Senators opposing North Carolina’s onerous certificate-of-need laws have no plans to stop pushing reforms.
“I am still committed to CON reform, and we will make it happen,” Sen. Joyce Krawiec, R-Forsyth, told Carolina Journal on Friday, June 21. “We look forward to continue our work with stakeholders to improve the process.”
Krawiec on Thursday said she planned to strip CON provisions from Senate Bill 361, the Health Care Improvement Act of 2019, before a floor vote, which was scheduled for Monday. CON repeal, which divides lawmakers during annual debates, had its detractors in the Senate Rules Committee. It passed after Krawiec said she would remove the provisions.
Other primary sponsors of the bill are Sens. Dan Bishop, R-Mecklenburg, and Ralph Hise, R-Mitchell.
CON changes could happen without going through the legislative process.
“Some CON reforms are contained within the budget,” said Krawiec, chairwoman of the Senate Health Care and Appropriations on Health and Human Services committees.
When the Senate released its budget in late May it included provisions to exempt ambulatory surgery facilities, operating rooms, kidney treatment centers, psychiatric hospitals, and other mental health facilities from regulations requiring state approval to open.
The House budget did not include CON language. That chamber is traditionally less receptive to changing the status quo, although a bipartisan group of members introduced House Bill 857 to whittle away some CON laws. It failed to gain momentum.
House and Senate budget negotiators were still working to finalize a compromise budget through the weekend. There is speculation a spending plan could be released Monday. Whether the Senate CON items survive is uncertain, and they still face Gov. Roy Cooper’s scrutiny as part of his budget approval.
A Senate source told Carolina Journal that Senate budget negotiators are in unison on keeping CON reform in the budget, but House budget chairmen are divided on the issue.
Hise, the Senate’s third-highest-ranking officer and chairman of the Finance Committee, sponsors CON repeal annually. He is not giving up hope.
“We’re taking extra time to make sure that we get meaningful CON reform passed this session,” Hise said.
When S.B. 361 was first introduced in March, it called for full repeal of all CON laws, but was scaled down before Krawiec agreed Thursday to pull the language altogether. Bishop said during the bill introduction CON regulations were obsolete and ineffective in meeting their original goal of controlling health care costs.
“In practice, CON laws put government control ahead of patients and doctors, handcuffed health-care providers from offering care in their communities, increased health care costs by stifling competition, undermined the doctor-patient relationship, and added anxiety about the quality of care to those who were most vulnerable,” Bishop said. He also is a chairman of the Senate Health Care and Appropriations on Health and Human Services committees
Hospitals steadfastly resist CON changes. They argue health care is a regulated market, and overlaying competitive free-market revisions would harm them financially. They say hospitals must treat all patients regardless of ability to pay, and standalone clinics wouldn’t have that obligation. Hospitals say competitors would siphon off services they rely on to survive, especially harming rural hospitals.
A request for comments from the N.C. Healthcare Association that represents hospitals and large health systems was not successful.