The Senate is moving forward with certificate of need repeal. But some call the move a dramatic shift that reneges on weeks of work. The plan to scrap hospital regulations points to a bigger picture about the legislative process.
Certificate of need regulations require hospitals and nursing homes to get state approval before opening new locations or expanding services. It’s intended to keep health care facilities from flooding the market.
But Republican lawmakers have chipped away at CON for years. They argue opening up the market will bring down costs. And House Speaker Jose Oliva (R-Hialeah) has made a full repeal a top priority.
“That is why we must get rid of policies like the certificate of need, which have only served to create local and regional monopolies,” Oliva said during his opening remarks of the legislative session.
The Senate, however, has not been as eager. Lawmakers spent weeks carefully crafting legislation, trying to ease the impact for hospitals that would potentially face much more competition.
The measure would have only applied to hospitals, not specialty health care centers. new hospitals would be forced to accept Medicaid and Medicare, have at least 100 beds in addition to the emergency room and provide charity care.
But an amendment in the Appropriations Committee brings the Senate language much closer to the House’s. It fully repeals certificate of need in two years and scraps provisions such as the Medicaid and Medicare requirements.
"This is much more similar to the House proposal, although we do have very specific delays in implementation," said Sen. Gayle Harrell (R-Stuart), the bill's sponsor. "Theirs is a total out-and-out repeal of CON.”
The flip-flop left many lawmakers on the Senate Appropriations Committee stunned.
“You’ve taken all that work – all the protections, all of the nuances that we worked hard to craft that gentle balance of a bill that I thought was a very positive bill, and we have really just thrown that away," said Sen. Aaron Bean (R-Fernandina Beach). "So my first question is: what happened?”
Harrell sidestepped questions as she pushed through a measure that would make sweeping changes to the state’s health care system. The measure delays CON repeal for two years, which would give lawmakers time to refine issues raised, Harrell said.
That left the panel divided. Some, like Sen. Rob Bradley (R-Fleming Island), welcomes the changes. Bradley says current law restricts health care access.
“There’s an entity that wants to build a hospital literally a mile from my house," said Bradley. "And because the laws being what they are, and their competition litigating it and arguing against it, that hospital’s not going to be built.”
Meanwhile, Sen. Tom Lee (R-Brandon), who voted for the bill, lambasted his colleagues for making what he calls a “mockery of the entire committee process.”
“I tell you, I apologize to people who might be surprised I voted for that amendment, but I knew it was going to pass," said Lee. "I knew this committee had been worked, and I knew the votes were there.”
The shift may be a bargaining chip. Senate President Bill Galvano (R-Bradenton) is championing a major infrastructure package. But that effort has struggled to pick up momentum in the House.
Lee said he doesn't have many issues with the content of the bill, "but I have to say the process stinks to high heaven.”
Harrell dodged the implications, but offered little explanation for the new language. She admits she doesn’t know how the bill will affect the industry. But she wants the legislature's Office of Program Policy Analysis and Government Accountability to conduct a study.
Bean says he knows what will happen. He thinks smaller, specialty hospitals will profit at the expense of rural and inner-city hospitals that provide the bulk of charity care.
“Your previous bill protected them," said Bean. "Your previous bill protected the taxpayers from having a hospital in every neighborhood that fills up with Medicaid patients that we are on the hook for.”
The measure is now ready for a floor vote. The House’s version has already been approved.