HARRISBURG, Pa. (WHTM) — As recently as 2019, describing the physical footprints of hospital systems in central Pennsylvania — based on where their 24/7 hospitals with emergency rooms was, anyway — was easy.

Penn State had the biggest hospital of all but (including its children’s hospital) just one hospital location: Hershey. Western Dauphin County and the West Shore, including pretty much all of Cumberland County, belonged to UPMC. Central Lancaster was Penn Medicine’s. Almost everywhere else belonged to WellSpan:

But then UPMC, in its first major move since entering the region through its aquisition of the Pinnacle system, built a hospital in York (UPMC Memorial) to compete head-to-head against WellSpan York Hospital. Penn State bought Holy Spirit in Camp Hill from Geisinger and built a new hospital (Penn State Health Hampden) in the Enola area and Penn State Health Lancaster, encroaching — at least from a standpoint of big physical hospitals — on the territories, respectively, of UPMC and Penn Medicine:

Or is that what it did? Not from Penn State’s perspective.

“Our Hershey Medical Center hospital was always full,” said Dr. Robert Harbaugh, a senior vice-president with the system. So “we could either build more buildings on this campus, or we could say, ‘Well, you know, maybe we should go to where our patients come from instead of always asking our patients to come to Hershey.’”

In other words, Harbaugh says Penn State finally built hospitals in areas it always considered within its footprint.

David Gibbons, senior vice-president of UPMC Health Services Division and regional market president for UPMC in Central Pennsylvania, says the system’s foray into York with a full-service hospital — complementing its Harrisburg, West Shore (Enola area), Carlisle and Community Osteopathic (Lower Paxton Township) — worked well.

“We have a number of initiatives that we’re reviewing right now for continued expansion at that campus alone,” Gibbons said. “So it really has been a tremendous story of success and growth.”

WellSpan, meanwhile, is building three new “microhospitals” in Newberry, Shrewsbury and Carlisle.

Penn State Hampden’s 110 new beds are just a mile from UPMC West Shore’s 166 beds.

Many of the new hospital beds are — like those at Hampden and West Shore — in Cumberland County, which some years is the fastest-growing county in the state. Still, Harbaugh knows the criticism: “You can look at metrics that say: ‘This area is over bedded; there are too many beds.’”

Gibbons is even more direct: “We do have an excess of hospital beds in this region.” (For its part, WellSpan said in a statement, “Our hospitals operate at full capacity on a regular basis.”)

But if central Pennsylvania has too many hospital beds, for whom is that a problem? For the hospital systems, perhaps, which absorb the costs of unoccupied beds — but not for system patient or employees, according to several studies, including a working paper published in June by the National Bureau of Economic Research.

The paper found in less competitive regions, healthcare costs rise and health employment falls after systems merge, and salaries decline for the jobs that remain.

The 11 counties of abc27’s viewing area — Adams, Cumberland, Dauphin, Franklin, Fulton, Juniata, Lancaster, Lebanon, Mifflin, Perry and York — are served by six different hospital systems (ranked here in order of revenue for the full systems, including, for some, large parts outside central Pennsylvania, according to figures from the industry newsletter Hospitalology and other abc27 News research): UPMC ($27.7 billion), Penn Medicine ($10 billion), Geisinger ($7.7 billion), Penn State Health ($3.8 billion), WellSpan Health ($3.7 billion) and Fulton County Medical Center ($120 million).

Not all compete directly — few customers find themselves choosing geographically between Geisinger, Fulton County and Penn Medicine. Still, those are a lot of players compared to some regions with similar population sizes — a highly competitive market, both Harbaugh and Gibbons said.

Although these figures include the systems’ operations in all markets, the highly competitive central Pennsylvania market could partly explain the operating losses for both systems in their most recent fiscal years, according to Hospitalology figures — among all six systems with hospitals in the region, only Penn Medicine and WellSpan eked out operating profits.

But Gibbons said the competition that challenges the systems is great for consumers.

