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The Wake County commissioners’ 5-2 vote supporting a merger of WakeMed with Charlotte-based nonprofit hospital system Atrium Health sends the proposal to the Federal Trade Commission and the state Attorney General’s Office.
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The News & Observer reached out to the FTC on Tuesday to ask about the process for reviewing the proposed merger.
“As a general matter, the FTC does not comment on pending mergers or acquisitions,” FTC spokesperson Vicky Caslow said in a statement.
The FTC does have a standard process for reviewing mergers, and it typically works with state attorneys general when looking into them. And the state attorney general is required to review the merger, according to state law.
But Wake County Commissioner Vickie Adamson — who cast one of the two votes against the merger Monday night — pointed to a recent statement the FTC made on a somewhat similar merger proposal in Ohio.
In that situation, Fairfield Medical Center (FMC), an independent nonprofit hospital in Lancaster, Ohio, was selling itself. Originally, Fairfield chose a bid from OhioHealth, a nonprofit hospital system in the state.
But the FTC blocked that acquisition. The transaction would have “risked raising costs and reducing the quality of care for Ohioans” according to an FTC statementr.
The FTC also raised concerns about Fairfield’s thoroughness in identifying a potential buyer.
The FTC pushed Fairfield to start a process to seek other potential buyers, and it ended up being bought by a different nonprofit hospital system.
WakeMed and Atrium’s merger is not a sale. WakeMed will continue to exist, just under Atrium’s ultimate authority. Fairfield was outright sold.
But Adamson said it appears — similar to Fairfield — that WakeMed has not done due diligence in considering options outside of Atriums.
“There was data looked at on other hospitals, but they weren’t given an opportunity to bid on this,” Adamson said before Monday’s vote.
WakeMed’s leadership has said it hired a consultant to help them look at a potential deal with Atrium and other hospitals, but they never put it out to bid because WakeMed is neither a public entity required to do so nor a for-profit corporation with shareholders or ownership.
“I was told they fell in love, and they were soulmates,” Adamson said, adding that WakeMed only considered Atrium for the deal. “So I cannot tell you that this is the best deal going forward.”
The merger originated in a request for proposals WakeMed sent out for a medical partner in cancer treatment, WakeMed Board of Directors Chair Thad McDonald III told the county commissioners in June.
Only Atrium responded to that request.
“Our executive team, as they began working with Atrium, found an organization almost a mirror image of WakeMed, an organization with a similar history, similar culture and a similar purpose to care for all,” McDonald said at the time. “The executive team then took a deep dive into Atrium, confirmed these similarities and engaged attorneys to look at a partnership between the two entities.”
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When UNC Health made an offer to acquire WakeMed, WakeMed CEO Donald Gintzig said it would decrease competition in the area. WakeMed was actually restricted from considering the offer via an agreement with Atrium.
The primary reason WakeMed officials have given for the merger is Atrium’s pledge to invest $2 billion into expanding and renovating WakeMed facilities over 15 years.
But that might not be a good enough reason for the FTC to let the merger go through.
“FMC’s decision to abandon the OhioHealth deal should serve as a reminder that financial distress is not a blank check for mergers that would substantially reduce competition between hospitals and risk leaving patients with higher costs and lower quality care,” FTC Chair Andrew Ferguson said.
The FTC did not answer questions posed Tuesday asking how long reviewing the merger could take.
In the case of the Fairfield sale, the proposed deal with OhioHealth was announced in November 2025. By September 2026, that deal had been reviewed, challenged, abandoned and replaced by a deal for a smaller nonprofit hospital system to buy Fairfield.
But that merger happened in a different state with different hospital systems. Wake County is also roughly seven times bigger than Fairfield County, Ohio.
The N.C. Attorney General’s Office is required to have 30 days notice before the sale, exchange or disposal of WakeMed property. That notice should have all the information the office needs to review the deal. And the attorney general can request an additional 30 days to review the transaction, according to state law.
“We’ll begin that work when we receive official notice and all documents from the parties,” wrote Nazneen Ahmed, a spokesperson for Attorney General Jeff Jackson, in an email to The N&O on Tuesday.
Gintzig has previously said healthcare prices will go up regardless of whether the merger goes through.
On Tuesday, Adamson said the whole purpose of the merger is to give WakeMed a partner with more leverage over insurance companies.
“What we were told the first time this was introduced to us was WakeMed needed rate increases,” she said. “That’s what their goal was, to partner with a larger organization so they could negotiate with insurance companies for rate increases.”
Ardis Watkins, executive director of the State Employees Association of North Carolina, said the plan will raise costs for state employees via the state health plan.
“The state health plan made it clear that cost for state employees and retirees would rise if this takeover goes through, and they would rise by out-of-pocket premium costs alone of around $10-$15 a month for state employees,” she said.
Gov. Josh Stein negotiated caps on WakeMed’s price increases if the deal goes through to “not more than 1.5 times the annual increase in Medicare costs for the next five years” in a separate agreement announced Sunday night. But additional details of that agreement and what it means for prices have not been finalized.
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