WakeMed’s Merger Moves Forward, but Accountability Questions Remain
Protesters rally against WakeMed Merger with Atrium Health. Source: TheNews&Observer.
Since January 2024, plans for a merger between WakeMed and Atrium Health have quietly been in development. In early May 2026, the merger proposal was announced publicly. Just days after its public release, UNC Health made a proposal that was promptly rejected. WakeMed’s board of directors asserted that partnership with Atrium was in the hospital’s best interest. The speed of the proposal since its public announcement has concerned several members of the public, Wake County board members, and government officials. Governor Josh Stein originally opposed the proposal, but ultimately shifted to support the agreement after negotiated revisions. On September 21, 2026, the Wake County Board of Commissioners voted 5–2 for the merger.
With so much uncertainty ahead, criticism of the merger persists. WakeMed serves Wake County, one of the largest and fastest-growing counties. A possible merger would affect many people. The primary concern is accountability for Atrium going forward. WakeMed is an independent non-profit, so it is already separated from direct government control. WakeMed became a non-profit in 1997 under an agreement to continue operating as a community hospital. To keep this agreement, the Wake County Board of Commissioners was given voting responsibility on any changes to the hospital’s structure.
In light of a merger, a 14-member board between Atrium and WakeMed could govern the hospital. Wake County’s Board of Commissioners will be responsible for appointing eight of the fourteen representatives, but Atrium could hold the power to dismiss the WakeMed CEO. This means that while it may appear that Wake County retains primary control, Atrium will actually obtain a substantial role, which could make it difficult to ensure public accountability in the future.
The emphasis on accountability centers on financial concerns associated with a merger. Governor Stein's negotiations prompted commitments from Atrium such as a five- year cap on hospital prices, a minimum requirement of 8 percent of all adjusted revenue allocated for charity care, and a $2 billion investment into WakeMed facilities. However, even with these protections, North Carolina State Treasurer Brad Briner asserted that a merger of this size will reduce competition in the market, causing hospital prices to increase in the long term. Members of the public share similar concerns about price inflation. Briner's concerns point towards uncertainty about how heavily the very people these hospitals serve are being considered. While increased charity care seems to solve price concerns, critics may worry that this fails to address individuals just above that line who struggle to pay rising insurance premiums in the future.
Similar hospital mergers have taken place in recent years across NC, most notably the Novant merger in New Hanover. While New Hanover hospitals were fully county-controlled before this, the results are still helpful to examine in relation to the Atrium merger. In Novant’s case, there have been persisting concerns of a decrease in the quality of care in New Hanover hospitals. These concerns come in partnership with rapid infrastructure expansion in the area— an element also promised by Atrium in their deal. As more hospitals switch to this privatized model of operation, lack of quality control could be a roadblock many of them have to overcome.
The lack of communication with concerned members of the public during this merger process has inspired various community protests. While the future results cannot be fully predicted, protesters will remember the loss of control they felt upon the September 21 vote. Briner and citizens opposing the merger now look to Attorney General Jeff Jackson to review the agreement. The Attorney General has limited control to fully block the merger, but can evaluate whether it meets affordability and quality care standards. Additionally, if the merger were processed in the future, the Attorney General can file compliance lawsuits if agreed-upon standards are not met by Atrium.
Although the WakeMed board voted in favor of the merger, the Federal Trade Commission (FTC) may still object. Due to the lack of competition in this merger, it is uncertain whether the FTC will approve the WakeMed-Atrium merger. If the FTC’s approval is not granted, then the entire deal could fall apart. Regardless of future outcomes, this process has upset many officials and members of the public, leaving them unsure about future prices and accountability. Wake County’s expansion means it has growing healthcare needs, but it is unsure whether this merger is the solution.