With more healthcare mergers in Minnesota, Attorney General's office plays a key role

NINA MOINI: This evening, members of the public will have a chance to weigh in on a proposed health merger. Sanford Health and North Memorial Health announced last month they'd reached an agreement to combine. Sanford is based in South Dakota and operates in several Midwestern states, especially in rural areas. North Memorial runs two hospitals and a network of clinics in the northern Minneapolis suburbs.

The Minnesota attorney general has the power to review health mergers in the state and potentially sue to try to stop them under a 2023 law. AG Keith Ellison is currently running for re-election. His office is hosting tonight's public forum in Robbinsdale, and he's on the line. Thanks for taking the time this afternoon, Attorney General.

KEITH ELLISON: Yeah, here I am. Thank you.

NINA MOINI: There are concerns when something like this happens. Can you remind the public what your role as attorney general is in this and what the concerns are? My understanding-- it's sort of a fear of corporatization of care and less individualized care and then the system saying, but we really need to do this to be sustainable in the long term.

KEITH ELLISON: Well, the Minnesota State Legislature passed a statute that required for the attorney general to review certain health care entity transactions-- so, in other words, like mergers, for example. But anytime two companies want to get together and combine or consolidate, have a qualified transaction, it's the attorney general's job to review that transaction for the public interest to make sure that the public interest is going to continue to be served. So that's what the job that we have is.

And part of that is to hear from the public. And tonight, we're going to be having a very good meeting, a community public meeting. Folks can go on our website and can sign up. They can RSVP-- due to safety reasons, we ask people to sign up for these meetings-- and fill out the form. But it'll be in the Robbinsdale community.

And we'd love to hear from the public. We'll be meeting from 6:00 to 8:00. And it'll be an interesting and very important conversation. And we'll have folks there from Sanford and North Memorial, and we'll also have people there from the unions that work there, and we'll have people there from the community as well. So it should be a lively conversation, and we want to hear your voice as well if you can make it out to join us tonight. And just go right on the website and sign up online. And we'd love to have you with us.

NINA MOINI: Yeah, it's important to engage with the public over this, because there are potential concerns that you would be considering as you evaluate this proposal. Can you talk about some of the factors that you'll be looking at or what you'll be wanting to hear from the individuals who come out and their concerns about quality of care?

KEITH ELLISON: Absolutely. So the thing is that whenever two entities combined and there's this transaction, there is an impact on patient care. There's impact on the unions that work there at the entities that will merge. There might be impact on how people are able to access care. The agreement might call for investment in-- if it's a multi-site institution, it's important to make sure that the investment in all sites remains strong in each one of those places.

So we're looking at issues of, will this impact public health? Will it reduce or affect the community's continued access to affordable, quality care and the services that have been provided historically? Will it have an impact on competing health care options within primary and dispersed service areas? And other things like, well, what about delivery of health care to disadvantaged, uninsured, underinsured, underserved populations? We don't want to create health care deserts. We want to make sure people can continue to get served.

And as I already noted, will there be an impact on health insurance services, skilled healthcare workers? And so there are a number of things to consider. And so there you go.

NINA MOINI: Yeah, I wonder about back in 2023 when Sanford and Fairview Health Services tried to combine. At that time, you held a number of public forums as well. It sounds like you were more skeptical of that deal. Are you concerned that this will be similar to that situation, which it sounds like the two just decided to give up on that deal?

KEITH ELLISON: Well, every deal is unique. And so I don't want people to think, oh, well, this deal's like that deal, and that deal didn't go down, so this one shouldn't go down. They're all unique. They're all separate. They all have to be evaluated on their own merits.

And so what we really want to do is do a good investigation. We want to do a good review. And that's the idea. I'm not walking into this prejudging whether this is a good transaction or not. We'll look at it the way that we are required to based on the statute.

But we really need your input-- and when I say your input, I mean the public's input-- to really make that decision. And so whenever there's a transaction like this that there is a potential impact on provider costs and trends, containment of health care spending, there's a potential impact on wages, collective bargaining. There's an impact on services that might be provided. So we just want to know, because we don't know everything right. That's why we do investigations. We're trying to find out facts.

NINA MOINI: What about the specific conditions of a deal? As you're gathering this information, can you just say the scope of what your office is able to do as it relates to the deal?

KEITH ELLISON: Yeah, after a free and fair and open and independent investigation, if we find that there might be a negative impact on public health, that there might be a reduction in communities' access to affordable, quality health care, if we find that there's a detrimental impact on competing health care options, if we find that there's going to be increased health care costs for patients or a number of things-- all these things are listed in the statute. If people want to-- if folks really want to get granular, they can look it up. But if we find that there's a negative impact, we can take action. The attorney general may enforce the statute to say that this would not be in the public interest.

But I want to just make sure everybody knows that that is not where we are right now. We are just reviewing. We are asking for public input. And I don't want to put any negative cast on this transaction. I just want to make sure everybody knows that we're doing our due diligence where we're doing our job, per the statute, to make sure that this transaction is in the public interest.

And just so everybody knows, there have been transactions where we've raised objections. There have been transactions where we have not raised objections. And so the fact that we're holding this hearing should not signal to anyone that we've already arrived at a conclusion. We have not. We want to hear from everybody, and we want to do a proper evaluation.

NINA MOINI: I understand that's an important point to make, is that you're doing your job. There is, there seems, a trend of consolidation in the healthcare industry. There's another merger or acquisition that's being talked about that's pretty big in the state as well. Do you consider the industry as a whole when you're viewing these mergers or take them case by case?

KEITH ELLISON: Well, as we go through our evaluation, the context of the transaction matters. So if there are a lot of other healthcare options available, that might signal-- and I'm speaking theoretically now-- that might signal that there wouldn't be a reduction in access if there are a lot of other options available. If there are not too many options available, then that individual transaction may take on greater importance in terms of the overall healthcare delivery and access that people need. So it kind of depends on context. So yeah, the answer is yeah, we do consider the wider impact and what is available for people to have healthcare access outside of this individual transaction.

NINA MOINI: And just lastly, what is the timeline on this review and responses from the health Systems? I know it sounds like they're going to be a part of the dialogue as well tonight at 6:00 in Robbinsdale. How long is this going to take?

KEITH ELLISON: It'll take several weeks. It'll take several weeks. We should be done. The statute lays out very specific timelines where they have to notify us. They have done that. And now we're going about our review. So that's what we're doing. And so we'll know something into August. The answer should be coming back.

I like to tell folks that if we-- they'd rather have us do a thorough job than a fast job. So I like to give us enough time to do our job. But yeah, I suspect we'll be through our review in a matter of weeks.

NINA MOINI: OK. And if people want to attend tonight, just to reiterate, they need to RSVP to find the location, correct?

KEITH ELLISON: Yeah, it'll be in the North Metro. But we live in a time when these things are necessary based on security reasons. But I want everybody to know that this will be very safe, and we have security there, and it'll be no problem. But yeah, we ask people to go online and sign up.

NINA MOINI: All right. Attorney General Ellison, thanks for your time.

KEITH ELLISON: All right. Thank you.

NINA MOINI: That's Minnesota Attorney General Keith Ellison. The public forum on Sanford Health's proposed acquisition, again, of North Memorial Health is at 6:00 PM tonight in Robbinsdale.