Legislature(2021 - 2022)BUTROVICH 205
03/25/2021 01:30 PM Senate HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| SB26 | |
| SB99 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | SB 26 | TELECONFERENCED | |
| *+ | SB 99 | TELECONFERENCED | |
SB 26-REPEAL CERTIFICATE OF NEED PROGRAM
1:32:00 PM
CHAIR WILSON announced the consideration of SENATE BILL NO. 26
"An Act repealing the certificate of need program for health
care facilities; making conforming amendments; and providing for
an effective date." He stated his intent to have an overview of
the bill and take testimony.
CHAIR WILSON said that well-intended government laws and
regulations have unintended consequences, especially upon small
businesses, that prevent the expansion of the economy in Alaska.
Some of the government's well-intentioned legislation have led
to limited consumer choice for services and stifled competition
and innovation and expansion among certain industries and
sectors. This includes the transportation sector, like between
Uber, Lyft, and the taxi industry. This has led to the same
situation with the hospitality sector with distilleries vs.
bars, wineries, and restaurants, and the healthcare industry as
well. These battles, unfortunately, were created by government
laws and regulations, which while well intended, did not work
well for Alaska at times. Alaskans need and deserve a free
market with the law of supply and demand for direct production
of goods and services. Competition is good for keeping prices
low. Healthcare is a complicated system. People will hear that
Alaska is the most expensive healthcare market in the world.
There will be diverse conversation on this topic. Some may not
be willing to testify on the record because of the pressure from
larger players. His office has heard from many who are fearful
of losing hospital privileges and hurting their relationships
with some providers who are Certificate of Need (CON)
recipients. SB 26 provides a window of a couple of years before
the repeal becomes effective. His office has examined some of
the historical arguments for CON that don't provide economic
justification for depriving customers of the benefits of more
freedom of choice.
1:35:42 PM
GARY ZEPP, Staff, Senator David Wilson, Alaska State
Legislature, Juneau, Alaska, said that since the legislation is
not new to any senator in the committee, he shortened the
presentation on the need to repeal the state's Certificate of
Need program. He took a moment to thank first responders for
their work during the COVID-19 pandemic. SB 26 provides an
opportunity for Alaskans. If people believe that a free market
economy benefits consumers, if people believe in private
ownership and local control of resources and property and local
choice and communities know what is best, then they should
support SB 26 and repeal government control of healthcare
options, facilities, and services. The Certificate of Need
program, known as CON, was first enacted in 1964 in New York.
The federal government mandated that states enact CON programs
during the 1970s when inflation rates were at near record levels
of about 20 percent. The thought at the time was that CON would
restrain healthcare costs, increase healthcare quality, and
improve access to care for the poor and underserved. Later in
the presentation the committee will see how that has been
working nationally and in Alaska.
MR. ZEPP displayed a map on slide 4 of the presentation showing
the current national status of CON programs. Thirty-five states
have CON programs. Three states do not but have an approval
process similar to CON. Twelve states have fully repealed their
CON programs. The federal law enacted CON in the 1970s and
repealed CON as a federal mandate in 1987.
MR. ZEPP presented Alaska's Legislative History of Certificate
of Need on slide 5. In 1976, Alaska passed its first CON law.
Since then, there have been a few minor changes. In 1990, the
state started charging for submitting an application when
seeking approval for a CON. Currently the fees are structured as
follows: for projects of $2.5 million or less, the fee is
$2,500. For projects over $2.5 million, the fee is .1 percent of
the total cost, up to a maximum of $75,000.
