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Certificates of Public Advantage (also known as “COPAs”) are regulatory regimes adopted by state governments that are intended to displace competition among healthcare providers. COPAs purport to immunize mergers and collaborations from antitrust scrutiny under the state action doctrine. Hospital mergers subject to COPAs can result in higher prices for patients without improvements in quality of care, reduced patient access to healthcare services, and lower wages for hospital employees who face fewer employment options. Learn more about our efforts and the history behind COPAs below.

Learn More About COPA

FTC staff presents important research and information about COPAs in this policy paper. Read more. 

In a hurry? Read this quick two-page summary of the key issues concerning COPAs. Learn more. 

COPA Assessment: FTC Initiatives to Learn More About COPAs

In 2017, the Commission announced its COPA Assessment Project, calling for empirical research and public comments on the impact of COPAs on prices, quality, access, and innovation for healthcare services.

In 2019, we heard from academics, health policy experts, healthcare industry stakeholders, state regulators and law enforcers, and staff from the FTC’s Bureau of Economics about empirical research on the effects of COPAs and practical experiences with COPAs. View workshop videos, transcripts, presentations, and more.

In 2019, the Commission exercised its 6(b) authority and issued orders to five health insurance companies and two health systems to provide information that will allow the agency to study the effects of COPAs. This study is ongoing and staff intends to report the findings publicly when it is completed.

Our State-Focused Actions

In recent years, staff has advocated against the use of COPAs to shield hospital mergers and collaborations from the antitrust laws. 

New York: In 2022, we submitted a public comment to the New York State Department of Health opposing a COPA application submitted by SUNY Upstate Medical University and Crouse Health System. Previously in 2015, we submitted a public comment to the New York State Department of Health expressing concerns about three COPA applications submitted under the Delivery System Reform Incentive Program. 

Texas:  In 2020, we issued a public comment opposing two COPA applications submitted by Hendrick Health System and Shannon Health System.

Tennessee/Virginia:  In 2016-17, we issued several public comments and provided testimony opposing the merger of Mountain States Health Alliance and Wellmont Health System to form the Ballad Health COPA.

West Virginia:  In March 2016, we submitted a public comment to the West Virginia House of Delegates expressing concerns about a proposed COPA law. In April 2016, we submitted a public comment to the West Virginia Health Care Authority opposing the formation of a COPA to shield Cabell Huntington Hospital’s acquisition of St. Mary’s Medical Center from an FTC antitrust challenge.

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