FTC Staff Opposes Proposed Indiana Hospital Merger

Today, Federal Trade Commission staff submitted a comment urging the Indiana Department of Health to deny an application that seeks to combine Union Hospital, Inc. (Union Health) and Terre Haute Regional Hospital, L.P. (THRH).

Union Health and THRH are proposing to merge under a proposed certificate of public advantage, also known as a COPA. The COPA could shield the proposed merger from antitrust scrutiny, leading to a deal that would likely impose higher costs and could lead to worse healthcare outcomes for Indiana patients, as well as lower wage growth for hospital workers, the comment states. In Vigo County, Ind., where the effects of the proposed merger would likely be felt most acutely by area patients and hospital workers, the merged entity would have a combined share of nearly 74% of all commercially insured inpatient hospital services.

Union Health and THRH filed a COPA application in September 2023, and then submitted additional information to the Indiana Department of Health in response to multiple information requests. The Indiana Department of Health has invited public comments, and will continue to accept them through Friday, September 6.

COPAs are regulatory regimes adopted by state governments that are intended to displace competition among healthcare providers. The FTC has a long history of advocating against the use of COPAs through comments and testimony submitted to state legislators and other stakeholders due to concerns that COPAs facilitate hospital consolidation and substantially reduce competition in healthcare markets.

Union Health’s proposed acquisition of THRH raises substantial risk of serious competitive harm and there is insufficient evidence to conclude that the potential harms from the merger would outweigh the claimed potential benefits, the FTC’s comment states.

The Indiana state legislature passed the Indiana COPA Act to allow hospital mergers that “may benefit the public by maintaining or improving the quality, efficiency, and accessibility of health care services offered to the public.” However, Union Health’s proposed deal with THRH would allow for anticompetitive consolidation in a highly concentrated market, thereby undermining the goal of improving healthcare services in the state, the FTC’s comment states. It is doubtful that the COPA regulatory conditions imposed by the Indiana Department of Health would effectively mitigate all of the potential anticompetitive harms to patients in the Terre Haute area – both in the near term and in the decades to come, the comment further adds. 

Additionally, FTC staff evaluated the financial conditions of Union Health and THRH, and concluded that both hospitals are financially stable and able to continue operations absent the proposed merger. FTC staff also performed a labor analysis and determined that the proposed merger would likely depress wage growth for registered nurses due to increased employer consolidation.

In recent years, FTC staff has seen a resurgence in COPA laws. In 2017, the FTC announced a policy project to assess the impact of COPAs on prices, quality, access, and innovation for healthcare services. This project has included research of past COPAs, a public workshop highlighting practical experiences with COPAs and related policy considerations, and an ongoing study of those that have been recently approved. The studies of past COPAs have revealed significant increases in commercial inpatient prices, as well as declines in quality of care. More broadly, access to affordable healthcare is of the utmost importance to American consumers. Promoting competition in the healthcare sector is a key priority for the FTC, including preventing anticompetitive hospital mergers.

The Commission vote to submit the staff comment to the Indiana Department of Health was 5-0.