MR. ZEPP presented slide 6, What are we trying to solve in
Alaska by repealing our certificate of need laws? The Department
of Justice, the Mercatus Center, and many others have studied
this issue for over four decades. Some have testified in the
Alaska legislature in support of repealing CON. He directed
attention to the points on slide 6 showing why Alaska should
repeal CON. CON programs limit the introduction and expansion of
medical services and equipment, rehabilitation centers, nursing
home beds, and medical imaging technologies. Data and research
on closures of rural hospitals show that they are related to low
patient volume, challenging payer mix (Medicare and Medicaid
patients, who pay less), geographical isolation and workforce
shortages. None of this has to do with whether states have CON
programs. Proponents will say that high-quality healthcare is a
reason for CON. Data and research indicate that outcomes are not
better with CON. CON programs are supposed to increase charity
care, but no evidence exists that charity care is higher in
states with CON. Racial disparities seem to increase in states
with CON. CON decisions are not approved by nonbiased medical
professionals. CONs are approved by Department of Health and
Social Services (DHSS) staff and elevated to the commissioner
for approval. CON programs grant a government-protected monopoly
to incumbent providers. According to the 2016 Alaska Milliman
report, which was done on half of the Premera Insurance Company,
hospital margins in Alaska can be up to 223 percent higher than
states in the lower 48.
1:41:48 PM
MR. ZEPP said that the CON is designed to restrain healthcare
costs. Evidence and studies show that CON regulations' effect on
cost has been inconsistent. CON regulations tends to increase
the cost of healthcare services. Alaska's general cost of living
ranks seventh among the states, so why does Alaska have the
highest healthcare costs in the world. Healthcare premiums in
Alaska are 130 percent higher than the states of Washington,
Oregon, Idaho, Wyoming, and North Dakota. Average hospital costs
in Alaska are 138 percent higher than those comparison states.
Physician payment levels are 148 percent higher than nationally
and hospital payments are 56 percent higher than nationally.
Alaska hospital margins can run 15.6 percent and Anchorage
hospital margins average 20.6 percent. That is five percent
higher than San Francisco, which is the next highest in the
country. Alaskans should have choice, competition, and Alaska
should allow new entrants and new technologies when it comes to
healthcare.
1:43:45 PM
MR. ZEPP presented slide 7, What happened to CON during the
COVID pandemic? Nationally, 24 states temporarily suspended
their CON laws and regulations. This gave healthcare providers
flexibility regarding capacity and equipment. Alaska suspended
CON for 10 months. One application was submitted during this
period. The CON laws and regulations are promoted as being
necessary for health and safety. The suspensions provided
flexibility and seemed to work out just fine during the
pandemic. If CON regulations can be suspended for 10 months
during a pandemic, he asked then why is CON needed in Alaska.
MR. ZEPP presented slide 9, How is Alaska's Certificate of Need
program working today? He asked if CON is working to reduce
healthcare costs to consumers, then why does Alaska have the
highest healthcare costs in the world. Alaska's Certificate of
Need laws have led healthcare providers to sell state-of-the-art
medical equipment and buy lesser quality, lower-priced medical
equipment to remain under the Certificate of Need $1.5 million
threshold. He asked wouldn't those dollars better serve Alaskans
if they were invested in healthcare facilities, innovation, and
allowing new entrants who provide additional quality health care
services. Alaska's Certificate of Need laws result in
territorial disputes and legal costs between healthcare
providers, because one healthcare provider objects to another
healthcare provider's plans to add healthcare services. He asked
does this improve or provide better quality healthcare to
Alaskans. Presidents George W. Bush, Obama, and Trump are on the
record for supporting the repeal of CON programs. Governor
Walker supports repealing CON programs in Alaska. The data
supporting the repeal of CON is voluminous.
MR. ZEPP said that SB 26 provides an opportunity for Alaskans.
He asked for support for SB 26 from those who believe in private
ownership and local control of resources and property and local
choice. Alaskans deserve choice when it comes to healthcare and
healthcare services.
1:47:11 PM
SENATOR COSTELLO asked what companies or business pay to have a
CON application prepared, how many CON applications the state
has in any given year, and once a company or business applies
for a CON, is that information public.
MR. ZEPP said that in 2018 and 2019, Delta Junction tried to
establish a higher level of healthcare facility. The folks there
did not have the expertise to provide the application, so this
presents a challenge to people who are just trying to improve
their communities. He deferred to DHSS to answer her questions.
1:48:58 PM
ALEXANDRIA HICKS, Program Coordinator, Certificate of Need
Program, Department of Health and Social Services (DHSS),
Anchorage, Alaska, said that regarding the cost of preparing the
application, in her tenure, applicants have employed many
different methods to go through application process. Some do it
in-house. Some have hired consultants to assist with the
preparation of an application. She is unaware of the costs.
