Nancy Mace: Health Care Needs Market Competition, Not Government Restriction

The case for repealing the Palmetto State’s anti-competitive “certificate of need” law …

by NANCY MACE || Far too often we look to government for solutions to our health care issues.  Unfortunately, politicians and special interests prefer pointing fingers and playing politics when it comes to these important matters, believing such approaches secure their ascent to power (or their ability to maintain a monopoly).

But when government, politics and overly burdensome regulations are removed, the door is opened for real competition with the free market consistently able to deliver a higher-quality product at a lower price for the consumer.

As we all know, health care is not getting any cheaper since government expanded its reach into the industry.  This is why it is incumbent upon leaders at all levels of government to push for expanded competition within the marketplace so that consumers are empowered with more options, not drained of more money (and deprived of quality care) by government mandates.

This week, I filed legislation (H. 3823) that would fully repeal South Carolina’s government-driven, crony capitalist system called certificates of need (CON).  This needlessly restrictive law requires that permission be obtained from a state-authorized agency before any new health care facility is built or expanded – or even if a new service is set to be offered at an existing facility.  This law has allowed some hospitals to hold a monopoly on any number of medical services in a given area.  And medical providers seeking a CON are required to navigate a labyrinth of red tape and sometimes years in delays.


In a 120-page report released in December 2018, the U.S. Department of Health and Human Services (DHS) recommended states repeal or scale back their certificate of need laws. The report highlights “States initially adopted CON laws to further laudable policy goals, including cost control and access to care. The evidence to date, however, suggests that CON laws are frequently costly barriers to entry for health care providers rather than successful tools for controlling costs or improving health care quality.”

This isn’t just a Republican position.  The administration of Barack Obama also supported a repeal of South Carolina’s CON laws.  At the urging of former Gov. Nikki Haley, the Federal Trade Commission and the U.S. Department of Justice issued a letter concluding “CON laws raise considerable competitive concerns and generally do not appear to have achieved their intended benefits for health care consumers.”

According to George Mason University’s Mercatus Center, CON laws lead to higher health care spending, fewer hospitals and a lower quality of care.  Specifically, their research concluded about $200 per capital of health care spending would be saved if we repeal the certificate of need laws.

Additionally, the same study shows that the presence of a CON program is associated with fewer hospitals in rural, suburban and urban areas alike.

This is why I’ve authored legislation to repeal the CON laws here in South Carolina.  A full repeal will break up the health care monopoly and unleash the free market, create much needed competition, expand access to high-quality health care and reduce costs for South Carolinians everywhere.

The Charleston County Medical Society and its president, Dr. Marcelo Hochman, have been true leaders in this effort. I’m proud this legislation has their endorsement and I look forward to working with them to repeal the CON law.

Nancy Mace is the first female graduate of the The Citadel.  A resident of Daniel Island, she represents S.C. House District 99 in the S.C. General Assembly.



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