The has long argued that competition makes the
economy better. But some states have stopped the agency from blocking hospital mergers that create local or regional monopolies, and the results have been messy. The Health 202 is a coproduction of The
Washington Post and KFF Health News. Two dozen states have at some point passed controversial legislation waiving anti-monopoly laws, allowing rival hospitals to merge and replacing competition with prolonged state oversight. Six years ago, Tennessee and
Virginia ushered in the largest state-sanctioned hospital monopoly in the nation with the creation of . For most of the residents in the Tri-Cities region of northeast Tennessee and southwest Virginia, the merged system became the only option for hospital care. For example, since the merger, patients before admission to hospitals, according to reports released by the Tennessee health department. “I do not want to further risk my life and die at a Ballad hospital,” said , a city council member in Bristol, Va. In an interview, Osborne said he spent 30 hours in a Ballad ER this year as he suffered diabetic crisis. “The wait times just to get in and see a doctor in the ER have grown exponentially.” The legislation that created Ballad is known as a certificate of public advantage, or COPA. The FTC has repeatedly warned states to be wary of COPAs, which “only exist to protect a merger that would otherwise be illegal under antitrust law,” , a deputy director of the at the agency, told KFF Health News in an interview last year. There have been about in the past three decades that depended on COPAs, and afterward, the feds saw rising prices, decreases in quality, reductions in access and a decrease in wages, Rao said. Since Ballad’s COPA, the merged system has set by the states in recent years. It has fallen short of charity care promises made to Tennessee by about over a five-year span. Ballad has attributed its quality struggles to the
Coronavirus pandemic, its charity shortfalls to Medicaid changes and its longer ER stays to staffing and discharge challenges it says are beyond its control. Ballad said ER times for admitted patients have dropped to about since its latest annual report. “On those issues Ballad Health can directly control, our performance has rebounded from 2022,” said a Ballad spokesperson, . The FTC announced in 2019 that it would study the Ballad merger but has yet to issue a report. . But on Tuesday, a state legislative subcommittee without debate, refusing to hear testimony from Tri-Cities residents who drove five hours to Nashville for a chance to speak against Ballad. , ,