Excluding the year 2020, the last five years the department has
had an average two CON applications a year. Some years are
busier than others, but that is the average. The department also
processes RFDs, requests for determination. When a facility is
unsure of the necessity of filing for a CON or has questions
about the monetary threshold or whether the service is an
addition, expansion, or alternation of services, it will submit
a request for determination to the department. The department
has gotten between five and six a year over the past five years.
There is a timeline and protocol when the department receives an
application and notifies the public of receipt of application.
Anyone interested in providing an application to be reviewed
concurrently may submit a letter of intent or application. No
information is shared at this point. Once the window for other
applications has closed and no letter of intent or other
application has been received, then the department will post the
application and the public notice with the particulars of the
project. At that point, it is publicly accessible through the
department web page.
SENATOR COSTELLO said she that would like to know at least from
one entity what it cost to prepare an application for a CON. Her
understanding is that a CON application is expensive to prepare.
She has heard concerns that once the data is public, it can help
competitors in the future. She would like to have more
information about cost of application.
CHAIR WILSON suggested that maybe a testifier, who is a former
program coordinator for CON and is the director of ASHNAHA
(Alaska State Hospital and Nursing Home Association) could
answer that.
1:55:59 PM
SENATOR BEGICH said that his issue is always the conflict
between the free market and the state's responsibility for
health and safety matters. Mr. Zepp said the free market is an
issue and cited the higher returns from hospitals that have a
CON. In order words, they are making more money because of the
CON. He asked whether free market operating principles wouldn't
discourage operators to stay in the state without the incentives
that brought them to a fairly-difficult place to operate.
MR. ZEPP replied that in his research and in talking to people
in states that have repealed the CON, there is not a flood of
change in those states when repealing CON removes barriers,
which enables new entrants and new technology.
CHAIR WILSON clarified that now 14 states have repealed CON,
including Florida and Georgia, and Tennessee is in the process.
SENATOR BEGICH asked if Mr. Zepp knows why racial disparities
increase with CON and can that data be found.
MR. ZEPP answered that he will provide that information.
SENATOR BEGICH said that he asked last year how removing CON
would impact rural communities whose facilities are provided by
the Indian Health Service (IHS).
MR. ZEPP responded that there are a couple of exemptions in
Alaska's CON regulations. They are the IHS, Native health
corporations, and a physician-owned facility.
SENATOR BEGICH asked if it would still be status quo for those
entities if the CON is removed.
CHAIR WILSON said that those exempted services could open up
anywhere in Alaska today.
1:59:52 PM
SENATOR BEGICH clarified, and Chair Wilson affirmed, that the
removal of CON would have no impact on that their legal ability
to do what they do now. Senator Begich said that his safety
issue is whether there are adequate regulatory protections
outside of CON for protections of public health for these
facilities. He assumes they exist in a number of different
statutes. He wants to know that healthcare provision will not be
diminished if CON is removed. Those who support CON argue that
it would deregulate the protections of the market.
MR. ZEPP replied that SB 26 only repeals CON laws and
regulations and doesn't affect medical licensing,
certifications, or current laws and regulations that addresses
that particular area.
CHAIR WILSON added that, technically, with CON the state has
seen facilities try to stay under the threshold of dollars, like
ambulatory surgery centers, so the facilities have one or two
rooms and don't have adequate medical staff. If something does
go wrong, it is going to go wrong quickly. Repealing CON would
allow those facilities to have the equipment and staffing they
need to provide safer services.
SENATOR BEGICH asked that if he decides to start a hospital or
clinic that would have needed a CON, now without the CON he
would just build and staff it or is there a process so the state
would ensure that he was a practitioner who could provide the
services.
CHAIR WILSON replied that he will let Deputy Commissioner Wall
answer that as the state has healthcare licensing regulations.
SENATOR BEGICH asked if Mr. Wall could also explain why the
fiscal note has an indeterminate Medicaid cost.
