Yale economist: Union, Regional merger would be hard on consumers
A Yale University economist contends the proposed merger of Union Health and Terre Haute Regional Hospital would not be good for consumers.
Zack Cooper, an associate professor at Yale and the director of the university's Tobin Center for Economic Policy, in a news release sent Tuesday contends the merger would raise commercial health care prices of the two entities 10% to 30%, raise local insurance premiums by 3% to 10%, and lower nurses' wages by approximately 5%.
He also says there would be about 500 job losses outside the health sector.
Yale said Cooper shared his analysis with the Indiana Department of Health in a March 21 public comment regarding the Certificate of Public Advantage application filed by the hospitals in early February.
'I've been studying hospital competition and hospital mergers for nearly 20 years, and I firmly believe this merger would harm members of the public in Terre Haute and Vigo County,' Cooper said.
'If the two parties are granted the COPA they're seeking, the merger would result in higher health care prices and job losses — there's no doubt about that,' he said.
Cooper contends:
• The merger would create a de facto monopoly. He says Union's acquisition of Regional would give it a local market share from 75% to 100%, effectively eliminating competition in the local hospital market.
• That assurances from the hospitals that consumers would be protected from undue price increases are insufficient. As currently proposed, he says the commitments generally apply to billed charges, which are not the basis for the majority of payments made by patients or insurers. Further, the commitments only apply for a period of seven years. Cooper says there are examples of commercial health care prices rising – sometimes by nearly 40% –when similar commitments in other COPAs expired.
• Judge by public comments, the local community is opposed to the merger. Cooper says 80% of Terre Haute residents responded negatively to news of the first COPA application, and he contends recent polling suggests 80% remain opposed.
• COPA laws like Indiana's do not protect consumers as intended. He contends academic evidence on this is overwhelming. And that, he argues, is why state Sen. Ed Charbonneau, R-Valparaiso, author of the original Indiana COPA law, is seeking to close the door on further COPA-enabled mergers.
Cooper also argues Terre Haute Regional is not likely to close absent a merger with Union.
The professor argues that according to analysis by the Federal Trade Commission, Terre Haute Regional has profit margins measured in percentage terms that are larger than 75% of hospitals in the U.S. He argues Terre Haute Regional's owners, HCA Healthcare Inc., could find another buyer.
The state of Indiana must rule on the COPA application for the proposed merger by Aug. 13.
The Tribune-Star received the Yale University news release about 2:45 p.m. Tuesday. It sought comment by telephone and by email from Union's and from Regional's spokeswomen about 3:30 p.m. Tuesday.
A Union Health spokeswoman later Tuesday afternoon said the company would not have a reply ready by the end of the business day.
Background
Indiana is one of about 20 states with COPA laws, which allow hospital mergers that the Federal Trade Commission otherwise might prohibit because they could reduce competition and could create monopolies.
In exchange for allowing these deals, the merging hospitals typically agree to meet a number of conditions imposed by the state to mitigate the harms of a monopoly. But some healthcare economists and the FTC argue that state oversight cannot replace competition, and they contend such mergers can ultimately harm patients.
Indiana's COPA law was passed in 2021. Union and Regional submitted their first application in 2024, but they withdrew it in November of that year, with Union saying it wanted to resubmit after further work with the Indiana Department of Health. It resubmitted on Feb. 5 of this year.
Union's acquisition of Regional is supported by the Terre Haute area's political leaders and by the Terre Haute Chamber of Commerce. Among the arguments put forth by proponents of allowing Union to acquire Regional:
• When Tennessee-based HCA Healthcare, Regional's owner, looked for someone to buy its for-profit hospital in Terre Haute, it found only one interested party: not-for-profit Union Health, which is based in Terre Haute and has another hospital in Clinton. Were this merger to fall through, it's possible no one would buy Regional and its associated offices, and both the physical hospital and about 500 to 600 healthcare jobs would be lost to the area.
• The area already has well-documented high incidence rates and poor health outcomes, and it should not be put in a one-hospital position.
• Union already has a dominant market share of the hospital health services market in the area, and it is well aware of the area's modest financial standing. (Vigo is 71st of 92 Indiana counties in terms of per capita income.) Union has said nearly half of Union's inpatient days in 2024 came from Medicaid patients.
• Union says it's owning Regional will not result in price gouging. Union Health CEO President Steve Holman said in Indiana Senate committee testimony: 'So the thing that we are just going to raise prices everywhere and gouge the community — [that] doesn't work. It hasn't been [the case in the] past 137 years [of] history, it's not now and [it] won't be in the future,' he said.
Opponents have argued that COPA laws are a work-around to dodge FTC oversight. They say an FTC review concluded economic harms outweighed the benefits in the proposed Vigo County merger and that the Indiana attorney general agreed.
Those critics say lack of a COPA certificate would not disallow a Union-Regional merger. The hospitals could, they argue, still avail themselves of the FTC process and a review by the Indiana attorney general and face the same scrutiny as other mergers and acquisitions.
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