The repeal of Kentucky’s certificate-of-need is an idea whose time has come
Politics is based on the exchange of ideas. So, there’s nothing more powerful than an idea whose time has come, and there’s no better example of that than the repeal of Kentucky’s certificate-of-need (CON) laws.
Heightened scrutiny of CON’s decades-long rationing of healthcare arrived with the 2022 election. Rep. Marianne Proctor, R-Union, and Sen. Gex Williams, R-Verona, were elected as change candidates, willing to challenge the status quo that prioritized special interests over the voters.
Both filed legislation to repeal CON in the ’23 session; both were instrumental in getting a legislative task force appointed to dive into the issue during the interim period.
That task force finished its work last week, issuing a short memorandum that largely summarized the arguments made by the various groups who offered testimony. Its sole recommendation was that “further study (is needed) to guide regulatory and statutory changes in Kentucky’s certificate-of-need program.”
It’s an unusual, yet revealing, conclusion to six months’ worth of work. The task force basically said certificate-of-need is complex with both strong arguments favoring repeal and legitimate concerns surrounding the consequences repeal might bring.
An undercurrent in the debate has been the significant differences between rural and urban health care delivery in our state. In northern Kentucky, certificate-of-need protects St. Elizabeth’s ironclad grip on the market. In smaller counties, CON is seen as a guarantor that local hospitals can continue to provide vital services in local communities.
Certificate-of-need isn’t quite a gordian knot, but it is a policy challenge that will require careful consideration to untangle.
The issue is ripe in northern Kentucky in a way that puts it at the center of the regional agenda. At one of the last task force meetings, Sen. John Schickel, R-Union, said now that the financing of the Brent Spence bridge construction has been resolved, certificate-of-need is the topic he hears the most about from constituents.
Schickel, who is retiring from the state Senate at the end of 2024, is committed to continuing the work on CON reform up until his last day in office. Opponents of reform are no doubt equally committed to defending their point of view and, in St. Elizabeth’s case, its regional monopoly.
The task force’s recommendation to continue studying the issue is sensible. It’s an opportunity to further educate the public about what exactly certificate-of-need is and to bring together constructive ideas about a path forward.
Unpacking the rural vs. urban dynamic should be a primary objective. A one-size-fits-all solution might be too much, too fast for rural lawmakers to accept. That could hinder progress for healthcare markets that are ready for more competition.
Pursuing principled policy in the face of powerful special interests takes time. The compelling argument is on the side of reform. The more the pro-market side keeps the certificate-of-need defenders defending their position, the clearer it becomes CON supporters are prioritizing their narrow interests over providing Kentuckians with greater access to quality healthcare.
Andrew McNeill is president and senior policy fellow at the KY Forum for Rights, Economics & Education (KYFREE), the leading free market think tank in Kentucky. He served in the Bevin administration as the Deputy State Policy and Budget Director. His email address is amcneill@kyfree.org
