Wake County commissioners approve WakeMed-Atrium combination in 5-2 vote

Commissioners Vickie Adamson and Tara Waters voted against the deal. Both said they had too little time between last week's revisions and Monday's vote to review the documents. Adamson said she was not confident the changes addressed residents' concerns about higher costs.

Deputies with the Wake County Sheriff's Office cleared the room of protesters who were shouting and interrupting commissioners as they began to vote, WRAL reported. The board then called a five-minute recess. Some audience members were allowed back in for the vote. The public comment period drew more than a dozen speakers, several of whom raised cost and access concerns.

What the commissioners approved

Under the deal, Atrium would assume the leading role in the nonprofit that operates WakeMed and promises at least $2 billion of investment in Wake County over 10 years. WakeMed says the money would enable or accelerate renovation and expansion of its Raleigh campus, expansion of hospitals in Cary and North Raleigh, further development of its Garner campus and two additional health complexes. WakeMed says the investment would lead to up to 3,300 new health care jobs.

The county would appoint eight of a new board's 14 members, and Atrium would appoint the other six, according to a summary given to county officials. The Assembly reported that Atrium would gain effective veto power over the county's appointments. WakeMed would keep its name and legal identity. The amended agreement sets a higher minimum charity care threshold, according to a joint statement from the two systems.

Atrium is part of Advocate Health. WRAL reported that Advocate brought in $22.5 billion last year, almost 10 times WakeMed's revenue. Definitive Healthcare, an industry analysis group, ranks the combined Advocate Health group as the fourth-biggest US hospital chain by total revenue.

Opposition and the UNC alternative

The State Employees Association of North Carolina warned the deal would raise premiums for the 750,000 people it says are covered by the State Health Plan. WRAL reported the plan insures more than 700,000 state employees, retirees and family members. Critics also say the full agreement has not been made public.

UNC Health offered to invest $5 billion in and around Wake County over 10 years, including at least $2.5 billion tied to WakeMed priorities, according to documents The Assembly obtained. WakeMed declined the UNC offer in May and stayed with Atrium.

The News & Observer reported that a letter from WakeMed chief executive Donald Gintzig to Gov. Josh Stein's office shows WakeMed would fund part, if not all, of the $2 billion itself, with Atrium promising to make up any shortfall. Separately, a Stein spokesperson said WakeMed had acknowledged receipt of the governor's Aug. 17 questions but had not responded in writing. Stein has no formal say in the merger.

State Sen. Jim Burgin said WakeMed has "a billion dollars in the bank" and about $900 million in construction projects under way. Burgin's bill to add state oversight of hospital mergers was stripped of that provision in June and did not pass; lawmakers are not expected back until November.

At a public hearing, Dr. Taylor Walker told commissioners Atrium's chief executive was paid $25.8 million in 2024, citing a state treasurer investigation.

The precedent both sides cite

Atrium combined with Wake Forest Baptist in October 2020. Former president Kevin High told commissioners the deal brought a $426 million emergency department and intensive care unit tower and a $100 million eye institute. A Brown University analysis found Wake Forest Baptist inpatient prices rose 28% after the combination.

More than a dozen current and former employees described tighter staffing, reduced incentive pay and pressure to cut costs. They spoke to The Charlotte Ledger and North Carolina Health News. An Atrium spokesman said staffing plans for nursing units have not been reduced since 2020 and that budgeted nursing hours per patient day have increased.

What happens next

The merger still needs approval from the Federal Trade Commission and the Department of Justice. WakeMed and Atrium said in a joint statement that they look forward to the regulatory review and will follow through on their commitments.