BY LUCY HODDER
Health care mergers and acquisitions have fundamentally changed the landscape of health care delivery in New Hampshire and across the United States. The pace of these health care transactions is accelerating across the industry, often justified as necessary to preserve existing services or ensure financial survival in a changing landscape.
However, the reality is far more complicated, and often troubling. For many Granite State families and businesses, health care mergers have resulted in higher costs and reduced access to essential services, a trend that will likely continue with the proposed acquisition of Catholic Medical Center (CMC) by HCA Healthcare, a for-profit health care giant.
As we reflect on the potential impacts of the acquisition, it’s crucial to recognize the potential risks that come with such change. HCA already owns three hospitals in New Hampshire and is the largest hospital chain in the country. Should this deal proceed, the hospital we once knew as CMC — its nonprofit mission dating back to the 1800s — would lose its charitable status, meaning it would no longer be held to the same accountability for charity care, community benefits and local governance. These historic community investments are the very programs that help ensure people in our state, regardless of their income, have access to the health care they need.
When nonprofit hospitals transition to for-profit ownership, the priorities can shift dramatically. The complex ownership structure of HCA, its out-of-state parent companies and its many for-profit affiliates, is often opaque, and as a publicly traded company, HCA answers to shareholders, not to the community.
HCA’s recent track record, including its decision to terminate labor and delivery services at Frisbie Memorial Hospital in Rochester in 2022 after promising to maintain them, is just one example of how profit-driven decisions can erode trust in the health care system. These mergers can have a profound impact on our communities.
Health care is not just another market commodity — it’s the foundation of our well-being. The costs of care have become a crushing burden for many families and small businesses. High health care expenses make it harder for our local economy to grow, for young families to stay here, and for our communities to thrive. In a state where a family of three may spend $1 out of every $12 on health care, these dollars are being strained by housing and child care costs and other critical needs like education and food. Too many people in our state are avoiding the care they need due to unmanageable “out-of-pocket” costs. Medical debt is growing. This financial strain ripples across our economy.
The ongoing CMC-HCA merger highlights what is at stake as our hospitals consolidate and the state shifts away from New Hampshire-based nonprofit health care institutions towards multiregional models that are often owned by or intertwined with large for-profit and private equity funded enterprises.
The New Hampshire Department of Justice’s Charitable Trust Unit is reviewing this transaction, and public input will be critical. We need to ask tough questions about how this merger will impact the accessibility and affordability of health care in Manchester and beyond. Will we see cuts to critical services? Will costs rise even further? Will longstanding community health programs be maintained? Who will answer our questions or protect access to care once the ink dries? These are the questions our statewide community must address. The stakes could not be higher.
At a time when health care costs continue to climb, New Hampshire needs an approach to addressing health cost growth that puts patients first. We need transparency in health care pricing and policies that protect access to care, especially for our most vulnerable residents. We also need resources like patient navigators and advocates to help guide Granite Staters through the complexities of the health care system, ensuring they can find care in a changing landscape and that they understand their rights and options.
The Oct. 23 public hearing (4:30 p.m. at Manchester Memorial High School) is an opportunity to stand up for what matters most: a health care system that can deliver affordable, high-quality health care for every Granite Stater.
Let’s make sure that hard questions are asked — and answered — and that all voices are heard. We need to hold these powerful multibillion-dollar institutions accountable for the future of health care and the future of our community health and well-being. This is a moment that calls for close scrutiny and a shared commitment to outcomes that ensure that every resident of New Hampshire can access affordable and equitable care.
Lucy Hodder of Hopkinton is a professor and director of health law programs at UNH Franklin Pierce School of Law.
