Georgia lawmakers are once again looking into the laws that govern the opening and expansion of hospitals and other medical facilities in state, as access to health care continues to be a cause for concern among Georgians.
At a Senate study committee hearing on state laws governing hospital expansion Tuesday, lawmakers and advocates discussed the effectiveness of the existing laws.
Before health care providers can build a new hospital or expand health care facilities, they must undergo a state approval process by filing a “certificate of need” with the state. Currently, Georgia is one of 35 states that have CON programs.
In neighboring South Carolina, state officials voted to repeal certificates of need last month, saying the program increased health care costs and decreased quality of care. Changes in Georgia could soon follow.
“What we’re doing here is just that we’re sitting at the table trying to make decisions. We know that [CON] is going to be tweaked or changed, abandoned. I am here to make sure that there’s access and quality care for my district,” said Sen. Freddie Powell Sims, a Democrat from Dawson. “That’s my biggest concern. Metropolitan areas don’t suffer nearly as much as the rural parts of the state.”
In the last legislative session, lawmakers lined up to rally for and against Senate Bill 99, which would have allowed the construction of new hospitals in counties with fewer than 50,000 residents without a certificate of need from state regulators.
Proponents of the decades-old program say the regulatory process helps rein in rampant medical spending and prevents hiring wars between rival hospitals in small communities.
But opponents of the law have called it outdated, saying it helps preserve the dominance of powerful hospitals. Removing the certificate requirement, they say, could pave the way for more accessible health care in rural areas.
Lt. Gov. Burt Jones, a newly elected Republican, made the overhaul a priority in this year’s legislative session, saying it would help provide “quality health care” for underserved communities. But his family business could also directly benefit from the proposal, sparking concerns of a conflict of interest.
During Tuesday’s hearing, witnesses argued that CON laws do not support rural hospitals. They also suggested that the laws create monopolies by making it difficult for competitors to open new hospitals.
There is a increasing nationwide trend of rural hospitals closures. Over a span of 10 years, from 2012-22, at least eight rural hospitals in the state were shuttered. In Georgia, 120 of the state’s 159 counties are considered rural.
Experts are also finding that CON laws are not necessarily meeting the objectives they were created for and that there are mixed outcomes when it comes to quality of care. The federal government passed CON laws in 1974 to contain health care costs, but later repealed the law. Around the nation, 35 states have maintained a state CON law, including Georgia.
“It turns out that states with CON laws have less patient access to medical care and lower quality of medical services,” said Dr. Thomas Stratmann, a professor of economics and law at George Mason University. “The effectiveness of CON laws could be measured by their outcomes, not by their intended outcomes.”
Stratmann co-authored “Certificate-of-Need Laws: Implications for Georgia” a study on CON laws in Georgia. During the hearing he asserted that the repeal of CON laws in Georgia might lead to the opening of additional rural hospitals.
“We need to open up access. Whatever that looks like,” said Victor Maldovan, a health care attorney based in Atlanta that works with providers in Georgia. “If you seed the field, you’ll get more primary care doctors. You’ll get more ambulatory surgery centers, imaging centers, whatever it might be if you remove barriers to access.
Lawmakers said that three additional committee meetings will happen by the end of the year. For two of those meetings officials will go into communities to hear from constituents and the final hearing will happen at the Capitol.
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