Wake County approves updated merger between WakeMed and Atrium after heated public hearing

# What happened

# Promises added to the deal

• A $150 million community benefit fund for Wake County.
• A price-cap commitment limiting increases at WakeMed to no more than 1.5 times the annual Medicare cost increase for five years.

# Governance and continuity The proposed board of directors for the merged entity would include eight Wake County appointees and six Atrium appointees. To preserve continuity, five of the county appointees would be current WakeMed board members.

# Remaining uncertainties and legal drafting Wake County Attorney Roger Askew acknowledged that some final contract language had not been drafted at the time of the vote. Commissioner Vickie Adamson expressed concern that the written documents presented during the meeting did not yet contain the governor's announced commitments. Askew said the price-cap language and the $2 billion commitment would be fully scrutinized before finalization but could not answer questions about what happens after the five-year price-limit period ends.

# How commissioners voted and why

• Commissioner Safiyah Jackson voted to approve the deal, saying the WakeMed board had concluded that a partnership with Atrium was the best strategic fit to preserve the hospital's safety-net role amid fiscal pressures. She noted WakeMed provides over $100 million in free care annually.
• Commissioner Vickie Adamson opposed the deal, calling it insufficiently clear and saying she could not support agreements announced verbally or without completed legal language.
• Commissioner Tara Waters voted no, citing a lack of transparency and last-minute changes made over a weekend before the vote.
• Commissioner Cheryl Stallings emphasized federal cuts increasing uninsured patients and argued a partnership could help handle rising financial pressures.

# Opposition and fiscal concerns Longtime residents, health advocates and state employees warned the merger could raise healthcare costs, reduce charity care over time, and lead to staffing cuts based on Atrium's practices elsewhere. North Carolina Treasurer Brad Briner publicized deep concerns, calling consolidation a factor that can reduce competition and raise prices and saying the decision complicates efforts to control costs for the State Health Plan. Briner urged additional oversight.

# Next steps The transaction still requires federal approval. Governor Stein invited the state attorney general to provide an independent assessment and reiterated his interest in giving the Attorney General more authority to review hospital transactions. County officials say they will finalize and scrutinize the written contract language before the deal is made final.