The fight to overhaul regulations for building and expanding hospitals and other medical facilities in South Carolina has been so combative that lawmakers may not resolve it this year.
The S.C. House Ways and Means committee this week passed a bill that took lawmakers six months to write, altering the certificate of need program and eliminating it entirely in 2020.
The process has been so exhausting that state Rep. Murrell Smith, leader of the group that wrote the bill, said he went from supporting the program to wondering why it even needed to exist.
The Sumter Republican said he still thinks the certificate of need program works for smaller places such as Sumter, Orangeburg and Aiken to make sure a large health care company doesn’t run smaller firms out of business and then reduce the amount of care. But he told state Rep. Jim Merrill, who wants to kill the entire program, that he doesn’t think South Carolina’s large cities need it.
“We’re going to have to disagree with this for about five to 10 years,” Smith said.
Any changes would not affect the legal fight between Piedmont Medical Center and Carolinas HealthCare System over who gets to build a Fort Mill hospital.
But the legislative discussions highlight why some believe there needs to be a change. The two hospital systems have been battling for almost 10 years before the S.C. Department of Health and Environmental Control, which issues the certificates, and in the courts.
DHEC has awarded the certificate of need for a Fort Mill hospital three times, twice to Piedmont and once to Carolinas HealthCare System. Each time the other sued.
The case is now before the S.C. Court of Appeals.
The bill that passed the House Ways and Means committee would allow existing hospitals, medical centers and nursing homes to add beds within a mile of their facility. It also would allow hospitals to expand services that are already approved under the program and remove the need to seek permission to buy costly equipment.
Currently, such facilities must get permission to buy anything that costs more than $600,000 – approaching the cost of an average MRI scanner.
A proposal to end the certificate of need program immediately failed. The committee opted to end it in 2020.
“Is this really going to end it, for real? Or is this just a stall?” asked Rep. Phillip Lowe, R-Florence and a physical therapist and developer. “There will be two more General Assemblies elected by then. Half of them won’t have heard this discussion. They’ll be fooled again.”
The program nearly died in July 2013 when Gov. Nikki Haley vetoed the $2 million that DHEC uses to run the program. Hospitals sued, saying lawmakers never voted to end the program. The state Supreme Court ruled in 2014 that since the law requiring the certificate of need was still on the books, DHEC had to find ways to fund it and continue it.
Conservatives such as Rep. Jim Merrill, R-Charleston, think the program is anti-free market, allowing the government to choose winners or losers instead of letting patient choices drive the market.
Democrats, such as Rep. Joe Neal of Hopkins, said the program fails to help bring health care to rural areas.
“It’s a process that’s driven by money and politics, not by health care and outcomes,” Neal said.
The bill moves on to the House floor, where another fight is expected. The outlook is even less certain in the Senate where the issue hasn’t even gotten a committee hearing.
Lawmakers also are preparing for another round of intense lobbying. Several House Ways and Means Committee members said the State House is packed with lobbyists from medical firms vying for their time at every turn.
“If any of you were not inundated with calls from lobbyists and special interest groups, then you need to probably be offended they didn’t think your vote was very important,” said Rep. Kenny Bingham, R-Cayce.