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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 But the federal government repealed its mandate in 1987, and since then 14 states have repealed their laws, according to the National Conference of State Legislatures .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: 13260

Reported Deaths: 625
CountyConfirmedDeaths
Hinds89324
Lauderdale67855
Madison65421
Scott58910
Neshoba51231
Forrest48034
Jones46713
DeSoto4616
Leake38410
Holmes36523
Rankin3496
Jackson29613
Copiah2784
Attala27014
Lincoln24320
Monroe24224
Leflore24025
Harrison2346
Newton2243
Lamar2194
Yazoo2152
Pearl River20327
Pike19611
Adams18615
Lowndes1607
Noxubee1586
Washington1535
Warren1506
Bolivar14010
Jasper1393
Oktibbeha13410
Smith13110
Covington1271
Chickasaw12612
Clarke12616
Kemper12510
Lafayette1233
Carroll11310
Wayne1090
Marion1088
Lee1045
Clay993
Winston981
Coahoma983
Lawrence901
Hancock8711
Simpson850
Itawamba857
Yalobusha824
Wilkinson829
Montgomery781
Sunflower773
Grenada752
Jefferson Davis712
Union715
Tippah7011
Marshall693
Panola622
Calhoun604
Tate591
Claiborne581
Humphreys537
Amite521
Walthall510
Tunica483
Perry462
Jefferson400
Prentiss383
Stone300
Choctaw292
Webster271
Pontotoc263
Franklin252
Tishomingo250
Quitman240
Tallahatchie241
George191
Alcorn151
Benton140
Greene71
Sharkey70
Unassigned00

Alabama Coronavirus Cases

Confirmed Cases: 14478

Reported Deaths: 551
CountyConfirmedDeaths
Mobile1996109
Jefferson161488
Montgomery118630
Marshall6499
Tuscaloosa50512
Lee49832
Franklin4476
Shelby43319
Tallapoosa39662
Butler34411
Chambers33623
Madison2964
Baldwin2749
Elmore2637
Etowah23610
DeKalb2213
Coffee2001
Walker1981
Dallas1973
Sumter1916
Lowndes18610
Houston1644
Morgan1621
Autauga1593
Calhoun1413
Choctaw1414
Pike1360
Colbert1362
Marengo1336
Hale1293
Russell1280
Lauderdale1282
Randolph1257
Wilcox1187
Marion11310
Bullock1111
Barbour1101
Clarke1022
St. Clair1021
Pickens934
Talladega912
Greene894
Chilton871
Dale830
Cullman760
Limestone740
Jackson692
Covington651
Washington645
Winston620
Macon602
Bibb591
Crenshaw582
Henry562
Blount491
Escambia433
Lawrence420
Coosa331
Geneva330
Cherokee332
Perry310
Monroe282
Clay272
Conecuh251
Lamar200
Cleburne131
Fayette110
Unassigned00
Tupelo
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