Cooper right about Certificate of Need, but for the wrong reason

Published August 4, 2022

By Brian Balfour

Gov. Roy Cooper had an op-ed published today in the Raleigh News & Observer calling out the hospital lobby as an obstacle to Medicaid expansion in North Carolina.

At the heart of the tension is the state’s Certificate of Need (CON) laws, which mandate approval from a state government board before medical providers can build new facilities or acquire certain medical equipment.

Naturally, the hospitals like CON laws because it restricts new competition, allowing them to keep prices higher.

Both the NC House and Senate have introduced bills this year to expand Medicaid in North Carolina. Included in the Senate proposal is a reduction in North Carolina’s numerous and restrictive CON laws. While otherwise largely supportive of efforts to expand Medicaid, the hospital lobby is refusing to accept the CON reductions as part of the deal.

In response, Cooper writes, “Our state has some of the most restrictive laws on hospital competition, so there is room to move,” on CON rollbacks.

Cooper adds that North Carolina needs “our hospital leaders to step up now and do what’s right for their patients and the health of our state.” The governor hopes that a little public pressure will cause the hospitals to relent and agree to the deal.

Cooper is right to urge for the repeal of some of our state’s archaic CON laws (total repeal would be ideal). But he is doing so for the wrong reason.

Indeed, Cooper couldn’t care less about rolling back restrictive CON laws, he just cares about a political victory to impress his base, i.e. Medicaid expansion. Moreover, expanding Medicaid would significantly increase the number of North Carolinians dependent on the government for their health insurance. Dependent people make for a reliable voting bloc.

Cooper is right when he urges hospital leaders to drop their opposition to CON repeal. But he is doing so for the wrong reason.