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There’s a big healthcare battle brewing in West Virginia that could have national implications.

A vote could come Friday on a bill that would protect certain hospitals from federal and state anti-trust regulation. Put it another way, if this legislation passes, its possible West Virginia could become home to massive hospital monopolies.

Last fall, the Federal Trade Commission challenged the $185 million deal between Cabell Huntington Hospital and St. Mary’s Medical Center, and federal a hearing is set for next month. The FTC argues the new, bigger hospital would have 75 percent of all inpatient admissions in the market.

"This is about money," said Timothy Duke, head of Steel of West Virginia, who opposes the deal and argues it would cost his company more to insure its workers  20 to 50 percent more. "This is not about quality and care giving. This is simply about the dollar."

The FTC is on a winning streak, successfully challenging hospital mergers in half dozen cases. And Northwestern’s Leemore Dafny says rather than take their chances in court, this West Virginia case suggests a new hospital strategy.

"This legislation is a marker," she said. "It’s the start of providers digging in and trying to protect themselves from laws that are designed to protect us, the end consumer."

Cabell Huntington did not return a call for comment, but it has argued the FTC doesn’t understand the competitive landscape in the state.

Follow Dan Gorenstein at @dmgorenstein