Teaching Race North Carolina

North Carolina Senate Leader Phil Berger, R-Rockingham, speaks at a news conference Wednesday, July 14, 2021, in the Legislative Building in Raleigh, N.C.

(The Center Square) — North Carolina Senate Leader Phil Berger believes a recent proposal from the North Carolina Healthcare Association to amend the state's certificate of need laws is more about optics than real reform.

The NCHA, which has traditionally opposed certificate of need reforms, sent a proposal to state lawmakers and Gov. Roy Cooper over the weekend that offered to support repeal of CON laws on ambulatory surgery centers, psychiatric inpatient beds, and chemical dependency beds, in exchange for legislators approving Medicaid expansion.

The Senate last session approved Medicaid expansion as part of a health care package that also included broader CON reforms, as well as approval for nurses to practice at the full scope of their training without physician oversight. The legislation did not gain approval in the House, which opted instead to study the issue further.

"As far as the hospitals' press initiative from the other day, if you look at the substance of their proposal and the way it was released, it looked to me like it was more to deal with public relations than a substantive or serious proposal to get something worked out," Berger, R-Rockingham, told reporters Tuesday, according to The Carolina Journal.

Berger suggested details of the NCHA proposal that would require ambulatory surgical centers to contain three specialties is evidence the state's health care industry is more interested in protecting its control over the system than improving the situation for residents.

"If you look at their proposal on ambulatory surgical centers, the only actors in healthcare who would be in a position to open such a surgical center are the hospitals," he said. "It looks to me like it's more designed to further entrench the monopolies that hospitals have. Ambulatory surgical centers in other states are, in many respects, orthopedic centers, or ears, nose, and throat centers, or eye centers."

Berger told reporters he hasn't spoken with House leaders, but doesn't plan to negotiate in the press over the proposal because hospital officials, the governor and others involved in talks know the Senate's position on CON reform, pointing to legislation passed by the Senate last session.

North Carolina CON laws are among the most restrictive in the country and disproportionately harm rural hospitals. The regulations — which mandate state approval of new health care facilities, expansions, technological advancements for procedures, in-patient beds, and other services — increase costs for patients while reducing the quality of care according to some studies.

Data from the Kaiser Family Foundation shows health care costs are 11% higher in the country's 35 CON states compared to those without the laws, while a study by the Mercatus Center at George Mason University shows mortality rates are 5.5% higher in CON states versus non-CON states.

The research suggests North Carolina's health care costs could drop by $213 per person if lawmakers repeal the state's CON laws permanently, a move that could also lead to as many as 55 more hospitals and 14 more ambulatory surgical centers.

"These laws are a perfect example of the 'unintended consequences' of centralized planning by government. The free market is the only way to accurately determine need in the marketplace, the government nor any state board can accurately do that," The Heartland Institute's Christina Herrin wrote in an op-ed published by The Center Square. "The best way to cut costs and provide better access to quality health care would be to remove regulations that limit competition. CON laws are an antiquated policy that negatively affect the most vulnerable in our society."

Berger told reporters Tuesday Medicaid expansion remains a priority for Republicans, but stressed the focus must also include ways "to increase access to care by making sure there are more facilities available for (thousands) of people," the Journal reports.

"We already have folks who have to wait days and weeks to get an MRI, appointment for a surgeon or medical provider," Berger said.