2:03:09 PM
ALBERT WALL, Deputy Commissioner, Department of Health and
Social Services, Juneau, Alaska, said that every regulation and
law that covers in this case, building a hospital, would be in
place outside of CON. The facility would need to meet the
requirements of building a new facility, become accredited and
licensed as a hospital and so on. There are a number of laws and
number of regulations that would apply. They would differ
according to the type of facility. CON covers a lot of
facilities. The fiscal note is indeterminate because the
department cannot identify what may or may not potentially
happen. His belief is that it would not cost the state anything
not to have the CON, but there could be costs to the state based
on the billing pattern of the facility once it was up and
running.
SENATOR COSTELLO said that under the disaster declaration, any
and all state regulations can be ignored. She asked if the
licensure rules Mr. Wall described were not followed under the
disaster declaration.
MR. WALL answered that he would defer to others about what was
waived. He is aware of a temporary waiver to increase bed
capacity in hospitals. He will ask Ms. Hicks to explain what is
currently in place for regulatory oversite of the CON process.
CHAIR WILSON asked Ms. Hicks to talk about how alternative care
sites are being handled currently without a declaration in
place.
MS. HICKS replied that the only standard waived because of the
declaration related to the pandemic was the addition of beds as
far as the CON is concerned. For example, an independent
diagnostics facility was not impacted because of CON because of
the emergency declaration because that facility would not add
beds. It was specific to waiving CON requirements regarding
additional beds. The emergency declaration was lifted so it is
not applicable at this point.
2:08:40 PM
SENATOR HUGHES said that it blows her mind that people were
advocating for this in the 60s and 70s to lower costs and
increase access for the underserved population. That doesn't
make sense logically. She asked how the case was made for CON
and did it ever achieve those goals.
MR. ZEPP said that in his research and talking to the Federal
Trade Commission officials, there was a high rate of inflation
and CON was a way to combat that. It did not work and the
federal government repealed it in 1987. It was a mandate tied to
additional federal funding. Every state except Louisiana enacted
some sort of CON program because of federal leverage. The
program was unsuccessful in restraining high health costs.
SENATOR HUGHES asked if the state will lose any federal dollars
by repealing the CON program.
MR. ZEPP answered not to his knowledge.
SENATOR HUGHES asked whether the states that repealed CON were
able to track any lowering of healthcare costs.
MR. ZEPP replied that the Federal Trade Commission, Department
of Justice, Mercatus Center, and other institutions have studied
that. All the empirical evidence that he can read shows that CON
did not control costs and did not achieve the results expected
when it was enacted in 1976.
SENATOR HUGHES said she wants to know the reverse, whether any
data shows that costs went down after CON was removed.
MR. ZEPP said that all the empirical evidence he has read shows
that in comparisons of states with CON programs to those that do
not, costs are lower and healthcare quality is higher for states
without CON. He does not know quickly how that happened after
the federal mandate was repealed.
SENATOR HUGHES said she wonders if within a state there is data
showing costs went down after it was repealed. She would assume
that happened, but that would be interesting to see.
MR. ZEPP said that New Hampshire in 2016 repealed its CON
program. He spoke to staffers and the legislator who had that
bill. They provided information that after the repeal of CON,
employment for healthcare professionals rose.
SENATOR BEGICH said that maybe NCSL (National Conference of
State Legislatures) has that data on the impact on prices pre-
and postrepeal of CON within a state.
CHAIR WILSON said his office can try to find that data.
SENATOR REINBOLD said that Eagle River is in deep need of a
facility and this is holding them back. She appreciated the
chair bringing this bill forward.
2:14:09 PM
MR. ZEPP presented the sectional analysis and noted many
sections are conforming amendments:
Section 1: AS 12.25.030(e) - Title 12, Code of
Criminal Procedure
PAGE 1, LINES 4-6:
This conforming section replaces the statutory
definition of a "health care facility" reference under
the "Arrests & Citations" chapter of statutes and
deletes the previous reference under the "Certificate
of Need" program.
