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Certificate of Need is keeping veterans from having more health care options in South Carolina

Two Doctors Walking away

By Frank Bullock

In 2018, the VA MISSION Act was signed into law. This landmark legislation gave more veterans who use the Department of Veterans Affairs for health care service access to care in their own communities if the VA can’t offer quality care in a timely manner. 

While this reform was sorely needed, there is another barrier in the way of accessing care in South Carolina — Certificate of Need (CON) laws. 

Under CON laws, health service providers are required to obtain permission from the state to purchase new equipment, expand their practices, or open new facilities. These providers must prove that the services are needed by the public, and their competition gets to have a say in whether the “need” is truly there. 

There are a few problems with this.  

First, the state shouldn’t be deciding what the public “needs” for health care services. Providers should be able to offer services they believe the public will use, and the public can decide if they want to use them. 

Second, limiting growth shuts down competition among health care providers and facilities. And limiting competition might be good for the established providers and hospital systems, but it’s bad for smaller providers who want to deliver a health care service but can’t meet the CON law requirements. 

When you limit growth and competition, consumers lose accessibility and affordability. New and innovative services can’t be built because CON laws place arbitrary requirements on them, mainly for the protection of the larger players. 

Third, veterans who are now eligible for community care through the VA MISSION Act are looking for health care providers. But as mentioned above, CON laws limit the growth of new facilities and services. With more and more veterans able to leave the VA to seek care, there is a growing need for expanded care outside the VA.  

Veterans having choices over where they seek their care doesn’t help much if there aren’t enough services for them to choose from. They will be stuck with either the limited resources available or staying in the VA with long wait times and lackluster care. 

I’ve been a patient at VA hospitals, so I know what it looks like to see government limit access and innovation in health care. We don’t want to keep that kind of overreach in our private health care systems. 

Many states have already repealed their CON laws, and for good reason. In the wake of the COVID-19 pandemic, states saw just how dangerous it is to limit services and capacity. South Carolina even temporarily suspended CON restrictions at the height of the pandemic. At the time when Americans needed health care options most, there was a barrier standing in the way of them getting care. 

We should take a lesson from the last three years and create the opportunity for more health care options, not fewer as dictated by large providers that don’t want the competition. Those with urgent and unique needs in our communities are depending on available care and the competition that makes choices better and more affordable. 

South Carolina is home to nearly 400,000 veterans, with health care needs that are unique, and, in some cases, life-threatening due to their service. If we want to be a good home to the veterans already here, and a destination for veterans in the future, we need to ensure we are prepared to deliver the health care services they need. 

Hopefully our state lawmakers will finally repeal these restrictive laws and open up South Carolina’s health care options. 

Frank Bullock is strategic director for Concerned Veterans for America in South Carolina and a veteran of the United States Coast Guard.