March 1, 2023
State Spotlight: Palmetto Promise Institute Works to Improve Healthcare Access in SC
Choices and options are rarely a problem. No shopper in a fully stocked grocery store has ever lamented having access to too much food. But certificate-of-need (CON) law proponents would have you believe that choices and options are dangerous.
In 35 states, CON laws have limited healthcare options for patients, increased healthcare costs, and literally cost lives. CON laws are outdated policies that protect industry insiders. This is why the Palmetto Promise Institute set out to educate South Carolinians about these protectionist laws and repeal South Carolina’s CON laws for good.
CON laws create regulatory agencies that control which businesses can open in a certain industry and how those businesses are allowed to operate. While CON laws exist in different capacities and industries in different states, they are most prevalent in the healthcare industry. According to the Mercatus Center, “In 1974, Congress passed the National Health Planning and Resources Development Act, requiring states to implement CON requirements in order to receive funding through certain federal programs. In 1986, the federal government repealed the CON mandate, and many states immediately began retiring their CON programs. […] Today, 35 states and the District of Columbia retain these restrictions.”
CON laws can control whether a new hospital can open in a certain area, the type of equipment that hospital is allowed to operate, and even the number of beds that hospital is allowed to have available for patients. According to Palmetto Promise’s Senior Fellow Oran Smith, “CON laws were intended to keep healthcare costs down so that hospitals could afford to provide a significant amount of charity care for the indigent. But that is not the case anymore. Hospitals are not providing a level of charity care equal to their tax breaks as nonprofits. And, a supermajority of peer-reviewed studies shows that CON actually raises costs, restricts access to care and does not improve quality.”
According to a report from the Americans for Prosperity Foundation, South Carolina’s CON process either delayed or ended $455 million worth of potential health care investment in the state between January 2018 and February 2021.
CON laws limit healthcare options, increase prices, and reduce healthcare quality regardless of the circumstances. But as the nation saw over the last few years, CON laws can be deadly during a pandemic. As COVID-19 was causing hospitals to be overwhelmed with sick patients, South Carolina (and numerous other states) waived many CON law restrictions for hospitals to allow them to meet demand. And as Dr. Marcelo Hochman, president of the Charleston County Medical Society, says, “A law that’s good enough to be lifted during an emergency is probably a law that should be lifted permanently.”
Every South Carolinian who’s ever needed medical care has felt the effects of South Carolina’s CON laws, but many don’t know what CON laws actually are. Palmetto Promise set out to change this through a public advocacy campaign that included news conferences, a temporary Executive Order, dedicated microsites on South Carolina’s CON laws, “Now This” style explainer videos, an infographic booklet, a white paper written with the Mercatus Center, a letter signed by the Governor, a Dear Colleague Letter, regular blog posts, paid social media campaigns, targeted “Trump Hates This SC Law” text messaging, and op-eds in the Wall Street Journal and USA Today.
The result of Palmetto Promise’s campaign was S. 290, a bill that would have repealed South Carolina’s Certificate of Need law. According to Reason Magazine, S. 290 “cleared the state Senate with a 35–6 vote in January. [But] was left to rot in a House committee and now will not receive a vote before the next legislative session, when the bill will have to start from scratch. If that bill had become law, it would have cleared the way for 28 projects that are currently tied up in legal battles despite having won preliminary CON approval, according to the Post and Courier. Another 34 projects awaiting review by the state’s Department of Health and Environmental Control would be able to proceed as well. […] Those delayed projects represent more than $1 billion in health care investment in the state.”
Even though the fight to repeal South Carolina’s CON laws will have to start over in the next legislative session, the coalition Palmetto Promise built around repealing South Carolina’s CON laws will give South Carolinians a fighting chance to have a healthcare system with better quality and more affordable options.
