Last month I had the opportunity to go back to my alma mater, Saint Louis University, and share with a crowd of medical students my thoughts on the future of health care in this country. We had a great conversation about where we’ve been when it comes to care provision, the failures of the system, and where we ought to go, but what I emphasized again and again was the importance of expanding health care supply. That can happen in a lot of ways, including through the reformation of licensing, scope of practice, and insurance laws. But I also emphasized the importance of a supply reform I view as low-hanging fruit for legislators—abolishing Certificate of Need (CON) laws for Missouri hospitals.
CON laws create barriers to opening all sorts of medical facilities without undue interference, supposedly to protect health care access. The research says these laws do the opposite, which is why support has grown for their repeal nationwide. But in contrast to previous sessions, it doesn’t seem that there’s legislation moving to the forefront yet that would unwind Missouri’s CON law. Frankly, that’s mystifying.
Over the last few years we have talked a great deal about the importance of CON reforms. We even included it as an item in our Blueprint. But apart from our work on the subject, the potential impact of CON reform on patient care is made clear by events taking place right now in the Kansas City area. Kansas doesn’t have a certificate of need law; Missouri does. Unsurprisingly, and as reported by the Kansas City Star, a network of microhospitals is sprouting up all over the Kansas side of the metro area. And as the Star notes, the same sort of innovations aren’t happening in Missouri.
But the law cannot change unless there is legislation to change it and champions to see it through. There is still time for bills that can expand the supply of health care facilities, of physicians, of care, and all the rest. That said, time is running out. If CON reform is going to get done, it needs legislative champions. It remains an open question who those will be in 2017.
