Statement Regarding Union Health’s COPA Application Withdrawal

The Director of the Federal Trade Commission’s Office of Policy Planning, Hannah Garden-Monheit, issued the following statement in response to the decision by Union Health to delay its proposed acquisition of Terre Haute Regional Hospital and withdraw its Certificate of Public Advantage (“COPA”) application with the Indiana Department of Health:

“This is good news for patients and healthcare workers in Indiana’s Wabash Valley region, because this proposed merger would raise healthcare costs, reduce access to quality care, and depress wages for hospital workers. We are heartened that the Indiana Department of Health appears to be taking seriously the many concerns expressed by the public about this merger, and hope they will ultimately deny the COPA. FTC staff will continue to closely monitor developments with this proposed merger.”

In September, the bipartisan Commission voted 5-0 to authorize FTC staff to submit a comment urging the Indiana Department of Health to deny an application that sought to combine Union Health and THRH under a proposed COPA. The COPA is a regulatory regime that 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 explained. Union Health stated it has withdrawn its COPA application to allow Union Health and Terre Haute Regional Hospital more time to outline the benefits they claim will result from their proposed merger.

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.

During the public comment period that ended on September 6, 2024, the Indiana Department of Health received over 360 unique comments, the vast majority of which expressed concern about the proposed merger. FTC staff obtained these comments through a public records request, and note that many patients and employees of both hospitals raised the following concerns:

The proposed merger would eliminate the only alternative option for healthcare services in the Terre Haute/Vigo County/Wabash Valley region, and many patients do not want a hospital monopoly.
Many patients have had negative experiences with Union Health, in terms of quality, customer service, and pricing, and they do not want to lose Terre Haute Regional Hospital as their preferred alternative. They believe quality is better at Terre Haute Regional Hospital and that this will be lost as a result of the proposed merger.
Many patients are concerned about the loss of existing competition between Union Health and Terre Haute Regional Hospital in terms of prices, quality, and access for healthcare services, as well as the long-term impact of higher healthcare costs and reduced quality when the COPA conditions are no longer in effect.
Some patients and hospital employees are concerned that the consolidation of services and facilities will result in increased patient travel and wait times, particularly for patients who reside in the south side of Terre Haute.
Many hospital employees are concerned about the negative impact the proposed merger would have on their wages and benefits, morale, and alternative employment options, as well as the quality of care and patient access to healthcare services. Several employees also expressed concerns about the noncompete clauses imposed by Union Health.
Some patients and hospital employees noted that both hospitals are financially sound and operational, such that the proposed merger is unnecessary.

The FTC has a long-standing policy project to document the impact of COPAs on prices, quality, access, and innovation for health care services. 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.