Section 2: AS 12.55.155(c)(36)(A) - Title 12, Code of
Criminal Procedure
PAGE 1, LINE 7 - PAGE 2, LINE 4:
This section provides for a new definition of a
"health care facility" reference under the "Sentencing
and Probation" chapter of statutes.
Section 3: AS 12.55.155(c)(36) - Title 12, Code of
Criminal Procedure
PAGE 2, LINES 5 - 7:
This section adds the definition of a "residential
psychiatric treatment center" reference under the
"Sentencing and Probation" chapter of statutes.
Section 4: AS 18.20.400(c) - Title 18, Health, Safety,
Housing, Human Rights, and Public Defender
PAGE 2, LINE 8 - PAGE 4, LINE 10:
This conforming section adds the definition of a
"residential psychiatric treatment center" reference
under the "Overtime Limitations for Nurses" chapter of
statutes.
Section 5: AS 18.20.400 - Title 18, Health, Safety,
Housing, Human Rights, and Public Defender
PAGE 4, LINE 11 - LINE 23:
A conforming section that adds the definition of a
"residential psychiatric treatment center" reference
under the "Overtime Limitations for Nurses" chapter of
statutes.
Section 6: AS 18.20.499(2) - Title 18, Health, Safety,
Housing, Human Rights, and Public Defender
PAGE 4, LINE 24 PAGE 5, LINE 5:
A conforming section that adds the definition of a
"health care facility" reference under the "Overtime
Limitations for Nurses" section of statutes and
deletes the previous "Certificate of Need" statutory
references.
2:16:22 PM
Section 7: AS 18.26.220 - Title 47, Welfare, Social
Services, and Institutions
PAGE 5, LINE 6 LINE 16:
This section is amended to add the state licensing
requirements for facilities and services under a new
statutory reference remove the previous requirements
for facilities and services under a "certificate of
need" program under the "Centralized Licensing and
Related Administrative Procedures" chapter of
statutes. The amended section maintains licensing
requirements for facilities and/or services.
Section 8: AS 18.35.399(9) - Health, Safety, Housing,
Human Rights, and Public Defender
PAGE 5, LINE 17 LINE 29:
A conforming section that removes the reference to
the "certificate of need" statute and replaces it with
the updated statue reference under AS 18.20.400 (d),
"Definitions".
Section 9: AS 18.07.021 - 18.07.111; AS
21.86.030(c)(1); AS 44.64.030(a)(18); and AS
47.80.140(b)
PAGE 5, LINE 30 PAGE 6, LINE 1:
This section repeals various statutory references
related to the "certificate of need" program.
2:17:34 PM
Section 10: Section 4, ch. 275, SLA 1976, is repealed:
PAGE 6, LINE 2:
Repeals a section of uncodified law in sec. 4, ch.
275, SLA 1976, which provided a transition to allow
medical facilities in existence or under construction
before July 1, 1976 to obtain certificates of need.
Section 11: Certificate of Need; Applicability:
PAGE 6, LINE 3 LINE 8:
Amends uncodified law and provides that the Department
of Health & Social Services may not take any action to
revoke, enforce, or modify a certificate of need
issued to a health care facility before the effective
date of the Act.
Section 12:
PAGE 6, LINE 9 - LINE 14:
Adds a new subsection that directs the Department of
Health and Social Services to create regulations
necessary to implement the changes made by this Act by
the effective date of the legislation.
Section 13:
PAGE 6, LINE 15:
Section 12 of this Act takes effect immediately under
AS 01.10.070(c).
Section 14:
PAGE 6, LINE 16:
Provides that, except section 13 of the Act, the
effective date of the Act is July 1, 2024.
2:19:08 PM
CHAIR WILSON opened public testimony.
2:19:18 PM
JARED KOSIN, President and CEO, Alaska State Hospital and
Nursing Home Association (ASHNHA), Anchorage, Alaska, said that
ASHNHA respectfully opposes SB 26. Problems do exist with the
current CON program, but the wholesale statutory repeal of CON
is not the answer. Healthcare is not a true free market. In a
free market, hospitals and ambulatory surgery centers could
compete on an equal footing for outpatient surgical services,
but hospitals must maintain emergency rooms, treat all patients,
regardless of ability to pay, and be open all the time.
