WakeMed and Atrium deal would raise State Health Plan costs, Treasurer says

State Health Plan members will face higher costs if a merger deal with Raleigh’s WakeMed hospital system goes through, said State Treasurer Brad Briner, who chairs the plan’s board of trustees. Briner told EdNC that teachers and other state employees would likely pay “10 bucks a month more just to keep WakeMed happy.”

The deal would be a “strategic combination” between WakeMed and Atrium Health — North Carolina’s largest health provider, based in Charlotte. According to a release from WakeMed, the deal would bring $2 billion to the WakeMed system that would go toward redevelopment and expansion.

WakeMed President and CEO Donald Gintzig has denied that the deal constitutes a merger or purchase, but the deal would allow Atrium to appoint six members to WakeMed’s 14-member board, and Atrium-appointed members would have a say in confirming and removing Wake County appointees, according to the News & Observer.

Part of the public criticism of the potential deal comes from the way the deal came to light. As part of a 1997 agreement that made WakeMed a private nonprofit, the Wake County Board of Commissioners must vote to approve potential deals such as this one.

On Friday, May 1, that critical vote was inserted into the board’s Monday consent agenda, which normally wraps noncontroversial votes into one for quick passage. Over that weekend, news of the deal spread, and by Monday, May 4, the vote was delayed.

Briner said Wake County commissioners told him they were caught off guard, and that they thought the vote was on a technical change — rather than a massive deal to combine two health systems.

“When people in any topic try to sneak something by you, it raises many more questions than it answers, and I don’t think this is any different,” Briner said.

Background on the State Health Plan

The State Health Plan (SHP) is a division of the Department of State Treasurer, and provides health care coverage to nearly 750,000 teachers, charter school employees, community college employees, other state employees, retirees, and their dependents.

The plan is currently administered by Aetna, but the board of trustees is looking for a replacement. Aetna’s three-year contract, negotiated by Briner’s predecessor former Treasurer Dale Folwell, started in 2025, replacing Blue Cross and Blue Shield of North Carolina, which administered the SHP for over 40 years.

Since Briner took office, the plan has been restructured in order to avoid a fiscal cliff — the plan, at one point, faced a $507 million deficit, which was estimated to grow to $1.3 billion by 2027. After across-the-board cost increases for members, which Briner at the time said “insulated our lowest-compensated state employees from those premium increases as much as we possibly can,” financial projections by the plan’s staff indicate that if the plan’s request to the General Assembly is fulfilled in this year’s budget, the deficit will be eliminated.

Most recently, the plan is aiming to lower costs through a new tiered-provider restructure. Read more below.

At the time of the premium increases, North Carolina Association of Educators (NCAE) President Tamika Walker Kelly voiced her opposition to cost increases for members.

“Considering the state of educator pay here in North Carolina, asking them to shoulder higher health care costs is not only unfair, but it is unsustainable,” Kelly said in May 2025. “Raising premiums means some employees — our bus drivers, cafeteria workers, teacher assistants, and even teachers themselves — will have to make difficult and impossible choices.”

Now, according to Briner, members might be forced to make those choices because of expected price increases if WakeMed merges with Atrium.

“We’re the payer of those prices. We’re the largest customer of WakeMed by far,” Briner said.

Briner voices his opposition to the WakeMed and Atrium deal

After news spread about the impending Wake County Board of Commissioners vote, Briner was one of a handful of elected officials who spoke out against the potential consolidation. He sent a letter to the commissioners expressing “serious concerns” and asking the board to “proceed with great caution.”

Briner told EdNC he understands WakeMed’s desire to grow, but that hospital consolidations hurt patients. He pointed to Novant Health’s takeover of a New Hanover County hospital and HCA Healthcare’s acquisition of hospitals in Buncombe County as mistakes not to make again.

“It’s the same thing that Econ 101 would tell you happens,” Briner said. “You take out supply, prices go up.”

Briner wrote in his letter to the Wake County commissioners that he is not aware of any example where patients have been left better off after a deal like the one on the table now.

He also wrote that the $2 billion investment that Atrium hopes to make in WakeMed would probably be made regardless of the deal. Therefore, the effective sales price of WakeMed is “ZERO,” he wrote.

“The combination of WakeMed’s strong finances, ample borrowing capacity, the favorable demographics of WakeMed’s service territory, and the continued growth of Wake County, ensure these investments will almost certainly be made whether this consolidation is authorized or not,” Briner’s letter says. “My background is in finances, but it does not take my expertise to know this is a raw deal.”

Briner’s “10 bucks a month” figure, representing his expected additional cost for plan members, was calculated based on the assumption of a 20% increase in WakeMed prices under the deal. Following a public statement from Gintzig, Briner tweeted that Gintzig had said “the quiet part out loud” when saying WakeMed faces competition with other systems, receiving 10% to 30% lower compensation for care.

Briner hopes that the Wake County commissioners reject the deal and prices for the SHP are unaffected. But if they aren’t, he said his options are limited: extra money would be “either coming from the taxpayers or the members.”

Briner noted that most Wake County babies are born in WakeMed hospitals.

“If WakeMed wants to raise prices a lot, it’s going to hit mothers the most,” he said.

Public comment period now open

After the vote on the deal was delayed, WakeMed announced a series of public listening sessions. The last of the currently scheduled listening sessions will be on Thursday, May 28. You can still submit comments through WakeMed’s website.

A potential complicating factor in the debate over a potential deal with Atrium is that, according to The Assembly, UNC Health offered WakeMed more than double Atrium’s offer. WakeMed quickly rejected UNC Health’s bid.

Briner’s message for concerned SHP members: “Express your voice.”

The public has at least 90 days from the original date of the vote to follow Briner’s advice.

“Express your voice, especially if you are in Wake County, and you vote for the commissioners. Go learn whatever you want about what WakeMed is saying. Listen to their side of the story, by all means. Make up your own mind,” Briner said. “But don’t sit this one out, don’t just let it happen.”

Editor’s note: Blue Cross and Blue Shield of North Carolina supports the work of EdNC.