The Hospital Lobby is Killing Free Market Reforms and Medicaid Expansion

September 19, 2022

Greed is a terrible thing.  But have you ever wondered why you have to wait weeks or months to get an appointment for a medical procedure in North Carolina? Or why there aren’t enough in-patient drug treatment beds to treat victims of the opioid epidemic in our state?  Or why certain kinds of medical treatments like kidney dialysis or certain imaging services aren’t available at all in your community?

The short answer is greed delivered in the form of a “Certificate of Need,” an archaic government-granted monopoly on services to certain hospital systems in the state.

These government-granted monopolies are licenses to print money. The North Carolina Healthcare Association and its member hospitals don’t intend to reform this lucrative system that enriches them and their executives without a fight – even if it means denying hundreds of thousands of North Carolinians access to healthcare and limiting access to quality healthcare to hundreds of thousands more.

That background helps explain the North Carolina Healthcare Association’s utterly unserious, late Friday afternoon PR gambit masquerading as “negotiating.”

For most of this year, the N.C. Healthcare Association tried to forbid any of their members from even speaking to senators about a compromise. Under fire from both Senate Leader Phil Berger and Gov. Roy Cooper, the hospital lobby last week finally relented and submitted an “offer” for compromise.

We’re told that at the same time the association was presenting its “offer” to Senate leadership, the group told every reporter in the state about it. That’s not a negotiation or an offer – it’s a PR stunt to try to deflect heat for killing Medicaid expansion.

A foolproof way to discern whether a negotiating move is a serious attempt at compromise or an unserious, face-saving PR maneuver is to see how long it takes for reporters to learn about it.

The greatest legislative accomplishments in the past few years have all been negotiated in good faith largely out of public view (e.g., the 2021 landmark energy deal; the 2021 budget deal). The greatest failures in the past few years have been “negotiated” through the press (e.g., the 2019 budget stalemate).

As for the substance of the offer, it’s about as unserious as the manner in which they presented it. It includes a laundry list of prerequisites that any hospital competitors must meet before they’re allowed to serve North Carolinians in need of care. The list is so long it will probably disqualify any hospital competitors from opening up shop – which is precisely what existing certificate of need laws do right now.

The group needs to either get serious about negotiating, find new leadership, or disband.