Ambulatory surgery centers do not have a duty to treat and can
have limited hours. Ambulatory surgery centers are a critical
component of healthcare. The point is that customers are not
choosing between two similarly situated goods in a free market
where the lowest cost wins, but they are choosing between two
totally different products. One is subject to a host of
expensive requirements that the other is not. For this reason
and many others, it makes sense to have some controls in place
to level the playing field and ensure a comprehensive healthcare
system is in place. ASHNHA is committed to working with the
legislature and the department to improve the CON program. The
way to do this is updating and revising CON standards and
calculations. These reside in regulations, not statute.
Decisions should be made using current data, not data from 2011
and 2012. ASHNHA urges the committee to look at the regulatory
framework of CON rather than a statutory repeal.
SENATOR HUGHES said that 12 or 14 states do not have CON. She
asked how they are managing this. Mr. Kosin describes an
impossible situation, but those states must have hospitals.
MR. KOSIN said that he would first look at Texas. He does not
know if Texas has a CON program in place, but he does know that
Texas has had an explosion of free standing emergency
departments. Those are boutique services on almost every corner.
Mr. Zepp said in his presentation that there wouldn't be a boom
of services, but ASHNHA has heard that that is a problem in
Texas. He cannot answer her question directly, but he has heard
stories about Texas.
CHAIR WILSON said that Texas taxes ambulatory services to combat
the differentials with facilities that fall under EMTALA
(Emergency Medical Treatment and Labor Act), like the emergency
rooms.
SENATOR BEGICH said that Mr. Kosin said that the current CON
system is flawed. He asked if Mr. Kosin has made suggestions to
the committee or provided ways to improve the CON law to address
some of the concerns in the legislation.
MR. KOSIN said that two years ago ASHNHA provided the department
a playbook on possible improvements to the regulations,
specifically to the standards and calculations used. The
department worked on it at some point, but he doesn't know where
that process is. ASHNHA did provide detailed suggestions on how
the department can update the program and adjust the formulas to
make it a more sensible program.
2:24:46 PM
SENATOR BEGICH asked him to provide that or any updates to the
committee.
MR. KOSIN answered that he will.
SENATOR HUGHES asked whether the requirement for a hospital to
have an emergency room and not turn anyone away is required by
federal law in order to get Medicaid and Medicare or is it a
state-by-state thing. Now that there are urgent care centers,
she asked why a hospital has to see someone with an earache. She
asked if that could be fixed in state law or is that a federal
requirement.
MR. KOSIN replied that EMTALA is the federal law that requires
that. ASHNHA would agree on trying to correct patient flow so
that people go to the correct place of care. It is economical
for the patient and better for the system of care. There
absolutely needs to be improvement there, but it is a federal
law that if someone comes to an emergency room there is duty to
treat.
SENATOR HUGHES said that she would hope that hospitals would
advocate for change at the federal level. It would be helpful if
a decision point system was in place to help consumers make
choices about appropriate care. She asked if anything prevents
hospitals from doing something like that.
MR. KOSIN replied that he does not know about the limitations
once someone enters an emergency department. Hospitals want that
result. Mat-Su Regional built two free standing urgent cares to
try to get people to access care at the right level. Mat-Su
Regional ran a superutilizer program to try to reduce
overutilization of the emergency department. Hospitals generally
want proper utilization to happen because it frees up bed space
and allows more efficient patient flow. That is what all models
of care are trying to get at.
SENATOR HUGHES said she knows that is not exactly related to
CON, but when trying to justify the need for CON because of
overregulation and the bottom line for hospitals, it is
pertinent. Hospitals should try to solve the fact that the
system has changed and people have other options.