“Competition in health care is very, very good. It drives innovation. It drives new models of care. It drives competition to create greater access and convenience,” he said. “But the most imporant is that it drives the overall improvement in the quality of care.”

The Federal Trade Commission has generally accepted that argument and used the same logic to block mergers in other markets that could have resulted in less competition.

Pennsylvania Republican Dave McCormick is set to take the stage at the Republican National Convention Tuesday night along with other Senate candidates. But his speech might sound a little different. 

McCormick has updated his planned remarks to address Saturday’s attempted assassination of former President Donald Trump, according to a source familiar with his speech. Unlike the other Senate hopefuls, McCormick witnessed the shooting firsthand. 

Just three days ago, McCormick was seated in the front row of Trump’s rally in Butler, Pennsylvania, and took cover as the gunman opened fire.

“Lots of energy and lots of positive noise and then all of a sudden, just shattered with these rifle shots,” McCormick told NBC News Saturday night. “And it was just sort of — people were in disbelief. It was very chaotic and very confusing for quite some time.” 

McCormick is in a hotly contested race against Democratic Sen. Bob Casey in a state that is key to both the race for the White House and the battle for the Senate. And while it’s yet not clear if or how Saturday’s shooting will affect elections this fall, any effects may be felt particularly strongly in Pennsylvania.

“I think because this incident occurred in Pennsylvania, you would imagine it’s going to have more of an impact in Pennsylvania than other places,” said Mike Barley, a former executive director of the state GOP. 

The shooting did have a temporary impact on the Senate race: Casey’s campaign began working with local TV stations on Saturday evening to temporarily take down its ads. Campaign spokesperson Maddy McDaniel said in a statement that the ads will resume “in the days ahead to educate Pennsylvanians on Senator Casey’s record, his opponent’s record and the stakes of this Senate race.”

On Monday morning, McCormick also called on Casey to agree to “suspend negative advertising.” (McCormick did not call on outside groups, which cannot coordinate with campaigns but launch many of the negative spots, to cease their attacks as well.)

Saturday’s shooting could also raise more immediate concerns about security at upcoming campaign events. 

”Safety needs to be top of mind,” said GOP state Rep. Stephenie Scialabba, who was next to McCormick on Saturday when the gunman opened fire.

“We’re all standing there, having these discussions about the future of the country. And next thing you know, we’re making eye contact under folding metal chairs, counting the shots and trying to determine where they’re coming from,” she recalled.

Scialabba said McCormick helped shield her and told her, “I got you,” confirming her account to the Butler Eagle. 

“It’s like his combat training kicked in and he was able to get us all out of there,” Scialabba said, referring to McCormick’s service as a former Army officer and veteran of the Gulf War. 

Scialabba said she is concerned about attending future campaign events, but she plans to go anyway “out of pure defiance.” She echoed other elected leaders and called for “extra thought” into language used in campaigning “to tone down this rhetoric.”

Both Casey and McCormick have also called for lowering the temperature. 

“We have consequential differences; we should debate them robustly,” McCormick wrote in a Wall Street Journal op-ed Sunday. “The left and right have vastly different visions, and both fear the consequences of losing. So let’s have that conflict—but let’s commit to keep it inside the context of elections, civil debate and policymaking.”

Casey told CNN’s State of the Union on Sunday, “We all have a role to play … both as citizens and as elected officials. What we should be categorically condemning is violence of all kinds, political violence or otherwise.” 

It remains to be seen if cooling down rhetoric is even possible in today’s ever-warming political climate — especially in a battleground state as critical as Pennsylvania. 

Some Pennsylvania political operatives were cautiously optimistic.

“Sen. Casey has always shown that he’s run campaigns based on substance, not style. And look, McCormick, in all honesty, strikes me the same way,” said Pennsylvania Democratic strategist Mike Mikus, who is not working with Casey. “This race was never going to be an over-the-top battle royale. It was always going to be based on differences both on policy and background.” 

Barley, the former state party leader who is not working with McCormick, also said a more positive campaign is possible “because of the unique nature of the two people.” 

