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Carolinas HealthCare System's flagship hospital in Charlotte, N.C. (Carolinas HealthCare)

Carolinas HealthCare System and UNC Health Care are planning to merge by the middle of next year, the two hospital systems said Thursday. The combined not-for-profit giant would own a medical school as well as numerous hospitals, clinics, outpatient centers and other facilities throughout North Carolina and South Carolina.

Why it matters: This is the biggest proposed not-for-profit hospital system merger so far this year, creating a regional behemoth with $14 billion of revenue that could exert large pricing power over health insurers. The UNC-Carolinas system would be one of the 15 largest health systems in the country by revenue — another step in the hospital industry's movement toward building up massive scale within a cluster of states.

Yes, but: There's no guarantee it will pass antitrust review.

More details: Gene Woods, CEO of Carolinas and the current chair of the American Hospital Association, would become CEO of the combined system. William Roper, UNC's CEO and the former head of Medicare and Medicaid during the Reagan administration, would be the executive chair.

This is not a merger of necessity. Both health systems have had strong bottom lines and already had dominant negotiating positions. Carolinas posted a 4.3% operating margin in 2016, and UNC had a 5.5% margin, according to audited financial statements.

Our thought bubble: There are a lot of moving parts here, and it may not be easy to merge the cultures of the UNC academic system with the public Carolinas system known for high executive pay. The Federal Trade Commission almost certainly will take an extremely close look at this deal as well, considering the Department of Justice is probing Carolinas for creating insurance contracts that steer patients toward its own system and away from lower-cost providers.

Go deeper

3 hours ago - Politics & Policy

Trump to issue at least 100 pardons and commutations before leaving office

Photo: Mandel Ngan/AFP via Getty Images

President Trump plans to issue at least 100 pardons and commutations on his final full day in office Tuesday, sources familiar with the matter told Axios.

Why it matters: This is a continuation of the president's controversial December spree that saw full pardons granted to more than two dozen people — including former Trump campaign chair Paul Manafort, longtime associate Roger Stone and Charles Kushner, the father of Trump's senior adviser and son-in-law, Jared Kushner.

  • The pardons set to be issued before Trump exits the White House will be a mix of criminal justice ones and pardons for people connected to the president, the sources said.
  • CNN first reported this news.

Go deeper: Convicts turn to D.C. fixers for Trump pardons

Schumer's m(aj)ority checklist

Senate Minority Leader Chuck Schumer. Photo: Tasos Katopodis/Getty Images

Capitalizing on the Georgia runoffs, achieving a 50-50 Senate and launching an impeachment trial are weighty to-dos for getting Joe Biden's administration up and running on Day One.

What to watch: A blend of ceremonies, hearings and legal timelines will come into play on Tuesday and Wednesday so Chuck Schumer can actually claim the Senate majority and propel the new president's agenda.

The dark new reality in Congress

National Guard troops keep watch at security fencing. Photo: Kent Nishimura/Los Angeles Times via Getty Images

This is how bad things are for elected officials and others working in a post-insurrection Congress:

  • Rep. Norma Torres (D-Calif.) said she had a panic attack while grocery shopping back home.
  • Rep. Jim McGovern (D-Mass.) said police may also have to be at his constituent meetings.
  • Rep. Adam Kinzinger (R-Ill.) told a podcaster he brought a gun to his office on Capitol Hill on Jan. 6 because he anticipated trouble with the proceedings that day.