South Carolina senators on Wednesday started what will likely be a debate over several days about whether to get rid of a state law that requires hospitals and other medical clinics to get permission to expand or buy most major medical equipment.
The original goal of the Certificate of Need programwas to make sure medical care was spread around the state and not concentrated in major cities. It also sought to ensure hospitals didn't end up in overspending because of competition.
But supporters of a bill to end the program said those kinds of limits aren't needed in a world where huge heath care companies work together to use the rules to muscle out competition. They said those large conglomerates have the money to take risks on new heart centers or cancer treatment facilities or entire hospitals without going bankrupt.
“The systems know this game and they play it well. They will often block each other and horse trade," said Dr. Robert Brown, an ear, nose and throat specialist in Greenville who is part of an independent practice. “The small businesses like mine who pay taxes are unable to actually play in that sandbox. If we'll get tied up in court, we won’t risk the investment."
Brown spoke at a news conference just before the Senate session started Wednesday. Senators voted the day before to make the bill a priority for debate before any other contested bill every day until it is resolved.
“It's good that we've carved out this time at the beginning for this very important issue," said Sen. Tom Davis, a Republican from Beaufort who spent more than an hour explaining the bill and answering questions.
The law requires permission from the state Department of Health and Environmental Control to build or expand hospitals or to buy expensive equipment like MRI machines. Supporters, including hospital systems across the state, said the rules save money by avoiding costly duplication of services, encourage health care to locate or stay in rural areas and assures care offered is the highest quality.
Several senators asked skeptical questions. Sen. Nikki Setzler, a Democrat from West Columbia, said he could not support the bill without assurances that strict licensing requirements where needed replace certificates of need.
Democratic Sen. John Scott of Columbia asked if this was the time to disrupt health care in the middle of the COVID-19 pandemic.
“We might be going a little too fast. We might not have enough data to look at, especially after the past 24 months," Scott said.
The program nearly died in 2013 when then-Gov. Nikki Haley vetoed from the state budget the $2 million officials used to run the program. Hospitals sued, saying lawmakers never voted to end the program, and the state Supreme Court ruled in 2014 that it should continue.
There were efforts to end the program over the next few years, but they never made it to the House or Senate floor.