2:29:09 PM
PORTIA NOBLE, representing self, Anchorage, Alaska, said that
CON laws across the country have limited supplies of services
and facilities. The approval process for CON is determined by
government. Government finds itself being lobbied by large
healthcare monopolies. CON law has driven up the cost to
consumer, lowered the quality of care, limited the availability
of needed services, and has fought competition in the healthcare
market. Any time in America, and especially during a pandemic,
healthcare providers should not need government permission to
expand their size and scope of practice. During the pandemic,
over 20 states waived or suspended CON laws relating to hospital
beds and essential services. It should not take a pandemic for
states to realize how CON laws threaten public health. It is
time to eliminate laws that harm patients and the spirit of
competition. She would be happy to share her information from
the Cato Institute and the Mercatus Center.
2:30:58 PM
RYAN MCKEE, Americans for Prosperity, Wasilla, Alaska, said that
removing CON would make it easier for new healthcare practices
to be established in Alaska and for current ones to expand. That
will create competition and drive costs down, which are so high
in Alaska. During the pandemic, part of the emergency order was
to suspend CON laws. If this was seen as a must have during the
pandemic, why bring it back postCOVID. Allowing more groups to
practice in Alaska, especially in rural Alaska, would be a
benefit to the state. CON laws only protects those already
established in Alaska from competition.
2:32:30 PM
SARAH HETEMI, representing self, Anchorage, Alaska, said that
during the COVID pandemic, many states suspended CON laws. North
Carolina first lifted CON laws on hospital beds and then 19
other states suspended a portion of their CON laws. The states
were reacting quickly to alleviate strains on medical systems to
better respond to the pandemic. Providers were allowed
flexibility to respond to the pandemic. She asked why that
flexibility is not allowed year-round for various services. The
Mercatus Center finds CON laws are associated with fewer
hospitals per capita, fewer ambulatory surgical centers per
capita, fewer rural hospitals per capita, fewer rural ambulatory
surgical centers per capita, fewer hospice care facilities,
fewer dialysis clinics, fewer hospitals offering MRI and CT
scans, longer driving distances to obtain care, and greater
racial disparities. Perhaps people were not aware of how harmful
CON laws were before the pandemic, but now they are. It would be
morally wrong not to repeal CON. It is a question of whether
people are for a better healthcare system.
2:35:15 PM
CHAIR WILSON closed public testimony. He held SB 26 in
committee.
| Document Name | Date/Time | Subjects |
|---|---|---|
| SB 26 Version B.PDF |
SHSS 3/25/2021 1:30:00 PM |
SB 26 |
| SB 26 Sponsor Statement.pdf |
SHSS 3/25/2021 1:30:00 PM |
SB 26 |
| SB 26 Sectional Analysis.pdf |
SFIN 3/16/2022 1:00:00 PM SHSS 3/25/2021 1:30:00 PM |
SB 26 |
| SB 26 Fiscal Note 1 DHSS DSS.pdf |
SHSS 3/25/2021 1:30:00 PM |
SB 26 |
| SB 26 Fiscal Note 2 DHSS Medicaid Svcs.pdf |
SHSS 3/25/2021 1:30:00 PM |
SB 26 |
| SB 26 - Updated CON Power Point - 3.25.21.pdf |
SHSS 3/25/2021 1:30:00 PM |
SB 26 |
| SB 26 ASHNHA Letter of Opposition.pdf |
SHSS 3/25/2021 1:30:00 PM |
SB 26 |
| SB 26 Heartland Institute Letter of Support.docx.pdf |
SHSS 3/25/2021 1:30:00 PM |
SB 26 |
| SB 26 Letter of Support Marty Kincaid_Redacted.pdf |
SHSS 3/25/2021 1:30:00 PM |
SB 26 |
| SB 99 version A.pdf |
SHSS 3/25/2021 1:30:00 PM |
SB 99 |
| SB 99 v. A Sponsor Statement 3.18.2021.pdf |
SHSS 3/25/2021 1:30:00 PM |
SB 99 |
| SB 99 v. A Sectional Analysis 3.18.2021.pdf |
SHSS 3/25/2021 1:30:00 PM |
SB 99 |
| SB 99 Fiscal Note DHSS DJJ.pdf |
SHSS 3/25/2021 1:30:00 PM |
SB 99 |
| SB 99 Public Comment Imbriani 3.24.21_Redacted.pdf |
SHSS 3/25/2021 1:30:00 PM |
SB 99 |