(The Center Square) — North Carolina Treasurer Dale Folwell is predicting more expensive and less safe medical care will result from a planned merger of Atrium Health and Advocate Aurora after Attorney General Josh Stein approved the deal.
"Hold onto your wallets, the Attorney General has failed the patients and taxpayers of North Carolina yet again," Folwell said in a Friday statement. "There is widespread evidence that mergers make hospital care less affordable and less safe."
Folwell’s comments followed an announcement from Stein the day prior that "there is no legal basis within this office’s limited statutory authority to attempt to prevent the Atrium-Advocate Aurora transaction."
While Stein said the state will "take no further action" to prevent the merger, he did express concern about "this combination’s possible effects on health care access in rural and urban underserved communities."
"Atrium has estimated that it will invest $25-50 million in the coming years to expand services in underserved communities in North Carolina; given the size and strength of this new combined entity, it is my strong belief that it can and should do more," Stein said.
While Stein echoed concerns Folwell has repeatedly highlighted in recent years, he claims "the law limits my office’s authority to protect patients’ health care access, quality, and costs."
"North Carolina has experienced a large number of hospital closures and combinations resulting in reduced services, particularly affecting rural residents," Stein said. "Too often, when one hospital swallows up another, patients end up paying more and getting worse care."
Folwell also pointed to Atrium Health’s history of pushing patients into medical debt, and legal issues plaguing Advocate Aurora.
"Atrium Health is notorious for its aggressive medical debt collections and has sued more than a thousand North Carolinians, while encouraging thousands more to open medical credit cards that can charge up to 18% interest," he said. "Further, its new partner, Advocate Aurora, is facing an antitrust lawsuit alleging anticompetitive behavior that has made health care prices higher in Milwaukee, Wisconsin, than in New York City."
The bottom line, according to Folwell: "This is just another example of the cartel putting profits and protectionism over patients."
Folwell and others in June detailed how North Carolina’s largest nonprofit hospital systems — including Atrium Health — recorded billions in profits during the pandemic as they collected $1.5 billion in taxpayer-funded COVID relief, all while billing impoverished patients eligible for charity care.
That report, titled "North Carolina Hospital Systems Profit During COVID," was followed by another report in October that showed most North Carolina hospitals – including Atrium Health – are overcharging patients and reaping millions in Medicare profits, while claiming losses in tax filings to minimize charity care required as nonprofits.
Atrium Health spokesman Dan Fogelman disputed the accuracy of the October report, titled "Overcharged: North Carolina Hospitals Profit on Medicare," and alleged the hospital system "provided more than $2.46 billion in free and uncompensated and undercompensated care, as well as other community benefits, last year."
Stein contends Atrium-Advocate Aurora has agreed to continue to comply with municipal hospital requirements, which requires the hospital chain to maintain current service levels in critical departments, provide indigent care as dictated by community needs, ensure no patents are denied because of an inability to pay, and provide care to Medicaid and Medicare recipients without discrimination.
"My office will continue to monitor the combined entity’s operations and its impact on North Carolinians’ health and well-being," he said. "If Atrium-Advocate Aurora is not in compliance with its legal obligations, my office will not hesitate to take action."
Advocate Aurora Health in May announced the planned merger with Atrium Health to create a massive six-state network of 67 hospitals.
The new health system will combine Aurora Advocate Health’s operations in Illinois and Wisconsin with Atrium Health’s hospitals in North Carolina, South Carolina, Alabama and Georgia. The 67 hospitals would be part of 1,000 sites for care, according to a statement.
To be known as Advocate Health, the proposed merger is expected to create 20,000 new jobs. Revenues from the combined health system are estimated at $27 billion.
The announcement was met with an immediate call by Folwell for the Federal Trade Commission, U.S. Department of Justice and the North Carolina Attorney General to block the merger in the regulatory approval process.
