‘A lot less bad’: Wake commissioners approve updated deal to combine WakeMed and Atrium

The Wake County Board of Commissioners voted 5-2 late Monday to approve a controversial merger between WakeMed and Atrium Health.

The vote came after a five-hour public hearing during which deputies cleared protesters from the chambers as commissioners were preparing to vote on the transfer agreement.

Atrium has pledged $2 billion in hospital improvements. WakeMed President and CEO Donald Gintzig has said that funding is vital as the county continues to grow.

WakeMed is the largest health system in the state’s largest county. The taxpayer-funded community hospital has served Wake County residents since 1961. In contrast, Atrium Health is a massive healthcare system with over 70,000 employees across 40 hospitals serving the Carolinas, Georgia and Alabama.

Longtime county residents, health advocates, and state employees voiced opposition to the merger, saying it would lead to higher healthcare costs, less charity care, and a likely reduction in hospital staffing, based on Atrium’s practices in other communities where it operates.

Governor Josh Stein, who voiced early reservations about the merger, entered the negotiation process over the weekend and by Sunday announced he would not stand in the way of the deal because Atrium had agreed to changes Stein said he requested.

Stein said improvements to the initial proposal included a sizable increase in charity care, a $150 million community benefit fund for Wake County, and a clarification that Atrium would make the $2 billion investment from its own assets, not WakeMed’s, over a 15-year period.

Stein said Atrium also agreed not to increase prices at WakeMed more than 1.5 times the annual increase in Medicare costs for the next five years.

After the commission voted, Stein invited Attorney General Jeff Jackson to provide an independent assessment.

“Since my time as Attorney General, I have been urging the General Assembly to give the Attorney General’s Office more authority to review hospital transactions,” Stein said in a statement. “Health care costs are too high, and additional oversight and authority would better protect patients.”

Wake County Attorney Roger Askew said the final deal  agreement increases the indigent care WakeMed can provide from 4.8% in the initial offer to at least 8% of total adjusted revenues.

Askew said the new board of directors will be made up of eight Wake County appointees and six Atrium appointees. For institutional continuity, five of the appointees would be current WakeMed board members.

Commissioner Vickie Adamson said it was troubling that the legally binding documents they were being asked to approve during the meeting did not contain the commitments announced by the governor a day earlier.

Askew said in some cases the final language had not been drafted. But he assured commissioners that the language regarding the price cap and the $2 billion commitment would be fully scrutinized before the deal was finalized.

“And we don’t know what happens [with the price cap] at the end of five years?” asked Adamson.

“No,” acknowledged Askew.

Adamson said the deal was “a lot less bad” than what was presented in May, but she could not support it.

Commissioner Safiyah Jackson said she had to consider WakeMed’s long-term sustainability.

For two years, the WakeMed board studied whether the community hospital could survive alone and sustain its mission.

“They considered Duke, UNC, Novant and Atrium. They unanimously and still today unanimously maintain that Atrium was the best strategic fit,” said Jackson.

Jackson said while her vote would certainly make some angry, her decision was to try to protect the safety net for future generations.

“Every year, WakeMed provides over $100 million in free care to the most vulnerable families,’ said Jackson. “But standing alone in a changing world is getting harder every day.”

Commissioner Cheryl Stallings said federal cuts under the One Big Beautiful Bill Act were leading to more uninsured patients coming to WakeMed. Those financial pressures would only increase without a partnership, she said.

Nearly 100 critics of the merger gathered in Raleigh’s Nash Square Monday before the meeting to urge the commission to vote against combining WakeMed and Atrium Health.

Commissioner Tara Waters stood with opponents under a century-old oak tree and said she could not bring herself to vote for a deal that lacked transparency from the start.

“I represent a district where people tonight will sleep in their cars. I represent a district where people don’t know where their next meal is coming from,” said Waters. “I’ll magnify the needs of the least among us. That is the call that we are all charged to do.”

Waters said the deal deserved more public engagement, not last-minute changes made over the weekend, followed by a rushed vote.

Merger oversight out, but whistleblower protections and CEO pay caps remain in NC hospital bill

Rebecca Cerese with the N.C. Justice Center’s Health Advocacy Project agreed the public deserved a much better process.

“The price cap is only for five years.That goes by in the blink of an eye,” said Cerese.”What are the protections after that? Atrium is a much more expensive hospital system.”

Members of the State Employees Association of North Carolina (SEANC) estimate a combined WakeMed-Atrium would raise healthcare premiums for state employees another $10 a month.

Faith leaders also criticized Monday’s vote falling on Yom Kippur, the holiest day of the year in Judaism, preventing many from being present at the hearing.

Chairman Don Mial along with commissioners Cheryl Stallings, Safiyah Jackson, Shinica Thomas, and Susan Evans voted for the proposed merger Monday evening with Tara Waters and Vickie Adamson voting against.

The Federal Trade Commission and the U.S. Department of Justice will have to approve the deal before it can proceed.