House Unveils Certificate Of Need Repeal; Oliva Says He 'Doesn't Know Where The Bill Will End Up'

Mar 7, 2019

The Florida House is moving forward with a big healthcare agenda at the direction of Speaker Jose Oliva. But  that agenda clashes with healthcare providers who say it could lead to worse, not better care.

Tallahassee's Capital Regional hospital (undated).
Credit Tom Flanigan

House Speaker Jose Oliva likens healthcare in Florida to a “five alarm fire” and he's pinned his sights on eliminating state rules regarding where and when facilities like hospitals and nursing homes can be built.

“We must look at areas where government has gotten in the way. We must engage the consumer so that market forces can apply. And we must embrace new technologies," Oliva said during his opening day remarks to lawmakers on the first day of the 2019 legislative session. 

"That’s why we must get rid of policies like Certificate of Need, which have only served to create local and regional monopolies.” 

The legislature has whittled away at Certificate of Need for years now, and is poised to do away with it all together.

“Competition in most areas is good as long as we can make sure the public is safe," Rep. Heather Fitzenhagen, R-Fort Myers, told a House healthcare committee Thursday. She says it’s time for the system to "go the way of the dinosaur.”  

Fitzenhagen argues repeal would pave the way for the market to determine need, and would allow for more transparency when it comes to pricing and better patient care.

“Without CON there would be more beds available, more care in communities, and market forces will determine whether a hospital can exist and thrive.”  

The research on that goes both ways. the Mercatus Center at George Mason University found certificate of need laws don’t increase access to health care for the poor, but they can limit the supply of such services.  But research from the Florida State University College of Medicine found eliminating the rules could worsen the state’s shortage of doctors and nurses.  There could be more beds, but not enough people to work them.

Florida Hospital Association lobbyist David Ashburn with Greenberg Traurig adds removing those rules won’t address litigation costs—which critics have said is a problem that arises when hospitals sue each other for the right to open facilities in certain areas.

“There are things that can be done to the litigation process, because it is an administrative process, to pare that down further and reduce costs there. But elimination of the program in its entirety is not needed to address that.”   

The Florida Healthcare Association represents nursing homes.  It's chief lobbyist, Bob Asztalos says, reating nursing and hospice centers in places they aren’t needed results in an overall drop in occupancy which could end up costing the state more money than it would save.

“We’re afraid that if you eliminate the CON process and our occupancy falls, you may see unintended consequences of these market forces, where nursing homes will work to keep their beds full," he said. "Keeping nursing homes full benefits the state. So we would ask you remove nursing homes from the bill.”   

"I think almost everyone wants to be exempted from this bill," Oliva said in response to the FHCA's request for exemption.

“I think we are starting the premise that Certificates of Needs have not been helpful. This bill has to go through the process, go through the Senate and we have to have a conversation about it. I don’t know where the bill will end up. But I do know it has to end up in a place that is meaningful and prevents the monopolies we created through those policies.”

Previous attempts to eliminate certificate of need have given nursing homes a carve-out. But a complete repeal of certificate of need has historically failed to gain traction in the Senate.