reconsider the laws on the certificate of public advantages that Greenlight Hospital Monopoles. This year, the legislators of Tennessee presented an invoice To restructure state monitoring of these mergers after An attempt last year To repeal his Copa law. In 2023, Maine repealed its Copa law, joining Minnesota, Montana, North Carolina and Northern Dakota.
“I hope they reconstruct the laws due to the research on the long -term damage of COPAS,” said Christopher GarmonAn economist from the city of the University of Missouri-Kansas who studied Copa mergers.
Indiana is one of the 19 states that still have COPA laws, which allow mergers that the Federal Trade Commission considers illegally because they reduce competition and often create monopolies.
In exchange for the approval of these transactions, merger hospitals generally agree to meet the conditions imposed by their state to mitigate the misdeeds of a monopoly. But health care economists and the FTC said that state surveillance could not replace competition and that these mergers ultimately harm patients.
The first Union Health application was donated. The State Ministry of Health received hundreds of commentsWith most opposing the agreement, according to an examination of the KFF Health News documents obtained thanks to a request for public state files. Doctors, health economists and FTC were one of those who called on state regulators to deny the union’s proposal.
Union drew its application In November, just a few days before the state was to rule on the agreement.
When Union filed his new request in early February, this time he promised a multitude of commitments and concrete promises to improve the health of residents in largely rural communities that surround high. Among them, there were promises to maintain the emergency services of open hospitals and hospital services in operation, and to link the increase in hospital costs to the consumer price index for medical care, to essentially establish a ceiling so that the costs do not exceed medical inflation.
He also refounds his argument to describe Regional as a declining hospital, which said that the union endangers the region to lose access to services if the merger is not approved. HCA Healthcare, based in Tennessee, has regional high land.
In this scenario, Union warned, if the regional should close, the health system would essentially have a monopoly anyway, “without any surveillance, terms or conditions” of a COPA. Instead, he said, a green light from state regulators could avoid closing the hospital and guarantee monitoring of the combined hospital system.
The union’s first request did not argue that the merger was necessary for the region to remain viable. In public comments submitted in September And MarchThe FTC has argued to state regulators that the two hospitals are “financially stable”, adding that the region is “part of the country’s largest hospital system with enormous financial resources”. He also cited the hospital’s financial reports that showed that the profits from the regional high land hospital were better than those in most other hospitals in the country.
“This reconditioned COPA request presents the same problems as before,” said Clarke Edwards, acting director of the FTC policies office, in a March 17 declaration After the Commission, unanimously opposed the merger.
HCA did not answer questions about the characterization of the Union that Regional is a declining hospital.
Despite the union insurance that the merger would benefit the region, an analysis of the first proposal revealed the opposite. Zack CooperAn economist of health and an associate professor at the University of Yale, estimated that the price of care would increase by at least 10%, that 500 jobs would be lost and that the salary of nurses would decrease by at least 7%.
Despite the new application and the new promises, “the nature of the agreement has not changed,” said Cooper. He said that his conclusions remain unchanged and that the Union benefits – not the community.
“Life is easier for a business if you are facing less competition,” he said. “There is less pressure to compete on quality. There is less pressure to compete on the price. ”
In January, State senator Ed Charbonneaua republican and a key architect of Indiana 2021 COPA Actpresented the legislation to repeal the lawThis would have seized the Union’s chance during a second possible merger attempt.
In February, sitting side by side during a hearing of the State Senate Health Committee, the CEO of the Union Health Steve Holman, the president of the High Earth Chamber of Commerce, Kristin Craig, and Greg Goode state senatorA republican representing the region, testified against the bill.
Holman told legislators that the merger would improve the health of the region. He also noted that the hospital system had already spent $ 3 million in legal costs pursuing the agreement. He said he seemed that the legislators were trying to paralyze the chances of the Union. “Why did this come now?” Holman asked.
The bill aimed at repealing the COPA law made its doors by a committee by a vote of 7 to 4. Mike Bohacek state senatorA republican who represents a region at a three -hour road north of the high land, said that he had voted against the repeal of the deference law towards local officials.
“I don’t have a dog in this fight,” said Bohacek.
Charbonneau later changed his invoicewinning the support of Union and Goode. The new version has crossed the Senate. It is now supported by two powerful Republican representatives in the House: Brad BarrettChairman of the Public Health Committee, and Bob HeatonMajority whip of the house. Heaton represents parts of the county of Vigo.
Union Health’s spokesman Amanda Scott said in an email to Kff Health News that the Union and the Regional Hospital “recognize the importance of final approval” and that the Union considers this as its last chance to acquire its rival.
But the new governor of Indiana, the Republican Mike Braun, took office in January, promising to repress consolidation, especially in health care.
Earlier this year, Braun Gloria Sachdev To direct a newly created cabinet post supervising state healthcare agencies, including the State Health Department, which will decide on the merger.
As CEO of the Indiana Employers Forum, a coalition of companies that fought on high hospital prices, Sachdev was a frank critic of the merger proposed on high land. In October opinion In Indianapolis star, she urged regulators to think about how these mergers can crush communities.
Sachdev, now the Secretary of Health and Family Services in the State, has not answered questions about the new offer. After Kff Health News asked the Governor’s office if Braun had a final authority on the fate of the Union merger request, the spokesman for the Ministry of Health, Greta Sanderson, provided a joint statement from the Governor’s agency and office: “Governor Braun will expect to be informed of the mind and to ensure that the decision is thoughtful and objective with the best interests of the clogs.”
The State has until June 21 to examine the request for merger before rendering a decision, according to the Ministry of Health. The public can comment On the proposal until March 23.