WakeMed says it couldn’t consider a UNC Health merger if it wanted to. Why not
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- WakeMed said its agreement with Atrium prevented it from having conversations with others.
- UNC proposed investing at least $5 billion in and around Wake County over about 10 years.
- WakeMed said a combined WakeMed/UNC would control about 80% of the healthcare market.
When WakeMed officials turned down an offer to join the UNC Health system rather than Charlotte-based Atrium Health, they said they had carefully reviewed UNC’s proposal and explained why they think Atrium is a better fit.
But this week, they also disclosed that WakeMed has an agreement with Atrium that prevents it from seriously considering any other offers. UNC Health made its proposal in a seven-page letter to Thad McDonald, head of WakeMed’s board of directors, on May 5, four days after WakeMed announced its plans to join Atrium.
“We respectfully thanked them and let them know we had a signed agreement,” McDonald told Wake County commissioners on Monday. “We had worked on this agreement for more than three years, and the terms of which prevented us from having conversations with anyone else.”
UNC interpreted McDonald’s response differently. In an email Thursday, UNC spokesman Phil Bridges noted that while McDonald’s response said WakeMed had an agreement with Atrium, he did not explicitly say it prevented the health system from talking to others.
“On the contrary, it states that they will continue to review our proposal as they remain engaged with the community around WakeMed’s path forward,” Bridges wrote.
UNC Health hasn’t given up, according to Bridges. The state-owned health system remains interested in discussing its proposal with the WakeMed board and Wake County commissioners and “sharing more about why UNC Health’s proposal better serves the people of Wake County and North Carolina, as well as how we believe that we are better aligned with our respective missions.”
During a meeting Monday, Wake commissioners were keen to learn more about UNC’s offer, which on the surface seemed more generous than Atrium’s. UNC officials said they would invest a minimum of $5 billion “in and around Wake County over the next approximately 10 years,” with about half of that “tied directly to WakeMed priorities.”
By contrast, Atrium has pledged to invest $2 billion in WakeMed, money that would allow it to expand and update its main campus in Raleigh and expand its hospitals in Cary and North Raleigh.
McDonald said UNC’s offer lacked details on where the money would be spent, particularly when it comes to WakeMed’s flagship campus in Southeast Raleigh, which needs updating.
In addition, said WakeMed president and CEO Donald Gintzig, UNC will likely spend $5 billion on new hospitals and other facilities in the Triangle regardless of whether it ties up with WakeMed.
“They told me they’re going to invest $5 billion anyway,” Gintzig told Wake commissioners. “So here’s your chance to get $5 billion and $2 billion on top of that in this community.”
Chapel Hill-based UNC Health has two hospitals in Wake County, Rex in Raleigh and Rex Holly Springs, and has asked state regulators for permission to build a third in Wake Forest. It is also building a hospital in southern Durham County, just outside Research Triangle Park, near Morrisville and Cary.
UNC Health proposed folding WakeMed into the UNC system while preserving its role as “Wake County’s anchor health system.” It said UNC Health’s operations in Wake and Johnston counties would “be aligned under the leadership of WakeMed” and that WakeMed would have members on the UNC board.
UNC also said that as a state agency it is exempt from some of the regulatory hurdles that a WakeMed/Atrium merger must go through. It emphasized that UNC offers an “in-state, publicly governed, Triangle-based partnership,” attempting to contrast itself with Atrium, which is part of a larger nonprofit company, Advocate Health, that operates in six states.
“We believe our organizations share a fundamental mission to serve the people of Wake County and North Carolina with high-quality, accessible, and sustainable care,” the UNC proposal said.
What would joining UNC mean for competition?
Critics of the WakeMed/Atrium deal, including State Treasurer Brad Briner, say it would reduce competition in ways that increase costs for patients and reduce quality.
WakeMed officials counter that joining Atrium means Wake County would still be served by three health systems, including UNC and Durham-based Duke Health. They say a combined WakeMed/UNC, on the other hand, would control 80% of the healthcare market in the county, reducing competition in ways the Atrium merger would not.
“I really feel strongly that a three-system competitive market will give people greater health care choices and further establish us as the state’s premier healthcare region,” McDonald told Wake County commissioners.
WakeMed needs county commissioners to approve changes to the documents that allowed the county-owned Wake Medical Center to become a private nonprofit in 1997. Those changes were before the board on May 4, but it opted to delay a decision for 90 days to give WakeMed more time to answer questions.
If commissioners approve the changes, the Federal Trade Commission, along with the N.C. attorney general’s office, must agree the merger doesn’t violate state and federal antitrust laws that protect consumers from unfair business practices.
This story was originally published June 12, 2026 at 5:00 AM with the headline "WakeMed says it couldn’t consider a UNC Health merger if it wanted to. Why not."
