Under pressure from anti-regulatory Republicans, lawmakers in several states have introduced legislation to overhaul or repeal healthcare certificate-of-need programs.
For example, a budget proposal in New York would eliminate funding for the state's health systems agencies, saving $5 million annually. New York's eight HSAs conduct health planning activities, including CON review.
The shift of power to Republicans in state legislatures and governorships has noticeably affected the kinds of legislation being proposed, observers said. Yet it's doubtful that many of the measures will be adopted this legislative session.
While acknowledging that there is a more conservative influence on CON laws, it hasn't been overwhelming, said Thomas R. Piper, director of Missouri's CON program and a member of the board of the American Health Planning Association in Washington. Some 40 states still have CON laws in one form or another, he noted.
"Certificate of need, for better, for worse, is on the books, and it's easier to modify what exists than to start over," Piper added.
Once the states start studying CON laws, they find "it's not the best method, but it does help reduce costs," said Helen S. Leeds, a research associate with the Intergovernmental Health Policy Project in Washington.
No count of the number of bills dealing specifically with repeal or overhaul was available.
New Jersey is one state that has proposed an overhaul of CON law. The state Department of Health's proposal seeks to ease red tape and speed up the CON review process. The state Senate Health Committee was scheduled to hold an informational hearing on the proposal late last week.
But because some providers are not subject to CON review, the New Jersey Hospital Association is recommending that CON be eliminated, except for proposals to add adult inpatient beds.
In Pennsylvania, a member of the House Health and Welfare Committee has introduced a bill to phase out the state's certificate-of-need process effective July 1.
Repealing the CON law would benefit consumers and providers through lower costs and potentially better healthcare, said Rep. Jere L. Strittmatter (R-Lancaster County), sponsor of the phase-out bill. Currently, it costs the state $575,000 a year to fund the division that conducts CON reviews.
Although Pennsylvania Gov. Tom Ridge hasn't specifically endorsed repeal, his fiscal 1996 budget calls for eliminating funding for the state board that hears appeals of certificate-of-need and licensure decisions.
At a recent public hearing, Scott A. Becker, president of Butler (Pa.) Memorial Hospital and chairman of the Hospital Association of Pennsylvania's planning and healthcare data committee, recommended that the state proceed with a mandated review and evaluation of CON. HAP believes sufficient data have not been presented to demonstrate the need for immediate repeal, he said.
But an executive of Lancaster (Pa.) General Hospital testified in support of repeal, saying the current process remains restrictive, requires long lead times and increases the cost of healthcare services.
Despite the CON law, St. Joseph's Hospital in Lancaster, just eight blocks from Lancaster General, received CON approval to perform open-heart surgery, Strittmatter noted. Lancaster General is a major provider of the procedure and ranks well in the state's report on cost and quality.