If You Don’t Build It, They Won’t Come

What are Republicans really doing in Raleigh? I get asked this question often by even the most diehard conservatives. Many times, I hear from people who are frustrated, and who are wondering if their activism and the people they elect are really making a difference. The answer I have for you is a resounding “Yes!” Oftentimes, the conservatives that you elect make a difference in ways that you never see in the headlines.

We only hear about the big ticket things that are in the News daily. A few of those issues recently have been, Medicaid Expansion, Teacher Pay, Medical Marijuana, Voter ID, Critical Race Theory, etc. 

One issue that does not get a lot of exposure is Certificate of Need (CON) laws. They are dry and technical laws. But they are also costing you money, and in some cases I believe that they are costing  lives.

CON laws were initiated in the US during the 1960s. They started like every failed government program, with good intentions that soon pave the way to you-know-where. This law prevented building medical facilities or obtaining medical equipment without permission from the Government.

The plan was to control healthcare costs by allowing a government board to limit the number of medical facilities and services in each region. You don’t need 10 expensive and niche heart machines in a small place like Yadkin County, for example. Supporters believed that CON laws would prevent unnecessary duplication of medical services and infrastructure. Democrats who controlled the North Carolina General Assembly went along with the fed and passed CON laws in this state in the mid-1970’s.

Entities have spent millions of dollars and years of time, to try to obtain a CON for expansion of services. Imagine a requirement to do that for any other service. One couldn’t open a pizza store, grocery store, drug store, etc. without government approval. It’s crazy thinking. 

Certificate of Need laws had the opposite impact. (Central planning does not work… who would have thought?) They stifled competition, limited consumer choice, and lead to higher healthcare costs for everyone. Ronald Reagan repealed Certificate of Need (CON) laws at the federal level in the 1980’s. This repeal eliminated the federal requirement for healthcare providers to obtain most government approvals before expanding or opening new facilities.

To my knowledge, this is the only federal government program that has ever been eliminated. Once something is put it place, it cannot be eliminated. But CON was so bad that even the federal government realized it was a monumental failure.

Reagan supported the repeal of the CON laws because he supported the principles of free market competition and limited government regulation. He knew that the CON laws led to monopolies and stifled competition.

Many states followed suit and repealed all or parts of the CON laws. North Carolina continued with these onerous laws. Our state has become the 4th most regulated in the country. Only Vermont, Washington, DC and Hawaii have more restrictive CON laws than our state. We have nothing else in common with these three. This is not good company for us to hang out with.

During my career in the Senate, conservatives have been working hard to chip away at CON. In 2017, we passed legislation to relax CON requirements for certain healthcare facilities and services, including psychiatric hospitals, nursing homes, and ambulatory surgery centers. We did this to promote competition, reduce healthcare costs, and improve access to care. If your relative had to live in a nursing home, wouldn’t you want them to have a lot of choices about where to go? I know that I sure would.

Hospitals, medical organizations, and state-level healthcare associations spend big to fight these efforts. In North Carolina, the North Carolina Hospital Association and the North Carolina Healthcare Association has spent over $2 million on lobbying since 2010. 

I have sponsored CON Reform bills every session since I have been in the Senate. Finally, last week we saw it pass. This reform includes medical facilities, equipment purchases, hospital beds and ambulances, Substance abuse facilities, etc. This legislation is going to reduce costs and improve access as well as the quality of the care that you and you families receive. We passed it against severe opposition and against all odds. Now we still must get concurrence on the NC House side and a signature from the Governor. This is the right thing to do and will be good for North Carolina.