Make us your home page

Today’s top headlines delivered to you daily.

(View our Privacy Policy)

Florida may stop approving new hospital beds. Will that mean unequal access for rich and poor?

Sen. Rob Bradley, R-Fleming Island, says the health care industry needs competition to help fight rising costs.

Special to the Times

Sen. Rob Bradley, R-Fleming Island, says the health care industry needs competition to help fight rising costs.

TALLAHASSEE — When someone wants to build a hospital or nursing home in Florida or add beds in an existing facility, the state has to agree that their community has a need for expanded health care.

It's a regulation meant to ensure that poor and rich communities alike have equal access to hospitals, hospices and other health facilities. But at $10,000 to $50,000 per facility application, it's also costly and can lead to lengthy, and much pricier, lawsuits.

For years, Republican state lawmakers have worked to repeal the regulation — known by the three-letters CON, or certificate of need — which they say is anticompetitive and inefficient. This year, the political environment in Tallahassee may finally allow them to do so.

A proposal to gut the rules won support this week from a Florida House panel, the Senate is pushing a similar proposal and Gov. Rick Scott identified it as a top priority for the upcoming legislative session.

"We've got an outdated certificate-of-need process," Scott, a former hospital executive, said. "(Ending it) would help improve quality. It'd also control price and increase access."

The Senate shot down a repeal effort last year, but dramatic turnover has improved its prospects. Of the chamber's 40 members, 20 are new this year, and many voted to repeal CON as House members last year.

While pro-repeal Republicans argue the rules limit competition, they face opposition from influential health care interests, which have a foothold in virtually every legislative district in the state.

Hospitals and nursing homes say ending limits on the number of beds they can build in a particular area could make it harder for patients in poor or rural areas to find good-quality care. Their doomsday scenario: Without having to ask the state for permission to build, companies would be drawn to wealthier areas where more of the patients have private insurance plans that pay hospitals more than Medicaid.

"Repealing CON could create a two-tiered health system in Florida," said Clint Shouppe, a lobbyist who represents BayCare Health System. "One for patients with good-quality insurance and one for Medicaid and charity care patients."

Hospitals offset the costs of charity care patients and low Medicaid rates with patients who have private insurance. And Shouppe said he worries new hospitals could open intending to treat only those whose health plans can pay full price.

They have another motivation: Forcing new hospitals to go through a lengthy approval process with the state helps to limit competition. And Sen. Rob Bradley, R-Fleming Island, who is sponsoring the Senate proposal, says competition is exactly what the health care industry needs to fight rising costs.

"You have to be prepared for a new day in health care," Bradley said. "We can be a leader in free-market approaches to health care delivery. An important part of that is making sure that if a market can support competition, that we don't have unnecessary regulations in place to prevent that competition."

Florida is not the first state to consider ending CON, which dates back to a federal law that has since been repealed. In all, 13 states have taken the regulations off their books.

In hospitals, the effect has been minor. States with the restrictions have just 13 percent fewer hospital beds than those without the restrictions.

Bradley and House sponsor Rep. Alex Miller, R-Sarasota, say extra licensing requirements in their bill help mitigate concerns that quality would decrease.

But nursing homes and hospices have presented more of a challenge in other states. Operators of Florida homes fear that an explosion of new facilities could lead to unfilled beds and not enough money to provide quality care.

Each unfilled bed means lost revenue. And lost revenue, according to the Florida Health Care Association, leads to deteriorating and understaffed facilities, especially those that serve Medicare and Medicaid patients for whom the homes' payouts are much lower.

In 2015, Indiana state lawmakers were forced to pass a moratorium on new nursing home construction after too many facilities opened in the wake of that state repealing its CON laws.

Even some Republicans who support repealing regulations have expressed concerns that nursing homes could cause a problem.

"I believe what we have here is a bill that is very well intended and will work indeed for hospitals, but it doesn't appear to me that there is any evidence in record that it will work for nursing homes or hospices," said Rep. Shawn Harrison, R-Tampa. "We need to be very careful with how we deal with our most elderly and frail."

Times/Herald staff writer Jeremy Wallace contributed to this report. Contact Michael Auslen at [email protected] Follow @MichaelAuslen.

Florida may stop approving new hospital beds. Will that mean unequal access for rich and poor? 02/15/17 [Last modified: Friday, February 17, 2017 7:59pm]
Photo reprints | Article reprints

© 2017 Tampa Bay Times


Join the discussion: Click to view comments, add yours

  1. Tampa Bay small businesses give Tampa B+ for regulatory climate


    In a recent survey about small business sentiments toward state and local government policies that affect them, Tampa Bay ranked at No. 25 out of 80 — a B+ overall.

    Tampa Bay ranked No. 25 out of 80 in a recent survey about how small business owners feel about state and local government policies that affect them. | [Times file photo]
  2. Dirk Koetter to Bucs: Take your complaints to someone who can help


    TAMPA — It was just another day of aching bellies at One Save Face.

    Dirk Koetter: “All of our issues are self-inflicted right now.”
  3. Seminole Heights murders: fear and warnings, but no answers


    TAMPA — Interim Tampa police Chief Brian Dugan elicited loud gasps from the crowd of about 400 who showed up at Edison Elementary School on Monday night to learn more about the string of unsolved killings that have left the southeast Seminole Heights neighborhood gripped by fear.

    Kimberly Overman, left, comforts Angelique Dupree, center, as she spoke about the death of her nephew Benjamin Mitchell, 22, last week in Seminole Heights. The Tampa Police Department held a town hall meeting Monday night where concerned residents hoped to learn more about the investigation into the three shooting deaths over 11 days in southeast Seminole Heights. But police could give the crowd at Edison Elementary School few answers. [OCTAVIO JONES   |   Times]
  4. Juvenile justice reform seen as help for teen car theft problem


    ST. PETERSBURG — One of Tampa Bay's largest religious organizations has decided to make reforming the juvenile justice system one of its top priorities for next year.

    One of Tampa Bay's largest religious organizations, Faith & Action for Strength Together (FAST), voted Monday night to make reforming the juvenile justice system one of its top priorities for next year. FAST believes civil citations could help Pinellas County?€™s teen car theft epidemic by keeping children out of the juvenile justice system for minor offenses. [ZACHARY T. SAMPSON  |  Times]
  5. U.S. general lays out Niger attack details; questions remain (w/video)


    WASHINGTON — The U.S. Special Forces unit ambushed by Islamic militants in Niger didn't call for help until an hour into their first contact with the enemy, the top U.S. general said Monday, as he tried to clear up some of the murky details of the assault that killed four American troops and has triggered a nasty …

    Gen. Joseph Dunford said much is still unclear about the ambush.