NEW YORK (Reuters) - Ascension Health and Providence St. Joseph Health are in discussions about a merger that would create the largest hospital chain in the United States, the Wall Street Journal reported on Sunday, citing people familiar with the situation.

A deal between the two non-profits would give the combined entity 191 hospitals in 27 states and annual revenue of $44.8 billion, the paper said. That would surpass the nation’s current largest operator, HCA Healthcare Inc (HCA.N), a for-profit company.

Ascension and Providence did not immediately respond to requests for comment.

The two have been in talks about a deal for months but have not reached an agreement, the Journal reported. The paper said that unlike for-profit companies, mergers of nonprofit hospital operators do not typically involve one entity buying the other.

The merger talks come at a pivotal time in the industry, as a series of deals, changes to the Affordable Care Act and rising drug prices have shifted the healthcare landscape.