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Senate Panel Advances ‘Certificate Of Need’ Repeal

Will “supermajority” in GOP House block this free market reform for another year?

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As they did last year, Republicans in the South Carolina Senate are moving quickly in 2023 to do away with a program that unfairly restricts health care providers from serving their patients by unnecessarily limiting competition in the Palmetto State’s health care marketplace.

I am referring to the so-called “Certificate of Need” (CON) program, which injects politically driven government bureaucracy into the health care marketplace.

Administered by the S.C. Department of Health and Environmental Control (SCDHEC), this restrictive “regulatory regime” forces hospitals to seek state approval if they wish to build new facilities, open new practices or purchase certain types of new equipment.

Last year, the S.C. Senate passed a bill doing away with CON during the first month of the legislative session – but it stalled in the S.C. House of Representatives when powerful “Republican” leaders refused to allow it to the floor for a vote.



Sound familiar? The GOP-controlled House – which entered 2023 with a “supermajority” – is all about defying common sense medical reforms, it seems.

Despite the House’s prior recalcitrance, senators are poised to advance a similar bill this year.

Sponsored by Wes Climer, Penry Gustafson, Josh Kimbrell, Dwight Loftis, Harvey Peeler and Sandy Senn, the latest version of a CON repeal bill – S. 164 – cleared the S.C. Senate medical affairs committee by an overwhelming 13-4 margin this week. It will be debated on the floor of the full Senate early next week.

The committee approved the bill on a voice vote, meaning there is no permanent record of how each member of the committee voted on the measure. Despite this lack of procedural transparency, limited government advocates celebrated the bill’s early progress.

“Certificate of need laws hold back health care for patients,” said Candace Carroll, state director for Americans for Prosperity. “These burdensome regulations make it near impossible to open a new hospital or offer new services. This leaves South Carolinians, particularly those in rural areas, without the care they need. I am glad to see this first step and plan to stay engaged with lawmakers as the repeal works it way though the legislature.”

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Senate president Thomas Alexander presides over the opening session of the 125th General Assembly on January 10, 2023 (FITSNews)


There is ample evidence attesting to the inefficacy of certificate of need laws.

Two years ago, the Palmetto Promise think tank issued a report on South Carolina’s CON program, concluding that the Palmetto State has “one of the most restrictive CON programs in the nation.”

“Rather than market demand determining the supply, under CON laws, clinicians and medical facilities must seek approval from the state before purchasing or expanding services they provide to patients,” the report found. “Competitors can then delay and even prevent new facilities from being built through the CON process.”

Meanwhile, a recent report from the Mercatus Center at George Mason University found that certificate of need laws “restrict access to health care, make services more expensive, and undermine the quality of care.” Mercatus data further revealed that certificate of need laws add $200 annually to per capita health care spending in the Palmetto State.

Senate sponsors are optimistic about the legislation’s chances this year.

“Opening up health care to more competition will give patients more choice and lower costs,” Climer told me. “I’m grateful for the senators who stood up for patients today and look forward to debate on the Senate floor soon. Over the last few months we’ve had productive conversations with leadership in the House with an eye towards a resolution that can become law this year.”



Will Folks is the founding editor of the news outlet you are currently reading. Prior to founding FITSNews, he served as press secretary to the governor of South Carolina. He lives in the Midlands region of the state with his wife and seven children.



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$60 Dose of Advil January 12, 2023 at 5:06 pm

How about making a hospital get a “certificate of need” to overcharge patients?

Jordan January 13, 2023 at 8:21 am

Limited Government Advocates? CON is outdated, but the promised savings to the patient are just junk economics. According to a study by Forbes the most expensive states for healthcare have repealed CON and some of the lowest have CON.

Frederick Barton Top fan January 16, 2023 at 1:51 pm

Not true Jordan. Google Forbes on certificate of need, and you will find the complete opposite.

Anonymous January 25, 2023 at 4:32 pm

CON is barrier to patient access of care. Hospitals have a monopoly that is used to benefit them and not patients.


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