The proposed merger of University Hospital in Louisville with the Saint Joseph Health System based in Lexington could deliver significant benefits, but also raises difficult questions.
Gov. Steve Beshear should make sure he has the answers before approving the hospital lease and operating agreements necessary for the merger to move forward.
Attorney General Jack Conway also has a role in protecting the public interest, in consultation with the Federal Trade Commission, which governs hospital mergers.
University Hospital is the provider of last resort for the poor and uninsured in Kentucky's largest city and the surrounding area. The hospital and University of Louisville faculty who practice there are a critical link in the health care safety net.
Controversy over the merger has centered on how reproductive medicine would be delivered and taught once University Hospital is run under Catholic Church dictates.
U of L officials have promised they will find ways for poor patients to keep receiving the full range of care, including procedures that would no longer be allowed, such as emergency abortions and elective sterilizations.
U of L officials need to back up the promises with detailed plans soon. (They could have saved themselves a lot of grief by readying the plans before the merger agreement was signed in June.)
There are other, broader questions of access to health care that should not be lost in the clamor over how to reconcile the demands of a teaching hospital with those of Catholic archbishops.
The partners in the merger, which also includes Jewish Hospital & St. Mary's Health Care of Louisville, have promised to serve the under-served. Again, the promises must be backed by specifics. And there should be a measuring stick agreed on now to see if the promises are kept.
One in five Kentuckians depend on Medicaid, the federal-state insurance program for the poor, elderly and disabled. That number will rise as federal health care reforms bring much of Kentucky's uninsured population into Medicaid.
Medicaid pays hospitals less than private insurance.
The Saint Joseph system treats a lower proportion of Medicaid patients than University Hospital and many others. Beshear should pin down Saint Joe's plans for absorbing more of the Medicaid load.
That's not to imply Saint Joe and its parent, Catholic Health Initiatives, aren't offering a lot.
They have promised to invest $200 million to expand Louisville's academic medical center, which would include Jewish Hospital. Leveraging Saint Joe's capital at a time when the state has been cutting higher education is a smart strategy for advancing Louisville's medical center, expanding its clinical practice, attracting private-pay patients and thus being able to afford to keep serving the poor.
Saint Joe also has promised $420 million to support the merged system's statewide mission and health care services.
In a state desperate for rural physicians, the flow of people and expertise between U of L and Saint Joe hospitals could ease the shortage.
In return, Catholic Health Initiatives, a Denver-based non-profit, would control a hospital that's served a vital public role in Kentucky.
All in all, this merger merits keen, careful and open-minded consideration.