Commissioner Tara Waters Explains WakeMed–Atrium Vote, Raises Questions About Costs and County Power

A hospital agreement with lasting consequences. A commissioner who voted no. And questions about who will protect patients when the promises become policy. In this episode of PC Politics, Wake County Commissioner Tara Waters connects the WakeMed–Atrium debate to the power—and accountability—of county government.

RALEIGH, N.C. — Wake County Commissioner Tara Waters says her opposition to the proposed WakeMed–Atrium combination was about more than a hospital partnership. It was about whether residents and their elected representatives had enough information to understand a decision that could reshape healthcare for generations.

In a one-on-one PC Politics — Real. Raw. Relevant. interview with Spectacular Magazine CEO/Publisher Phyllis Coley, Waters explained her no vote, questioned the approval process, and outlined why county government matters even to residents living within a city or town.

One concern remained unresolved for her: As of the October 10 interview, Waters said she still had not seen the detailed terms of the proposed five-year protection against price increases.

Why Waters Voted Against the Agreement

Wake County commissioners voted 5–2 on September 21 to approve amendments to WakeMed’s articles of incorporation and its transfer agreement with the county, allowing the proposed combination to advance. Waters and Commissioner Vickie Adamson voted against it. The county’s approval did not complete the transaction. 

Waters said her objections included transparency, the timeline, healthcare affordability and the potential loss of local control.

She described an earlier stage of the process when, she said, only some commissioners were given access to the full documents. Waters said she subsequently obtained access after a colleague publicly challenged the arrangement, but the experience undermined her confidence in the process.

“I was not opposed to a partnership,” Waters said. “I was opposed to the process.”

For Waters, the distinction matters: Her position was not that WakeMed could never benefit from a larger partner, but that a decision of this magnitude required a more transparent and fully informed review.

The Promises—and the Questions Behind Them

WakeMed and Atrium argue that joining together would strengthen healthcare access, expand services, and provide resources for a growing community.

Their revised commitments include $2 billion from Atrium sources over 15 years for capital investment, stronger financial-assistance protections and limits on price increases. The hospitals have also outlined protections against certain aggressive medical-debt collection practices.

Those commitments improved the proposal, but Waters said they did not resolve her concerns about how it reached commissioners.

She pointed to questions surrounding the source of the $2 billion investment as an example of why examining the underlying documents mattered.

Public reporting after the vote established that final language covering both the investment and the five-year price protection still needed to be completed. Commissioners made their approval conditional on the county attorney verifying that the final contract reflected those commitments.

During the interview, Waters questioned what protection patients would have beyond the five years — and said she could not fully assess provisions she had not yet seen.

Who Would Hold the Power?

Another central issue is the difference between retaining a local board and retaining local decision-making authority.

Waters explained that WakeMed currently operates with its board of directors at the top of its governance structure. Under the proposed arrangement, Atrium would become its sole controlling member.

WakeMed would remain a nonprofit legal entity with a board, but Atrium would acquire significant authority. The transaction therefore involves a substantial change in control, even though it is not structured as an outright sale.

Waters said county appointments to the hospital board remain an important way to protect community interests. However, she urged residents to look beyond the number of appointments and consider what authority those board members would actually exercise.

Her emphasis was on patients with the fewest alternatives—including people facing financial hardship and residents who depend on WakeMed’s safety-net role.

County Government Reaches Beyond City Limits

The conversation also addressed a common misunderstanding: Living within a municipality does not mean county government has no role in a resident’s daily life.

Waters described county responsibilities spanning public health, social services, child welfare, emergency management and education funding, along with investments in libraries, parks and other community amenities.

She explained that county government and municipal governments have distinct responsibilities and work together on shared priorities, including affordable housing.

The BOCC’s countywide reach does not make it a supervisory board over city and town councils. Rather, residents within municipalities are served by both levels of government.

WakeMed’s history helps explain the county’s involvement in this particular agreement. Waters noted its origins as a county hospital and the county’s continuing role in appointing members of its governing board.

Accountability Continues After the Vote

Although she opposed the agreement, Waters said she intends to continue working with hospital leaders, healthcare professionals and residents.

“I don’t think it is the time to put up walls, but rather to extend our hands,” she said.

She encouraged residents to attend commissioner meetings, contact elected officials and request information about the agreement’s protections and implementation.

“At the end of the day, we work for you,” Waters said.

Watch the full PC Politics conversation below for Waters’ explanation of her vote, the proposed changes to WakeMed’s governance and why she believes public engagement must continue after an election—and after a major decision.

This interview presents Commissioner Waters’ perspective. In the episode, Coley welcomes responses from WakeMed, Atrium Health, and commissioners who supported the agreement.