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AG Stein Statement on Atrium Transaction, Health Care Transactions in NC

For Immediate Release:
Thursday, December 1, 2022

Contact: Nazneen Ahmed

(RALEIGH) Attorney General Josh Stein today announced that there is no legal basis within this office’s limited statutory authority to attempt to prevent the Atrium-Advocate Aurora transaction; therefore, the state will take no further action. Attorney General Josh Stein’s statement is below:

“My office has conducted a thorough review into this transaction and concluded that there is no legal basis to prevent it. I appreciate Atrium’s efforts to respond to our numerous inquiries and its commitments to comply with its obligations under the antitrust consent order with my office, as well as our state law’s requirements governing municipal hospitals across its service area. However, I am concerned about this combination’s possible effects on health care access in rural and urban underserved communities. Atrium has estimated that it will invest $25-50 million in the coming years to expand services in underserved communities in North Carolina; given the size and strength of this new combined entity, it is my strong belief that it can and should do more.

“My office will continue to monitor the combined entity’s operations and its impact on North Carolinians’ health and well-being. If Atrium-Advocate Aurora is not in compliance with its legal obligations, my office will not hesitate to take action.

“These hospital system consolidations are increasingly common, and our state’s refusal to accept the federal government’s offer to expand Medicaid is only exacerbating the issue. North Carolina has experienced a large number of hospital closures and combinations resulting in reduced services, particularly affecting rural residents. Too often, when one hospital swallows up another, patients end up paying more and getting worse care. Currently, the law limits my office’s authority to protect patients’ health care access, quality, and costs. We can do better, so I will be working closely with leaders in the legislature to address this health care loophole. I will continue to fight on behalf of patients.”

Atrium-Advocate Aurora has represented that it will continue to comply with municipal hospital requirements, including a commitment to:

  1. Maintain current service levels in critical departments (i.e. surgery, obstetrics, pediatrics, and outpatient and emergency departments);
  2. Provide indigent care as dictated by community needs;
  3. Ensure that no patients are denied care because of an inability to pay;
  4. Provide care to Medicaid and Medicare recipients without discrimination.

In addition, Atrium has represented that the new entity will not take action to penalize or threaten to penalize any insurer for providing transparency or steered plans, and it will increase eligibility for full financial assistance to patients whose income is up to 300 percent of the federal poverty line, matching its new partners’ policies in Illinois. The new entity will provide annual reports to the Attorney General’s Office on these efforts, which will be available to the public.


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