NC treasurer says WakeMed–Atrium deal could raise health costs for state workers
AI-generated summary reviewed by our newsroom.
- Treasurer Brad Briner said the WakeMed–Atrium deal could raise costs for the health plan.
- Briner said the State Health Plan is already seeing increased medical costs.
- Wake County commissioners delayed a vote on the combination for up to 90 days
When the news broke Friday of a proposed merger of WakeMed Health and Atrium Health, numerous state and local officials pushed back.
That included Republican State Treasurer Brad Briner, who serves as chairman of the board of the State Health Plan. He sent a letter to Wake County commissioners to voice his concerns.
“The State of North Carolina and the Wake County Public School System are among the county’s largest employers, and our constituents will feel the gravity of the decision you make,” wrote Briner, subsequently listing concerns such as costs increasing, quality of care worsening and the deal not providing benefits to WakeMed.
Wake County commissioners voted Monday to delay actions related to the merger for at least 90 days Monday.
In an interview with The News & Observer on Monday, Briner laid out more of his concerns directly related to the health plan’s impacts.
“This is a simple business transaction. (Atrium and WakeMed) want to gain more market power so that they can charge more,” said Briner.
On Tuesday, WakeMed leaders said during a press conference they had work ahead to sell skeptics on the benefits of the merger but were confident they would win people over, The N&O reported.
That included Thad McDonald, a retired OB-GYN who heads the WakeMed board of directors and who said he was “acutely aware of the angst this announcement has caused with staff, with community leaders and with patients, and will say at the outset I completely understand.”
“When first presented with the possibility, our executive committee felt the same thing. But after two years of due diligence, we came to see the pure beauty of it,” McDonald said.
WakeMed is one of the Triangle’s three big health care systems and was owned by the county until 1997, when it became an independent nonprofit. Meanwhile, Atrium Health is part of Advocate Health, the nation’s third-largest nonprofit academic health system centered around Wake Forest University School of Medicine in Winston-Salem, The N&O reported.
Steve Smoot, who heads Advocate Health operations in North Carolina and Georgia, said the company shares WakeMed’s commitment to care for every person who walks through the door, regardless of ability to pay, The N&O reported.
The North Carolina State Health Plan covers 750,000 North Carolinians, including thousands across Wake County and surrounding areas.
Costs going up in State Health Plan
Briner told The N&O that anyone who is “paying attention to the State Health Plan, (knows) it’s a struggle.”
“We walked in the door with a big deficit,” said Briner, who took office in 2025. “We’ve been working on closing that. But the medical trend is going against us. We were up 15% last year on medical trends.”
The plan has undergone significant changes under Briner, including tiered premium increases and higher deductibles – all attempting to correct a projected $507 million deficit in 2026 that had been expected to grow to $1.4 billion by 2027. Updated estimates no longer forecast those deficits.
But Briner has said that there will likely be more premium increases down the line, and recent data presented to the plan’s board shows the plan is projected to lose $8.1 million in 2026 primarily due to lower-than-expected premium revenue and higher-than-expected medical claims costs.
The data also showed that the plan’s medical costs jumped 15.8% in 2025 — nearly double an industry benchmark of 7.9% and significantly above the public-sector benchmark of 10.2%. While changes are being made, cost pressures “do not abate. That’s where we come at it from and that is our primary concern,” Briner said.
“You see, when these mergers happen — and we’ve had multiple of them in the state before — prices go up, quality goes down, or both. It’s never that the patients are better off or the payers are better off. So could this be a first-of-its-kind example where that’s the case? I’m willing to hear that case be made, but it would defy the history out there.”
Preferred provider system
Another area where the plan could be impacted is the “preferred provider” system it is building. Under this approach, the State Health Plan lays out contracts with certain providers and designates them as “preferred.” Patients pay lower out-of-pocket costs when they use these providers and more when they don’t. In return, preferred providers benefit from a higher volume of patients directed their way.
Asked whether WakeMed was negotiating with the plan to become a preferred provider — and how a potential merger with Atrium might affect that — Briner said “you should assume that every provider in the state is an eligible candidate to be a preferred provider.”
Briner said negotiations occur at the system level, not the county level. Therefore, if Atrium were to consolidate with WakeMed, it would “give them substantially more market power and ability to negotiate higher prices because of the many points of access that they do have,” Briner said. “When you have supplier power, prices go up for the end payer.”
Briner said he hopes the consolidation does not happen as WakeMed is “a well-run business” that “is very profitable in its own right,” and not distressed.
“But if we missed something and this has to happen, then at least charge them for it. It literally is being given over for free, and I don’t know why they would do that.”
WakeMed has said the merger would result in a $2 billion investment in the health system, including redeveloping and expanding facilities in Raleigh and Cary, and would create 3,300 new health care jobs in Wake County over the next five years, according to previous reporting by The N&O.
Documents posted on the Wake County Board of Commissioners website — including a proposed amendment to WakeMed’s articles of incorporation and a transfer agreement — show that WakeMed would remain a nonprofit but would be fully integrated into Advocate Health. WakeMed would continue to be governed by a board, but six members would be appointed by Atrium and the remaining eight by county commissioners.
The $2 billion investment is described in the transfer agreement as Atrium Health’s intention “to make or cause to be made capital expenditures in furtherance of WakeMed’s strategic initiatives” over the 10 years following the deal’s closing. There is no direct monetary compensation included in that transfer agreement.
Briner pointed to Buncombe County and New Hanover County, where officials established endowments to address access and affordability issues following hospital mergers. In New Hanover, the public hospital was sold to Novant Health. Mission Health, a formerly nonprofit system in Asheville, was sold to for-profit HCA Healthcare.
Briner said he was aware of the “possibility” of a consolidation of WakeMed and Atrium before the news on Friday. He’d heard rumors since he took office.
“There have been rumors of mergers of just about every combination you could think of health systems in the state,” he said. “(We) didn’t know that this one was serious.”
Richard Stradling contributed to this reporting.
This story was originally published May 5, 2026 at 5:21 PM with the headline "NC treasurer says WakeMed–Atrium deal could raise health costs for state workers."
