Six things to know:
1. Mr. Charbonneau, a primary author of Indiana’s 2021 law enabling COPAs, is now advocating for its repeal, citing concerns about its effect on competition and patient care. “I didn’t think I was doing 100% the right thing last time,” Mr. Charbonneau said, according to KFF Health News. “I do think I am this time.”
Mr. Charbonneau did not respond to Becker’s request for comment.
2. In November, Terre Haute, Ind.-based Union Health withdrew its COPA agreement for its proposed merger with Terre Haute Regional Hospital, a 278-bed facility operated by Nashville, Tenn.-based HCA Healthcare.
3. Union Health pulled its COPA application nine days before the state was set to make a final decision on the deal. The FTC in September advised state officials against approving the transaction, arguing it would “likely impose higher costs and could lead to worse healthcare outcomes for Indiana patients, as well as lower wage growth for hospital workers.”
4. Union Health in November said it plans to resubmit a COPA to merge with Terre Haute Regional.
5. Indiana is one of 19 states with COPA laws. COPAs facilitate hospital consolidation, which is a key driver of higher healthcare costs without improvements in care quality, according to the FTC. The agency argues that hospitals only seek COPAs for specific mergers that would otherwise violate antitrust laws and often result in monopolies.
6. Five states have repealed their COPA laws: Minnesota, Montana, Maine, North Carolina and North Dakota.
“Unfortunately, these legislative changes also eliminated state regulatory oversight of the hospital systems that were allowed to merge under COPAs,” The FTC wrote in a 2022 policy paper. “Furthermore, antitrust enforcement was no longer practical since the mergers had long been consummated. As a result, these systems can now exercise their substantial market power unconstrained by state oversight or antitrust enforcement against merger-related harms.”
