HCA Healthcare and its Asheville, North Carolina-based system, Mission Health, have settled antitrust allegations brought by several local government groups in a deal that will create a new $1 million charity care fund for low-income patients.
The closed-seal deal, announced Wednesday, stems from the large hospital chain’s $1.5 billion purchase of nonprofit Mission Health back in 2019.
Following reports of worsening quality and criticisms of the system’s management, the cities of Asheville and Brevard, as well as Buncombe and Madison counties, filed lawsuits, later consolidated, that alleged HCA acquired Mission in order to secure its existing monopoly over the region’s general acute care market. The complaints pointed to HCA’s substantial market share in the area—more than 85% of the Asheville region’s general acute care market, and roughly 90% of Buncombe County’s inpatient hospital care.
The complaints had also alleged that market power allowed HCA to use “anti-competitive provisions” when contracting with insurance plans, including “all-or-nothing provisions,” “anti-steering” and “anti-tiering” provisions and “gag clauses.” Mission Health had also raised prices faster than others across the state, discontinued certain services and reduced staffing, according to the complaints.
HCA’s bid to have the litigation dismissed was denied by a federal judge in 2024. In Wednesday’s settlement announcement, the chain and Mission Health said they continue to deny the allegations.
“Mission Health and HCA believe that their conduct was, at all times, consistent with federal and state antitrust laws, that none of Mission Health’s contracts contained the provisions challenged by Plaintiffs, and that neither Mission Health nor HCA has done anything to exclude competition or limit insurance company innovation in Western North Carolina,” the joint statement provided by a Mission Health representative reads. “Nevertheless, Mission Health and HCA are pleased that the resolution of this action allows them to continue to show their commitment to Western North Carolina through the establishment of a new charity fund and by continuing to operate consistent with applicable state and federal antitrust laws.”
Under the terms of the deal outlined in the statement, Mission will be donating $1 million to a to-be-created charity fund that will help cover healthcare costs for patients at up to 400% of the Federal Poverty Level. Mission will also continue to operate its Transylvania Regional Hospital for an additional three years beyond the 2019 agreement’s 10-year window.
Additionally, Mission will “cooperate in the negotiation of space adequate for the provision of adult day care services in Brevard, North Carolina and to seek for Mission Hospital quality verification as a trauma center; and provides the Plaintiff municipalities and counties with additional information related to Mission Health advisory boards,” according to the statement.
The cities and municipalities have also pointed to the settlement statement when asked for comment on the deal.
“Plaintiffs recognize that Mission Health and HCA Healthcare’s continued commitment to and support of Western North Carolina through charity care and otherwise are vital,” the statement reads. “Plaintiffs are grateful for the work of the doctors, nurses and staff of Mission Health and HCA during the Hurricane Helene disaster and its aftermath, and are glad to have resolved this matter in a way that benefits the people of Western North Carolina.”
Though the local governments’ complaints have been settled, HCA and Mission still face legal pressure from North Carolina’s attorney general. In late 2023, then-Attorney General Josh Stein sued HCA for allegedly falling short of the quality and access commitments it made in 2019 to secure the deal. The state’s current attorney general, Jeff Jackson, said earlier this year he had no intention of dropping the case.