“I think they’re both generally gentlemen. And they like to campaign that way,” Barley said — though he added that the candidates cannot control the largely negative ads that come from outside groups. 

Pennsylvania GOP strategist Vince Galko, who is not involved in the Senate race, said there could be “more civility, more issue-based campaigning” in the short term. But Galko noted McCormick will also have to make his case against the incumbent. 

McCormick has continued to draw a contrast with Casey, telling CNBC on Monday that his message to voters is: “If you think the status quo is OK, if you think we’re on a good path, then you should vote for my opponent. Sen. Casey, he’s been there a long time. He’s voted with President Biden 98% of the time. If you think we need to make really significant changes on the border on economic policy, on criminal justice, on America’s role in the world, on energy policy — then, then pick me.”

Casey and his allies, meanwhile, have also been working to define McCormick, highlighting McCormick’s business record and his Connecticut residence.

Aside from some potentially less hard-edged messaging, it’s not yet clear if it could have a broader impact on the Senate race. 

McCormick faces a tough race against Casey, the son of a former governor who was first elected to the Senate in 2006. While Republicans argue the race will tighten as McCormick becomes better known, Casey has performed better than President Joe Biden in recent polling. 

A Pennsylvania survey from New York Times/Siena College, conducted last week, prior to the shooting, and released Monday, finds Casey at 50%, leading McCormick by 11 points among registered voters and 8 points among likely voters. Casey’s leads are outside the survey’s margins of error for both groups. The survey found Trump leading Biden by 3 points among both groups of Pennsylvania voters. 

Casey has historically fared well in Western Pennsylvania, even as Republicans have made inroads in the Trump era among blue-collar voters in the industrial areas surrounding Pittsburgh. 

That part of the state is also where Saturday’s shooting took place. 

“That’s the most important place in the whole race,” GOP strategist Brad Todd, who is working with McCormick’s campaign, said of Western Pennsylvania.

“There will be a whole lot of people in Butler and the surrounding counties who know people who were there, who’ve heard firsthand accounts,” Todd said, later adding, “I don’t know if that results in more engagement, if it results in more people paying attention, if it’s more enthusiasm.”

“I don’t know how it will change,” Todd added. “But I have to believe it will change.”

BETHAL PARK, Pa. – The parents of the 20-year-old who unleashed a barrage of gunfire toward former President Trump are licensed professional counselors through the Pennsylvania social work board.

Mary Elizabeth Crooks and Matthew Brian Crooks of Bethel Park, Pennsylvania, are licensed as professional counselors, according to the Pennsylvania Department of State Licensing System Verification service.

The 20-year-old attempted assassin’s parents both have active licenses, the service said.

Both Mary and Matthew’s licenses expire in February 2025, and they have been professional counselors since 2002, the records showed.

BREAKING INTO TRUMP SHOOTER’S CELLPHONE COMPLICATED BY MODERN TECHNOLOGY: EXPERT

Licensing information on Thomas Crooks’ parents (Pennsylvania Department of State)

Thomas’ family home is now the subject of an ongoing FBI investigation after the shooting on Saturday at a Trump rally in Butler County, Pennsylvania.

SOCIAL MEDIA PLATFORM REVEALS DETAILS OF SUSPECT’S ACCOUNT WHO TRIED TO KILL TRUMP

Crooks’ motive in the shooting remains unclear.

Records showed Crooks was registered as a Republican voter, but campaign finance reports also showed he gave $15 to a progressive political action committee on Jan. 20, 2021, the day President Biden was sworn into office.

An unidentified man answers the door at the home of 20-year-old Thomas Matthew Crooks, named by the FBI as the “subject involved” in the attempted assassination of former President Trump, in Bethel Park, Pennsylvania, on July 15, 2024. (REUTERS/Aaron Josefczyk)

Crooks’ bullet grazed Trump’s right ear and left firefighter Corey Comperatore dead.

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Crooks’ was stationed approximately 130 yards away in an “elevated position.”