Analysis: Clash of ideology on health care regulation

A clash of ideology was on display last week in the Mississippi Legislature.

Posted: Jan 28, 2018 9:15 PM

JACKSON, Miss. (AP) — A clash of ideology was on display last week in the Mississippi Legislature.

On one side were free-market conservatives who want to overturn the state's longtime system of limiting new medical facilities and services. On the other side are defenders of the current system who fear that changes could harm financially fragile parts of the state's current health care system.

The debate is over what are called certificates of need. Now, if someone wants to build a new hospital, buy an expensive piece of equipment, or offer a new medical service, they have to get approval from the state Health Department.

It was once a federal requirement that all states use such a system, aiming to create a statewide plan for a health system and cut costs by reducing duplication. But the federal government repealed its mandate in 1987, and since then 14 states have repealed their laws, according to the National Conference of State Legislatures .

Mississippi has not ended its system, despite conservative criticisms that the licensing system gets abused by existing providers seeking to prevent competition and has not reduced costs.

Some Republicans are trying to change that, though. House Medicaid Chairman Chris Brown last week sought to move House Bill 1174 to the full House. It would have removed major parts of the certificate system, no longer requiring approval before spending more than $1.5 million on medical equipment or before adding services such as heart surgery or cancer radiation treatments. It also would have removed the requirement that new outpatient surgery centers or kidney dialysis facilities get a state license.

The bill would have left the licensing requirement in place for other facilities, including hospitals and nursing homes.

"We think it will add competition into this market," Brown said. "We think it will increase access to health care and bring down the cost like it has in other states where they have a less restrictive process."

The measure would also stop tracking ownership of some facilities and no longer require state approval for a facility to be sold.

Brown asserted that the change would increase service in underserved areas, but many members of the committee scoffed at that idea. State Rep. Steve Holland, a longtime Plantersville Democrat who led Medicaid oversight when Democrats were in power, suggested that people would seek to provide more services in relatively affluent urban areas, but not in poor or rural areas.

"I think you're riding on a philosophy of freedom, which sounds good," Holland said. "Freedom does not always equal access to health care in Mississippi."

Holland also suggested that Mississippi, with a poor and rural population, might not be suited to plans that have been tried elsewhere.

"Health care and markets don't fit the typical definition of markets and free enterprise," he said.

Outpatient surgery centers have been a particular sore point. When first created, they threatened hospital revenue by providing a cheaper location for surgery that doesn't require an overnight stay. In some places, hospitals now own the surgery centers, though, and Brown said he hoped his bill would encourage more physicians to compete with hospitals.

Lawmakers already have tried to expedite the certificate of need process, with a law that took effect in 2016 mandating time limits on how long health officials could take to review and rule on an application.

Not surprisingly, though, there's a clash on whether those changes have gone far enough.

"It takes too long to get the certificate," Brown said. "It's too expensive to get the certificate."

Holland, though, saw it differently.

"It's a lot better now than it's ever been in history," he said.

Mississippi Coronavirus Cases

Data is updated nightly.

Confirmed Cases: 91935

Reported Deaths: 2780
CountyConfirmedDeaths
Hinds6903153
DeSoto532153
Harrison368771
Jackson334367
Madison318086
Rankin313473
Lee254066
Jones236078
Forrest231069
Washington215671
Lafayette203039
Lauderdale1984123
Bolivar177465
Oktibbeha173749
Lamar156633
Neshoba1524103
Panola140926
Sunflower138543
Lowndes138457
Warren136650
Leflore134380
Pontotoc120416
Pike120148
Monroe117665
Scott115925
Copiah115433
Coahoma110927
Holmes108458
Marshall106714
Grenada104535
Lincoln104453
Yazoo103429
Simpson100142
Union96524
Tate94537
Leake93535
Adams89135
Wayne87121
Pearl River84850
Marion83633
Covington79321
Prentiss78617
Alcorn75310
Newton74722
Itawamba74121
George73913
Tallahatchie73418
Winston71919
Tishomingo65035
Attala63625
Chickasaw63524
Tippah63516
Walthall58925
Clay56216
Hancock55420
Noxubee54015
Jasper53615
Clarke52538
Smith51714
Calhoun50612
Tunica47213
Montgomery45020
Claiborne44916
Lawrence42212
Yalobusha41314
Perry39016
Humphreys36915
Quitman3625
Stone34611
Greene33516
Webster32813
Jefferson Davis32211
Carroll30812
Amite30710
Wilkinson30117
Kemper28515
Sharkey25812
Jefferson2359
Benton2151
Franklin1863
Choctaw1775
Issaquena1033
Unassigned00

Alabama Coronavirus Cases

Confirmed Cases: 128818

Reported Deaths: 2284
CountyConfirmedDeaths
Jefferson18648332
Mobile12949288
Montgomery8560170
Madison736573
Tuscaloosa7015112
Lee558259
Shelby550149
Baldwin502148
Marshall376342
Etowah326344
Calhoun321139
Morgan312925
Houston260621
Elmore247547
DeKalb230119
St. Clair218134
Walker217780
Talladega199925
Limestone191919
Cullman180017
Franklin172728
Dallas172526
Russell16912
Autauga162424
Lauderdale159231
Colbert157224
Escambia154324
Blount150413
Jackson146610
Chilton143325
Dale128042
Covington127027
Coffee12388
Pike11329
Tallapoosa112483
Chambers110642
Clarke104417
Marion91428
Butler90238
Barbour8097
Marengo69319
Winston68512
Lowndes64327
Pickens62214
Bibb6179
Hale60828
Bullock58514
Randolph58512
Lawrence57620
Monroe5708
Washington54513
Geneva5404
Perry5356
Wilcox52911
Cherokee52816
Clay5187
Conecuh51611
Crenshaw51531
Macon46619
Henry4524
Sumter41719
Fayette4128
Choctaw34212
Lamar3302
Cleburne3116
Greene29915
Coosa1573
Out of AL00
Unassigned00
Tupelo
Clear
67° wxIcon
Hi: 81° Lo: 58°
Feels Like: 67°
Columbus
Clear
68° wxIcon
Hi: 83° Lo: 60°
Feels Like: 68°
Oxford
Clear
63° wxIcon
Hi: 80° Lo: 55°
Feels Like: 63°
Starkville
Clear
66° wxIcon
Hi: 80° Lo: 57°
Feels Like: 66°
WTVA Radar
WTVA Temperatures
WTVA Severe Weather