Texas' largest not-for-profit hospital system will be even bigger after its planned merger with Houston's largest hospital network, creating a $14-billion health care giant.

Dallas-based Baylor Scott & White Health announced Monday that executives have signed a letter of intent to merge with Houston's Memorial Hermann Health System. The leadership of the two systems said the consolidation would help them better serve Texas, which is worst-in-the-nation when it comes to the share of residents without health insurance.

The combined 68 hospitals would account for 15 percent of state's total and cover much of north, central and southeast Texas, according to American Hospital Association figures. Doctors in that new network of hospitals and clinics would see nearly 10 million patients a year and employ more than 70,000 people in 30 counties.

"The cost of health care is the number one issue in America, whether it's in Washington, D.C., or Austin or in the benefits office of an employer," Baylor Scott & White CEO Jim Hinton said. "Taking cost out of the system will be an important part of this journey."

1 / 5From left, Deborah Cannon, Memorial Hermann Health System board of directors chair; Ross McKnight, Baylor Scott and White board of trustees chair, and Chuck Stokes, Memorial Hermann Health System's president and CEO, laugh after a press conference announcing the merger between Baylor Scott and White Health and Memorial Hermann Health System on Monday, October 1, 2018, at Baylor Charles A. Sammons Cancer Center in Dallas. (Daniel Carde/The Dallas Morning News) 2 / 5Baylor University Medical Center on Monday, October 1, 2018 on Gaston Avenue in Dallas. Dallas-based Baylor Scott & White Health announced Monday, Oct. 1, 2018 that executives have signed a letter of intent to merge with Houston's Memorial Hermann Health System. (Ashley Landis/The Dallas Morning News)(Ashley Landis / Staff Photographer) 3 / 5Deborah Cannon, Chair of Memorial Hermann Health System Board of Directors (left) laughs at Ross McKnight, Chair of Baylor Scott and White Holdings Board of Trustees who jokingly reminded her to not forget the hospital in his hometown of Throckmorton, Texas during a news conference at Baylor Charles A. Sammons Cancer Center in Dallas. The press conference was held to announce the intended merger of Baylor Scott and White with Memorial Hermann Health System, October 1, 2018. The boards of both non-profit hospitals have signed a letter of intent to merge into a combined system. (Tom Fox/The Dallas Morning News)(Tom Fox / Staff Photographer) 4 / 5Memorial Hermann Health System and Baylor Scott & White Health have signed a letter of intent to merge to create the largest health system in Texas Monday Oct. 1, 2018 in Houston. ORG XMIT: MER2018100115320901(Michael Ciaglo / Staff photographer) 5 / 5(Center right), Deborah Cannon, Memorial Hermann Health System Board of Directors chair, speaks as (left) Jim Hinton, Baylor Scott and White's CEO; (center left) Chuck Stokes, Memorial Hermann Health System's president and CEO, and Ross McKnight, Baylor Scott and White's board of trustees chair, listen during a press conference announcing the merger between Baylor Scott and White Health and Memorial Hermann Health System on Monday, October 1, 2018, at Baylor Charles A. Sammons Cancer Center in Dallas. (Daniel Carde/The Dallas Morning News)(Daniel Carde / Staff Photographer)

Hinton, who would become the CEO of the combined entity, said the consolidated health care network should be able to improve patient care while holding down cost increases. The benefits, he said, should come from the sharing of expertise, collaborations on technology and increased buying power and efficiency.

Most changes at the combined system wouldn't be obvious to patients of Baylor Scott & White or Memorial Hermann in the short term, officials said.

"There should be no impact to the delivery of patient care for either one of our systems," Chuck Stokes, president and CEO of Memorial Hermann said.

The merger comes at a time when there's great uncertainty about the health insurance marketplace.

President Donald Trump and his administration have so far failed to repeal the Affordable Care Act, better known as Obamacare, which incentivized people to sign up for health insurance and penalized those who refused to. The GOP-led efforts to have the law declared unconstitutional are expected to continue.

There is also uncertainty about how this merger might affect coverage by health insurance networks. While the systems currently have individually negotiated deals with the insurance companies, the larger combined entity might be able to negotiate better deals.

"Until we're one company, we can't talk about each other's contracts," Hinton said. "The short answer is 'we don't know.'"

Chuck Stokes, president and CEO of Memorial Hermann Health System (Courtesy: Memorial Hermann Health System)

If it goes forward, the merger is expected to be completed in 2019 with a goal of finalizing the deal by July 1. Executives, however, warned that they still need to complete their due diligence and get regulatory approval.

Deborah Cannon, chairwoman of Memorial Hermann, said the deal would need the approval of the Texas Attorney General and has been submitted to the Federal Trade Commission for review of anti-trust issues.

"Because we're in contiguous regions and not overlapping, we don't anticipate that will be a huge problem," Cannon said.

Both health networks are not-for-profits that started more than a century ago with religious missions. And both have also grown through mergers.

Monday's announcement is exactly five years after the merger of Baylor Health Care System and Scott & White Healthcare was completed. That deal made it the largest of its kind in Texas.

In 1997, Hermann Hospital merged with Memorial Healthcare System to create the largest healthcare system in Houston and the surrounding areas.

Hospital mergers and acquisitions have accelerated in the past few years. The 115 transactions in 2017 was the highest in recent history, according to consulting firm Kaufman Hall. There was also a higher percentage of not-for-profits acquiring assets from for-profit companies, which is reversal from previous years.

The top leadership of both organizations are expected to remain if the merger were approved. While Hinton would remain CEO, Stokes would work with him coordinating the merger and overseeing Houston area operations.

Jim Hinton, the CEO of Baylor Scott a& White Health, poses for a portrait in the lobby of their Dallas corporate offices in 2017. (Ashley Landis/The Dallas Morning News) (Ashley Landis / Staff Photographer)

The health networks would retain their names in their home regions. The new name of the overall parent organization hasn't been finalized.

It's not clear whether a merger would lead to job cuts. The CEOs noted that the two companies combined have nearly 5,000 job openings.

Despite the planned hirings, the Houston Chronicle reported in June that Memorial Hermann had laid off 460 so far in 2018. Stokes cited the "uncertain health care environment."

In other areas, such as at its flagship Memorial Hermann-Texas Medical Center, the system is expanding.

Hinton said he's not sure how the combined organization would rank nationally, but that's not been a driving factor.

"We'll be a large organization, 73,000 employees," he said. "We want to convert that size into value for the people we serve. That's really been our main focus."

Baylor Scott & White Health

47,000-plus employees

More than 7,500 physicians

More than 7 million patient encounters annually

More than 800 primary, specialty, and satellite clinics

49 hospitals

Memorial Hermann

26,000-plus employees

6,400-plus physicians

More than 2.4 million patient encounters annually

More than 300-plus care delivery sites

19 hospitals*

SOURCES: The companies

*Includes joint ventures