South Carolina’s certificate-of-need laws are costing lives. It’s time we repealed them


Every South Carolinian wants quality, affordable health care, available when we need it. Our laws, both state and federal, are getting in the way of that goal.

In Washington, the Affordable Care Act’s effective ban on the expansion of physician-owned hospitals stifles competition and keeps costs higher for patients.

In South Carolina, our state’s certificate-of-need law does the same thing, by requiring providers to seek government approval to build new facilities or expand existing ones. It’s a process fraught with cronyism, in which a provider’s own competitors can block new services from coming online.

These laws are costing people their lives. Both need to be repealed.

We urge every member of the South Carolina congressional delegation to sign up as cosponsors and work to pass H.R. 1330, the Patient Access to Higher Quality Health Care Act, which would repeal provisions of Obamacare that limit, for purposes of Medicare participation, self-referrals for new or expanded physician-owned hospitals. Because Medicare is such a huge chunk of business for hospitals, the provision effectively banned the creation of new physician-owned hospitals.

Repeal would mean more facilities would be built and expanded, increasing the availability of care. This is absolutely crucial for underserved areas, which encompass most of the Palmetto State.

There is no logic in limiting the number of hospitals, physician-owned or otherwise. Supporters of the ban argued that more physician-owned hospitals would mean higher costs and needless procedures. But research shows no significant difference in cost or quality of care among physician-owned, nonprofit, and for-profit hospitals.

The limits on physician-owned hospitals were largely the handiwork of hospital companies that wanted to stifle competition.

It worked, unfortunately. Competition was stifled, resilience was weakened, and when the COVID-19 pandemic hit, Americans paid the price.

By passing H.R. 1330, Congress would enhance the resilience of health care markets and save lives in the process.

By repealing South Carolina’s CON law, the legislature would be ridding the state of similarly anti-competitive policies that restrict access to care.

Studies show these laws degrade quality and affordability. So does real-world experience.

States that suspended CON laws during the pandemic experienced lower death rates than states that did not. A Mercatus Center study estimated that, without CON, South Carolina would suffer 5.1 percent fewer deaths as a result of post-surgery complications. Mercatus also found that South Carolina residents would have access to 34 additional hospitals if the CON law was repealed, as well as a host of other facilities.

When the pandemic struck, Gov. Henry McMaster suspended parts of South Carolina’s CON law to help providers better deal with the rush of patients. This happened across the country in the 35 states that still have CON laws.

That’s not an academic study or a theory. Leaders knew they had to work around these laws to get people the care they needed.

Instead of working around them the next time we’re faced with a health care crisis, we should get rid of them now.

Doctors and other health care providers shouldn’t have to go to federal or state regulators begging for permission to better treat patients.

Lawyers are allowed to own law firms and bankers are allowed to own banks. But physicians are functionally prevented from owning hospitals by a law lobbied for by, no surprise, hospital companies.

Those same companies work at the state level to limit competition by using certificate-of-need laws to block competitors from entering the market.

These laws force patients to pay more for lower quality care and puts lives at risk by limiting ready access to needed care. And they limit our ability to be better prepared the next time we’re faced with a deadly pandemic.

Pass H.R. 1330 to end the effective ban on physician-owned hospitals. Repeal South Carolina’s certificate-of-need law to allow health care innovators and entrepreneurs to expand access to care.

Candace Carroll is the State Director of Americans For Prosperity – South Carolina. U.S. Congressman Ralph Norman represents South Carolina’s Fifth Congressional District.