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A half-dozen University of Minnesota medical students voiced opposition Tuesday night to the proposed merger between Sanford and Fairview, saying they worried the deal would limit access to critical health care services while hurting the quality of the medical school.

Yet residents of Grand Rapids, the northern Minnesota community that hosted the public meeting, said Sanford offers economic stability and had delivered on previous merger promises in the north-central Minnesota city of Bemidji.

The back-and-forth came in the fourth and final public meeting convened by Minnesota Attorney General Keith Ellison, who is reviewing the impact on competition and charitable assets from a proposed combination to create one of the largest health systems in the Upper Midwest.

Debate over the megamerger is heating up at the Minnesota Legislature, including a committee meeting scheduled for Wednesday. Earlier this week, a top University of Minnesota official told lawmakers that a meeting on the merger was also scheduled for Wednesday between health system executives and the U.

Fairview owns the University of Minnesota Medical Center, which is the U's primary training hospital. The university says the merger plan has failed to account for its impact on the U's academic health center.

"The AG has said multiple times that it's more important to get this right than to do it fast," Chief Deputy Attorney General John Keller said at the start of Tuesday night's meeting.

At last week's meeting in Worthington, Keller revealed that Ellison's office had formally requested that Sanford and Fairview slow down the merger timeline, which targets March 31 as its close date.

"We expect that they will respect this request for more time," he said Tuesday. "We would not have asked for more time if we didn't need it."

South Dakota-based Sanford Health and Minneapolis-based Fairview Health Services announced plans in November for a merged health system that would be headquartered in Sioux Falls with a combined 78,000 employees and more than 50 hospitals.

Minnesota lawmakers have proposed legislation to slow or block the deal, which would move control of the U teaching hospital out of state. On Wednesday, a House committee is scheduled to consider a bill related to hospital mergers in the state.

In Grand Rapids, third-year medical student Matthew Foman lauded the U's teaching hospital for being one of just a few in the Upper Midwest to offer hospital-based abortion services. Citing the example of South Dakota political leaders who strongly oppose abortion, Foman questioned whether access would continue with Sanford's ownership.

Second-year medical student Morgan Whyte referred to South Dakota Gov. Kristi Noem in voicing concerns about Sanford's impact on the future at the U of medical treatments for transgender people. Citing the governor's move last year to terminate a state contract for a transgender advocacy group, Whyte said she was concerned the merger would "transform a health care access issue into a political issue at the expense of transgender and nonbinary people's lives."

Bill Gassen, chief executive at Sanford, said Tuesday that the merger "will not result in fewer options for gender-affirming care and comprehensive women's health care, including abortion."

Yet Foman said he's concerned about "the durability of this commitment and a fundamental difference in values and approaches to reproductive care."

First-year medical student Becca Sedivy, who was raised in Minnesota and plans to practice medicine in the state, said she and her classmates were drawn to the U for the quality of its medical education programs. But Sedivy said the Sanford-backed training program at the University of South Dakota was "unranked" and questioned whether the merger would prompt students to train and practice outside of Minnesota.

"We, the medical students at the University of Minnesota, did not choose Sanford Health for our medical education," she said.

Many residents of Grand Rapids, which currently is home to one of Fairview's two hospitals in northern Minnesota, said they just want a financially sustainable hospital in town.

A merger with Sanford Health promises significant community investments and better care, said Peter Aube, a member of the board of directors of the health system's hospital in Bemidji.

Aube lauded Sanford's track record in Bemidji — 70 miles west of Grand Rapids — following its 2011 merger with North Country Health Services, a nonprofit that ran the local independent hospital there.

Health care accounts for more than 25% of the jobs in surrounding Itasca County, so the financial strength of the region's hospital is critical, said Tamara Lowney, chief executive of the Itasca Economic Development Corp. The viability of the Fairview-run hospital and clinic is important, she said, because there's not another hospital in Grand Rapids.

"I know that the members on the team here at Fairview will ensure that the promises that are made are kept and that the future of our community is strong through the prosperity and permanence of such a strong partner as Sanford," Lowney said.

When Grand Itasca Clinic and Hospital merged with Fairview in 2017, the "sky, quite frankly, was falling," said former board member Mike Ives. Health care providers in Grand Rapids came to like Fairview, Ives said, but the health system has fallen on hard times financially.

"It's unsustainable," he said. "We need a strong partner that knows rural health, and that's Sanford."

Gassen cautioned against delaying the merger, saying planned benefits should not be put on hold. The combined system will not divert or transfer from Minnesota any assets donated in Minnesota, he said, adding that those donations "will be used exclusively for the charitable purposes intended."

But the University of Minnesota continues to believe the merger is moving too fast, said Dr. Bevan Yueh, chief executive of the University of Minnesota Physicians. The U has proposed regaining ownership of University of Minnesota Medical Center as part of a larger plan to renovate existing facilities and build a new hospital.

"We ask that the attorney general not advance this proposed merger without a comprehensive written resolution of how the university will be able to continue to use all of our public resources in service to Minnesota and how public interests in public investments will be protected," Yueh said in Grand Rapids.