‘Everything is on the table’ as Georgia lawmakers consider lifting hospital construction limits

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by Jill Nolin, Georgia Recorder [This article first appeared in the Georgia Recorder, republished with permission]

August 2, 2023

AUGUSTA – Georgia lawmakers from the House and Senate are putting the state’s system to restrict hospital and other health care services under a microscope this summer.

Both chambers have set up study committees to examine Georgia’s certificate of need program during the legislative off-season after Lt. Gov. Burt Jones came up short in his push to ease restrictions during his first session presiding over the state Senate. 

A bill that would have exempted most rural hospitals from the certificate of need process cleared the Senate earlier this year with a 42-13 vote but stalled in the House. It remains alive for next session, which begins in January.

The obscure sounding regulatory program controls the number of health care services in a geographic area by requiring health care providers that want to open or expand to show there is a demand for more services. A rival provider can challenge an application if they are within 35 miles of the proposed project.  

Supporters of the program argue the rules help protect fragile rural hospitals from start-ups that might pop up and poach patients seeking profitable services. Critics say it’s an antiquated system that limits access to care and hasn’t stopped rural hospitals from closing their doors.

The head of the Senate panel, Cumming Republican Sen. Greg Dolezal, has said he hopes the group will end its work with “different ideas than we walked in the room with.” House Speaker Jon Burns, a Newington Republican, instructed the House committee to “follow the facts.”

As some advocates press lawmakers to repeal the program, others are pushing for fewer rules or narrow exceptions for facilities like new birth centers, greater hospital accountability rules and more funding for cash-strapped rural hospitals that could be left more vulnerable. 

“One of the simple ways to produce cash is to adopt Medicaid expansion,” Jimmy Lewis, CEO of HomeTown Health, which represents rural hospitals, said at the House panel’s meeting in Augusta Tuesday. 

“I understand all of the politics associated with it, but the simple fact of the matter is if this could pick up 500,000 people, or so, for coverage on a payer mix that is six to 10% underpaid right now, that is a major, major program to produce cash,” he said. “You say, ‘What does that have to do with CON?’ Well, this is where we get money to continue to provide the services.”

Georgia is one of 10 states that have not fully expanded Medicaid under the Affordable Care Act. This year, North Carolina passed a measure that combined Medicaid expansion with changes to its certificate of need rules.

Under Gov. Brian Kemp, the state launched a partial expansion program last month for low-income Georgians who complete 80 hours of work or qualifying activity each month to gain and keep coverage. That program could enroll as many as 100,000 people, according to a state estimate.  

Rep. Mark Newton, an Augusta Republican who is an emergency physician, said Georgia Pathways creates a new coverage option for “the working poor” and keeps others on commercial plans that pay providers at a higher rate.

“So, we’ve got some good news for all those people who are hardworking across rural Georgia,” Newton said. 

But as the state rolls out the new Medicaid coverage option, hundreds of thousands of Georgians are poised to lose their public health insurance through a nationwide unwinding of a pandemic-era rule. Last month, about 96,000 people in Georgia lost coverage. Two-thirds of them were children.

“At the same time we’re getting people covered, we’re unwinding at 100 miles an hour,” Lewis said.

Rep. Butch Parrish, a Swainsboro Republican who is leading the House panel, said after the meeting that the group is focused on absorbing all the information that comes their way, sorting through it all and putting forward what they think are the best solutions.  

“I think everything is on the table,” Parrish said to a reporter when asked about Medicaid expansion.

‘A bureaucratic nightmare’

A woman who has been blocked from opening a birth center in Augusta made the case Tuesday for more leeway for new facilities like hers.

Katie Chubb, owner and founding director of the proposed Augusta Birth Center, submitted a certificate of need application to the state Department of Community Health in the fall of 2021.

The state denied the application that December, partly because she was unable to find a local hospital that would enter into a transfer agreement with her as required under the rules.

“In a post-Roe world, now more than ever, our services are needed, and we need to help women and to give them options during childbirth,” Chubb told reporters.  

Chubb, who is represented by the Pacific Legal Foundation, has taken the state to court in hopes of having Georgia’s certificate of need program ruled unconstitutional for birthing centers.  

Federal Judge Thomas W. Thrash Jr. granted the state’s motion to dismiss the lawsuit, but Chubb appealed that decision to the U.S. Court of Appeals for the 11th Circuit, where it is still pending. 

“That should not be the only way to solve this problem,” Chubb said. “There are only three birth centers in the state of Georgia, and there should be many, many more.”

Tony West, deputy state director of Americans for Prosperity Georgia, which is a libertarian leaning group, stood with Chubb at a press conference following Tuesday’s study committee meeting.

West said Chubb and her husband have had to “navigate a bureaucratic nightmare.”

“This is a lot of human capital and financial capital that should be getting invested into our health care infrastructure, and CON keeps that from happening. That’s why we’re not calling for tinkering around the edges – the legislative body in Georgia has tinkered around the edges of CON for decades – we have to get serious about ending it altogether,” West said.

Chubb received a word of encouragement from one member of the House panel, Dr. Valerie Montgomery Rice, president and CEO of Morehouse School of Medicine.

“I think we need to look at our process, and we need to understand that ‘more’ in some situations is best. More access points, more access to quality care, more access to opportunities to be able to give women choice,” Rice said.

“So, thank you for what you’re doing. Don’t give up,” she added.

The House “modernization” panel’s next meeting is set for Sept. 12 in Albany. The Senate’s “reform” committee plans to meet next on Aug. 28 in Columbus. 

Georgia Recorder is part of States Newsroom, a network of news bureaus supported by grants and a coalition of donors as a 501c(3) public charity. Georgia Recorder maintains editorial independence. Contact Editor John McCosh for questions: info@georgiarecorder.com. Follow Georgia Recorder on Facebook and Twitter.