Op-Ed: COVID-19 Necessitates Review of Certificate-of-Need Laws
In this piece originally published in Morgantown’s Dominion Post, Cardinal’s communications associate, Amanda Kieffer, argues that the COVID-19 crisis means that West Virginia must take a hard look at its certificate-of-need laws which often restrict the ability of the healthcare profession to serve its community. This is especially true during a crisis in which a “all hands on deck” response is required. Amanda’s piece can be found here and below:
Suffering severe pain and bleeding triggered by premature labor at 24 weeks, a pregnant woman sought medical care at the nearest facility: LewisGale Medical Center in Salem, Virginia. Her medical emergency, potentially deadly for both mother and child, required the highest level of care as quickly as possible.
Thankfully, the doctors and nurses were able to save the mother’s life. Unfortunately, they couldn’t save her baby because they did not have the neo-natal intensive care unit (NICU) they needed.
This is because, just six months before, the center’s Certificate of Need application to build an eight-bed NICU had been rejected by the Virginia’s health commissioner because the unit “wasn’t needed.” This Certificate of Need law, requiring medical providers to seek the government’s permission before expanding or offering new services, cost the life of a child.
There’s a saying in the Mountain State – “West Virginia is the BEST Virginia.” But, when it comes to such laws, we’re no better than Virginia. In fact, we’re worse – we have MORE Certificate of Need (CON) laws restricting medical providers from expanding healthcare services than Virginia does (21 specific regulations).
Certificate of Need laws were passed in the 70s and 80s by lawmakers claiming they would ensure an adequate supply of health resources, guarantee access to care for rural communities, increase the quality of care, and keep costs down.
However, experience and 40 years of research have shown these claims to be false. In fact, CON laws often do the opposite of what they were intended to do and hit the poor and those living in rural areas the hardest.
Rather than guaranteeing access to healthcare in rural states, like West Virginia, CON laws decrease access to hospitals and other forms of medical treatment. One 2016 study found that states with CON laws had 30 percent fewer hospitals per capita than those that didn’t.
In West Virginia alone, a 2015 study from the Mercatus Center at George Mason University estimated that CON laws have negatively impacted the supply of healthcare resulting in “2,424 fewer hospital beds, between 4 and 7 fewer hospitals offering MRI services, and between 13 and 16 fewer hospitals offering computed tomography (CT) scans.”
In addition to limiting access to healthcare in rural communities, Certificate of Need laws do not decrease prices. A joint report from the Federal Trade Commission and the Department of Justice found that “CON laws raise considerable competitive concerns and generally do not appear to have achieved their intended benefits for health care consumers.” Another study in the Journal of Industrial Economics found that nursing home-specific CON laws raised private-pay prices. In 2017, an audit found that West Virginia’s healthcare costs are actually increasing faster than the national average despite CON law advocates saying they would decrease costs.
The idea that CON laws improve quality of care is also unsubstantiated by the research. A 2016 study has shown that states with CON laws have higher mortality rates, particularly in cases of treatable post-surgery complications. This study also found that “mortality rates for pneumonia, heart failure, and heart attacks are significantly higher in hospitals in CON states relative to those in non-CON states.”
The COVID-19 crisis has further exacerbated the costs of CON laws and their artificial restriction of healthcare services.
We’re already seeing article after article after article every day warning of a nationwide shortage of hospital beds. But West Virginia shouldn’t wait for shocking headlines to prevent deaths caused by Certificate of Need laws.
Other states are realizing that Certificate of Need laws do more harm than good. Recently, Florida repealed most of their Certificate of Need laws. As a result, they’re already seeing healthcare providers make plans to build more facilities in their communities.
Earlier this week, the Cardinal Institute for WV Policy sent a letter to Governor Justice urging him to immediately and indefinitely suspend Certificate of Need laws in response to the COVID-19 crisis facing West Virginia.
This temporary measure to aid in the fight against COVID-19 should become permanent. It’s time for West Virginia to be a leader and put the health of its citizens first. West Virginia should repeal its Certificate of Need laws to protect and provide for the needs of its most vulnerable citizens.
Amanda Kieffer is the Communications Associate for the Cardinal Institute for West Virginia Policy.