New NC rules for 'unregulated' Mission/HCA health care monopoly? Lawmaker: explore options

ASHEVILLE - North Carolina eliminated caps on profits and other limits attached to the nonprofit Mission Hospital in 2015, allowing for what is widely understood to be an unregulated health care monopoly in Western North Carolina.

Now, with what critics say is a steep decline in patient care under Mission's current for-profit owner, some are saying new regulations could be warranted.

“We should explore options to mitigate the fact of a for-profit monopoly health care system in WNC," said N.C. State Sen. Julie Mayfield when asked July 2 about the possibility of reinstating caps or similar rules. An Asheville Democrat, Mayfield represents the district that includes Mission's home city of Asheville. The Citizen Times reached out to Republican Kristie Sluder who is running against Mayfield in the Nov. 5 election for District 49.

Nancy Lindell, a spokesperson for Mission and its owner, the Tennessee-based HCA corporation, did not respond to a request for comment.

Mayfield's comments follow a June 10 research paper by Wake Forest law and public health professor Mark Hall that delved into the elimination of Mission's state oversight. That happened in 2015 when the General Assembly repealed Mission's Certificate of Public Advantage or COPA, which codified the restrictions. Once unfettered, the hospital was bought by HCA.

"A mere two years after lifting state antitrust oversight, HCA purchased Mission Hospital, thus putting what one observer called a 'prepackaged monopoly' into the unregulated hands of the world’s largest for-profit hospital corporation," Hall wrote in his June 10 paper.

Since it's 2019 purchase of Mission, HCA has been sued by the state attorney general and Asheville and other local governments over anti-trust and breach of contract allegations. Mission nurses, meanwhile, have unionized and the hospital has faced federal sanctions after the deaths of four patients.

Hall told the Citizen Times July 2 that it stands to reason that the legislature would take some type of action. That could mean reinstating permanent regulations, he said. Another option could be to change rules to make the health care market more competitive.

"Or a combination of the two, where you reinstate regulation until the market becomes more competitive. So, you don't pick the 'regulation forever' side, or the 'we’ll just assume they’ll behave themselves' side," he said.

Mission/HCA has declined to comment on Hall's work, saying it wasn't impartial because he received a grant from Arnold Ventures. That philanthropic group is helping fund anti-trust specialists Fairmark Partners law firm, which is representing plaintiffs suing HCA.

Hall has said his research group has no connection to the litigation and that Arnold Ventures has no control over his research.

The General Assembly established the COPA in 1995 when Mission wanted to merge with St. Joseph's Hospital, situated across Biltmore Avenue. The COPA allowed the merger but also mandated limits on profits and other state oversight intended to head off negative effects of the new monopoly. During the following period of regulation that lasted until 2015, Mission stood out as "one of the most well-regarded hospitals in the country" both for high quality and good value, Hall wrote in his paper.

But then-Mission CEO Ron Paulus lobbied for the COPA's removal, saying the oversight was unnecessary . The repeal passed the legislature with bipartisan support, though some former General Assembly members now say it may not have been the right decision.

Along with Mayfield, the Citizen Times reached out to N.C. Sen. Kevin Corbin of Macon County. A member of the General Assembly's Republican majority, Corbin has been a vocal critic of HCA. In January 2023, he co-sponsored Mayfield's Senate Bill 16 to give future attorney generals more power to put conditions on hospital mergers or stop them altogether.

Mayfield said July 2 that there was more for the General Assembly to do.

"Just because the COPA went away doesn’t meant the monopoly went away. And, in fact, because it’s a for-profit monopoly, it’s even worse for the region," she said.

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Joel Burgess has lived in WNC for more than 20 years, covering politics, government and other news. He's written award-winning stories on topics ranging from gerrymandering to police use of force. Got a tip? Contact Burgess at jburgess@citizentimes.com, 828-713-1095 or on Twitter @AVLreporter. Please help support this type of journalism with a subscription to the Citizen Times .

This article originally appeared on Asheville Citizen Times: New NC rules for 'unregulated' Mission/HCA health care monopoly? Lawmaker: explore options