Reactions to Friday's announcement of WakeMed's plan to merge with Charlotte-based Atrium Health poured in from across the political spectrum Monday, with many urging Wake County Commissioners to hold off on a pivotal vote.
News of the potential consolidation became public Friday afternoon, when the Wake County Board of Commissioners posted its agenda for Monday evening's meeting.
An agreement to update WakeMed's articles of incorporation and a land transfer agreement with the hospital system to allow Atrium Health to take control of WakeMed was the 16th item on that agenda, listed as a consent agenda item.
Wake County's Board of Commissioners voted Monday evening to hold off on a vote for "at least" 90 days.
Concerns about the deal persist, ranging from its potential impacts on costs and quality of service to the four days between when it was made public and commissioners were set to cast their decisive votes.
In a statement posted to social media platform X on Monday, Rep. Erin Paré, R-Wake, said it appeared "there was an attempt" to avoid public scrutiny of the deal.
"The late announcement on Friday, coupled with a hastily scheduled consent agenda vote today by the Wake County Commissioners, raised alarm bells. The lack of transparency and process is concerning," Paré wrote.
Rep. Sarah Crawford, D-Wake, said Democratic lawmakers plan to meet with WakeMed and Atrium officials, as well as with officials from the State Treasurer's Office on Tuesday to better understand the potential deal.
"Our goal is to always work towards lowering the cost of health care for the citizens of North Carolina, the citizens of Wake County," Crawford said.
Crawford also said that lawmakers became aware of the deal last week in an email. She did not specify who sent that email.
House Democrats were holding a press conference Monday to discuss sweeping healthcare legislation that includes a provision that would require the Attorney General, State Auditor and State Treasurer to approve of any hospital merger or consolidation.
Under Democrats' proposal, there would be a public hearing at which the hospital systems would need to explain how the merger would impact accessibility and affordability of care if the system being purchased is a nonprofit or publicly owned.
'I would rather this deal not happen'
Sunday, Briner sent the Wake County Board of Commissioners a letter urging them to slow down the hospital consolidation.
Briner, a Republican, wrote that there have been numerous hospital consolidations across North Carolina in recent years, typically resulting in higher costs for patients or decreased levels of care.
"I am not aware of any example where these types of transactions have resulted in patients being better off, and it is highly unlikely that this one will be the first," Briner wrote.
Research indicates that hospital consolidations increase prices between 6-to-12%, Briner said in a Monday afternoon interview.
As the State Treasurer, Briner oversees the State Health Plan, which provides coverage to 750,000 state employees and retirees. Part of Briner's effort to help the Health Plan improve its financial position has been to encourage competition among healthcare systems, meaning that any significant merger causes alarm.
"As a large payer in the state, as a particularly large customer of WakeMed, when you see that that merger is going to cause higher prices for a plan that's already struggling financially, you have to speak up," Briner said Monday.
Briner also argued that the $2 billion in investments that Atrium is promising as part of the transaction would likely occur anyway due to Wake County's growth and WakeMed's significant borrowing capacity.
Briner labeled the consolidation "a raw deal" for Wake County consumers.
"To be clear, it's not my preferred outcome. I would rather this deal not happen because I think an independent WakeMed is better for the people of Wake County, better for the State Health Plan," Briner said.
If it must go through, though, Briner urged county board members to look at recent consolidations in Buncombe and New Hanover counties as an example. With those in mind, he said, Atrium should be able to fund a $1.5 billion endowment with the aim of boosting healthcare affordability and accessibility in Wake County.
Officials from WakeMed and Atrium parent company Advocate Health are planning to hold a media briefing Tuesday morning.
'Pull back the curtain'
State Auditor Dave Boliek, also a Republican, argued that posting news of the deal on an agenda the Friday before a Monday vote did not give the public enough time to weigh in on a deal where their elected officials have to vote to turn control over to Atrium.
"The people of Wake County and stakeholders who are affected by this move deserve to have more than a weekend to voice their opinions on a hospital takeover of this scale. Whether you support this transaction or not, taxpayers deserve full transparency from their government," Boliek wrote.
As much as half of WakeMed's revenue comes from Medicare, Medicaid and the State Health Plan, Boliek argued, giving the state even more of an interest in any transaction.
Boliek also called for Wake County commissioners to make public everything they know about the deal in order to give the public a chance to scrutinize it.
"It’s time to hit pause, pull back the curtain, and explain exactly what is being (voted) on, the information you have been provided, and the impact this would have on families, employees, and local businesses in Wake County," he wrote.
