22-02-2025
Union-Regional merger application available for public review
The document in which Union Hospital and Terre Haute Regional Hospital seek to merge — under state regulation rather than Federal Trade Commission approval — is now available online for public viewing.
Also, public comment on that application is being accepted by the Indiana Department of Health, and that comment period ends March 23.
The 2025 Application for a Certificate of Public Advantage was submitted to the health department by Union Hospital Inc. and Terre Haute Regional Hospital LP on Feb. 5. It can be viewed at A link also is available on that page for those who wish to comment.
Meanwhile, a bill that could have ended that merger attempt by essentially killing the state act that allowed for Certificates of Public Advantage has been amended; it cleared the Senate on Friday in a 49-0 vote. Senate Bill 119 now heads to the House, where it is sponsored by state Reps. Brad Barrett, R-Richmond, and Bob Heaton, R-Terre Haute.
Amendment 3 to Senate Bill 119 specifies that a hospital may not file an application under the COPA act after Feb. 15, 2025. It also specifies that the Indiana Department of Public Health must review and make a determination on any application filed under the act between Jan. 1, 2025, and Feb 15, 2025. And, under the amended bill, Indiana Department of Health must rule no later than Aug. 13 of this year.
In other words, the amendment — which cleared the Senate on a voice vote — allows the Union-Regional merger application to continue before the COPA process is shut down.
State Sen. Greg Goode, R-Terre Haute, who had previously testified in opposition to SB 119, spoke in the Senate in favor of the amendment on Wednesday and again on the bill itself Thursday.
Said Goode on Thursday, "This is a discussion about not losing a hospital, about not allowing a hospital facility to be abandoned, not allowing the loss of about 600 healthcare workers, not allowing for the loss of hospital healthcare services that my constituents need."
Goode also dismissed the Federal Trade Commission's recorded opposition to the COPA process and the proposed merger, saying Indiana state government showed more common sense.
"Instead of deferring to federal FTC bureaucrats in their cubicles — or perhaps they were working from home streaming 'Game of Thrones' while they're analyzing this important project — instead ... this body very wisely said let's project some Hoosier common sense, and we can figure it out together with the Indiana Department of Health."
Added Goode, "This legislation has evolved to allow the COPA process to play out, but it also wisely makes it clear for the Department of Health to do its job and [says] let's get to a decision."
On Friday, Goode said he was grateful to SB 119 author Sen. Ed Charboneau, R-Valparaiso, who continued to meet with him about the bill and who submitted the amendment.
Goode and others had previously noted the original COPA law was narrowly crafted to allow Vigo County and perhaps one other underserved area in the state seek a two-hospital merger under the COPA process. This bill now simply closes the process without harming the Union-Regional application already submitted.
Indiana is one of about 20 states with COPA laws, which allow hospital mergers that the Federal Trade Commission otherwise might prohibit because they could reduce competition and could create monopolies.
In exchange for allowing these deals, the merging hospitals typically agree to meet a number of conditions imposed by the state to mitigate the harms of a monopoly. But some healthcare economists and the FTC argue that state oversight cannot replace competition, and they contend such mergers can ultimately harm patients.
Indiana's COPA law was passed in 2021. Union and Regional submitted their first application in 2024, but withdrew it November of that year, with Union saying it wanted to resubmit after further work with the Indiana Department of Health. It resubmitted in early February.
Union's acquisition of Regional is supported by the Terre Haute area's political leaders and by the Terre Haute Chamber of Commerce. Among the arguments put forth by proponents of allowing Union to acquire Regional:
• When Tennessee-based HCA Healthcare, Regional's owner, looked for someone to buy its for-profit hospital in Terre Haute, it found only one interested party: not-for-profit Union Health, which is based in Terre Haute and has another hospital in Clinton. Were this merger to fall through, it's possible no one would buy Regional and its associated offices, and both the physical hospital and about 500 to 600 healthcare jobs would be lost to the area.
• The area already has well-documented high incidence rates and poor health outcomes and should not be put in a one-hospital position.
• Union already has a dominant market share of the hospital health services market in the area, and is well aware of the area's modest financial standing. (Vigo is 71st of 92 Indiana counties in terms of per capita income.) Union has said nearly half of Union's inpatient days in 2024 came from Medicaid patients.
• Union says it's owning Regional will not result in price gouging. Union Health CEO President Steve Holman said in Senate committee testimony: 'So the thing that we are just going to raise prices everywhere and gouge the community — [that] doesn't work. It hasn't been [the case in the] past 137 years [of] history, it's not now and [it] won't be in the future,' he said.
Opponents have argued that COPA laws are a ploy to dodge FTC oversight; that a FTC review concluded economic harms outweighed the benefits in the proposed Vigo County merger, and that the Indiana attorney general largely agreed; and that public comments opposed the merger under COPA by a 4-to-1 ratio.
Those critics say a shutting down of the COPA process would not disallow a Union-Regional merger. The hospitals could, they argue, still avail themselves to the FTC process and review by the Indiana attorney general and face the same scrutiny as other mergers and acquisitions.
