Indiana Attorney General Todd Rokita has formally opposed a proposed merger between Terre Haute’s only two hospitals, warning that the consolidation would create a “regional monopoly” and harm competition, care access and affordability in the Wabash Valley.
In an April 17 letter sent to the Indiana Department of Health, Mr. Rokita urged the agency to reject the proposed combination of Union Health and Terre Haute Regional Hospital, which is owned by Nashville, Tenn.-based HCA Healthcare.
The merger is being reviewed under Indiana’s Certificate of Public Advantage statute, which allows healthcare mergers to bypass typical antitrust scrutiny if the benefits to the community clearly outweigh any loss of competition.
“We all understand that hospitals face distinct challenges, but consolidation at the expense of free-market competition is not the way to address those challenges in this case,” Mr. Rokita said in a news release. “The creation of a regional monopoly would impose a negative impact on Hoosiers in the area seeking quality healthcare and affordable costs.”
Under Indiana’s COPA statute, passed in 2021, the IDOH must find that a merger will improve health outcomes, access and care quality beyond any harm caused by reduced competition. The attorney general’s office argued that no such benefits would materialize from the proposed Union Health and Terre Haute Regional deal.
Instead, Mr. Rokita warned that the merger would “lead to the monopolization of Terre Haute hospital systems that (would) be unchecked in raising healthcare costs, stifling innovation, suppressing wages, and reducing access to care.”
Union Health and Terre Haute Regional initially filed their COPA application in September 2023 but withdrew it in November 2024 just days before state health officials were set to make a decision. The hospitals resubmitted a new application in February, prompting renewed scrutiny.
The IDOH has scheduled a public town hall on May 1 in Terre Haute to gather feedback from residents and stakeholders. Mr. Rokita has encouraged all concerned citizens to attend and voice their opinions about the merger’s potential anticompetitive effects.
The Federal Trade Commission has also opposed the proposed transaction. In a second formal comment submitted to the IDOH on March 17, the FTC reiterated its position that the merger would eliminate competition, leading to higher healthcare costs, worse outcomes for patients and lower wages for hospital workers in the region.
“This repackaged COPA application presents the same problems as before,” said Clarke Edwards, acting director of the FTC’s Office of Policy Planning. “Competition consistently results in better outcomes for patients and workers than consolidation subject to COPAs. The Indiana Department of Health should deny this attempt by Vigo County’s only two hospitals to eliminate competition and avoid antitrust review.”
The FTC had first objected to the merger in September 2024, arguing that COPA protections could shield a harmful deal from appropriate federal oversight.
A spokesperson for Terre Haute Regional said in a March 17 statement shared with Becker’s that the hospital remains focused on the COPA process and is working closely with the IDOH to ensure it has “the information needed to make an informed decision regarding the healthcare needs of the Wabash Valley.”
Mr. Rokita acknowledged the unique challenges rural hospitals face, such as recruitment difficulties and geographic barriers to care access. However, he emphasized that those challenges “do not justify consolidation” in this case. “The solution is competition between strong competitors that fosters efficiency, ingenuity and technological advancement,” he wrote.
