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State Lawmakers At Odds Over Hospital Construction Rules

State lawmakers continue to butt heads on healthcare reform, specifically where new hospitals can be built. Both chambers want to improve access to healthcare, but they disagree on rules for hospital construction.

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In order to build a new hospital or revamp an old one, the state has to sign off. That stamp of approval is called the certificate of need. And the application process for that certificate can take months, and cost tens of thousands of dollars. Critics say the CON is a barrier to healthcare access. That’s why Representative Chris Sprowls of Clearwater wants to repeal the process entirely.

“What you will see here is the same focused approach that focuses on removing regulatory barriers that hinder competition and dis-incentivize innovation, by removing CONs, requirements for hospitals and hospital reviews,” he said.

But some worry loose regulations would disproportionately favor insured Floridians. Here’s Representative Alan Williams of Tallahassee.

“What prohibits one of these facilities from cherry-picking, taking the healthy sick person if you will, versus the one who may not be able to afford it? And the person who can afford it, who may have their own private insurance, what stops, what prevents that cherry-picking of those individuals?” he asked.

While the House paints with a broad brush, the Senate is taking a more nuanced approach, by focusing on rural healthcare. Some rural hospitals are already exempt from the CON, but Sebring Senator Denise Grimsley wants to do more.

“There are currently five hospitals in eleven eligible counties that qualify for this exemption. The change in the population density would exempt an additional nineteen rural hospitals from CON review process,” she said.

Gail Bellamy runs the Center for Rural Health Research and Policy at the FSU Med School. She estimates some 2 million rural Floridians struggle to access quality healthcare.

“They may not even have a stop light. They definitely won’t have a hospital. They may be 25, 30 miles away from the nearest great big hospital, which if you’re really sick that is not a short distance. But two million? Two million is bigger than West Virginia. Two million is bigger than Rhode Island,” she said.

Bellamy argues that healthcare needs can vary widely from county to county, and each should get the care that best suits that community.

“If you’ve seen one rural community, you’ve seen one rural community. It depends on where you are in the country, it can depend on where you are in the state. If you go up north to Gadsden county which is the highest proportion of African Americans in a county in this state. You drop down to where Immokalee is and you start seeing large numbers of immigrant, not just Hispanic but also Haitian,” she said.

That’s why Senator Grimsley wants to make it easier for rural hospitals to set up shop.

“Hendry County has 38,000 people, and it has 1,190 square miles, it’s a huge county. They at the time wanted to rebuild closer between, to be more central between La Belle and Clewiston. Because right now all the La Belle residents are having to go to Lee County for their healthcare. At the time they just couldn’t afford the CON payment, it’s a community hospital,” she said.

Grimsley’s bill has one more committee stop before it reaches the floor. Meanwhile, Representative Sprowls’ bill is ready for a full vote in the House.

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