Two hospitals in Indiana have finally closed their merger agreement despite some regulatory and public pushback. On November 10, the Indiana Department of Health approved a Certificate of Public Advantage (COPA) application from Union Health and HCA-owned Terre Haute Regional Hospital, giving the organizations the green light to join under a single health system.
Terre Haute Regional Hospital is a 278-bed Level III Trauma Center that generated $113 million in net patient revenue in 2024, the latest financial information available.
The deal between Terret Haute and Union Health had been in the works since 2023, when they first submitted their COPA application to the state. The Federal Trade Commission opposed the deal, writing that “the merged entity would have a combined share of nearly 74% of all commercially insured inpatient hospital services.”
The application was rescinded in November 2024 and then resubmitted in February of this year, along with a comprehensive list of final terms and conditions designed to offset the loss of competition in the Wabash Valley region. Some of the commitments Union Health made in the new application include a limit on commercial rates to an average of no more than 265% of Medicare rates for the same services, 10 years of pricing oversight, and a promise to maintain both hospital campuses and all major services. Although the state still believes the merger would lead to a monopoly, it appears these concessions were enough to get approval.
Indiana is one of 19 states that have COPA laws, which permit hospital mergers that the Federal Trade Commission would otherwise consider illegal.
After this deal is completed, Union Health will have three hospitals under its network, totalling more than 600 beds.
