Virginia’s COPN Law Ensures Access to Health Care for All Virginians

connaughtonby Sean Connaughton

In response to your January 5, 2015, opinion, “Certificate of Need: A Bad Idea with Political Staying Power,” Virginia’s Certificate of Public Need law has at its core the recognition that many preconditions for an effective “pro-business” marketplace don’t exist for health care and that a regulatory process designed to ensure that Virginians have access to essential health care services is necessary for the public good. The law has undergone significant reforms through its 40-year existence in Virginia; however, its fundamental role of providing Virginians access to essential and high-value health care remains intact.

Nearly every Virginian is within a 20-mile drive of a hospital, which is staffed 24 hours a day, seven days a week, 365 days a year. These full-service hospitals offer a wide array of services, some are profitable, others are not (oftentimes the profitable services help subsidize the cost of those that are not profitable). They are required to care for all patients regardless of their ability to pay; held to higher quality and safety standards; subsidize the societal costs of training the health care workforce; maintain services 24/7/365; and provide surge capacity to deal with natural or man-made disasters. They also must contend with environmental, labor, occupational health and safety and other regulations that many businesses face, as well as the fact that the major purchasers of health care – Medicaid and Medicare – pay well below the cost of providing care. They do this because their communities depend on them to be there in any situation. One must only look at local, state or national news coverage when a full-service hospital closes or stops offering a specific service in its community to see the public outcry. There are no strong market incentives to provide many essential services, and there is no business case for a new market entrant to treat patients who cannot cover the cost of their care.

Rightly stated, hospitals contribute to the financial burden of caring for Virginia’s low-income uninsured. In 2013, Virginia’s hospitals provided over $628 million in financial assistance. In the face of continued cuts imposed by the Affordable Care Act, sequestration under the Budget Control Act of 2011 and the American Taxpayer Relief Act, one third of Virginia’s hospitals operated in the red last year, before many of these cuts went into effect, and bond rating agencies are forecasting an even bleaker 2015 outlook.

In 2000, the Virginia General Assembly passed a bipartisan law to responsibly deregulate COPN. In phasing out the law, certain protections were put in place to ensure a balanced and controlled approach to adequately address access to essential services and health professions training; disaster preparedness; safety net health care; quality of care oversight and accountability of all health care providers; and market fairness. Unfortunately, lack of funding put the deregulation plan on hold. However, COPN continues to work for Virginians today.

While alternatives to COPN review may be more prevalent now than when the program was enacted, a solution for how best to cover the costs of serving the indigent and uninsured populations has not been provided, and the usefulness of COPN regulation in controlling use of resources remains an important consideration for how the state chooses to ensure access to care for low-income uninsured Virginians. If COPN was to be deregulated, the ability of all Virginians to receive access to vital health care services must remain intact.

The deregulation of other industries has led to public perception of diminished quality services in those fields. We cannot afford to let that happen with health care. We must insure that health care, if deregulated, is done in a responsible manner to protect all Virginians. Reasonable people can disagree about COPN, but no one wants to place the stability of our health care system and access to essential and high-value health care services at risk.

Sean T. Connaughton is president and CEO of the Virginia Hospital & Healthcare Association.

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24 responses to “Virginia’s COPN Law Ensures Access to Health Care for All Virginians

  1. I can’t argue with anything that Connaughton has said here. What I find to be the most intriguing part of his message is the idea that hospitals in Virginia serve a public mission — they function, in effect, as public utilities. He doesn’t come out and say it, but the implication is that, given hospitals’ role in providing critical public services in our communities, we need to ensure their profitability.

    The unstated flip side of the hospitals-as-utilities argument is this: If we ensure hospitals’ profitability, should we also regulate their profitability? In exchange for guaranteed profitability, should there also be a cap on what they earn? That would be an easy case to make for the not-for-profit hospitals, which never purported to be profit-maximizing institutions (although some of them are highly profitable). It would be more difficult to make for the for-profit hospitals. It’s a discussion worth having.

  2. I did not get the “profitability” part. What I got was that we don’t want them going broke – and as a consequence going away are not going away but the mission has been compromised.

    but did Jim Bacon agree with this :

    ” …. an effective “pro-business” marketplace don’t exist for health care and that a regulatory process designed to ensure that Virginians have access to essential health care services is necessary for the public good. ”

    I would ask Jim and TMT and others if they agree with the above statement?

    If you agree with that statement – could I take you one step further and ask if – we ARE going to do this – that we do it in the most cost-effective way possible – since the money to do this – is coming from your pockets?

    I’ve pointed out before and will again – EMTALA is not just about ERs. It’s about charity care – beyond the ER… that Mr. Connaughton states above is a “public good” and Jim B seems to agree is a public utility.

    Oh.. and I DO THANK Mr. Connaughton for offering his perspective…

    • I see Connaughton as doing his job a president of a trade association – advance the economic interests of his members. I’m not sure whether he thinks hospitals are public utilities or not, based on his discussion. If they are public utilities, there is a better case for CON – to keep down costs. But with that goes price regulation. Public utilities are normally permitted to charge rates that should enable them to recover their reasonable cost plus a fair rate of return on investment. There is nothing about a public utility that suggests it should give away free service. If you want electricity, you need to pay your bill. There are sometimes funds that help low-income people pay their utility bills. The funds are normally sustained by other customers donating money above their utility bill. For telecommunications, customers are assessed additional fees (Universal Service) that help provide discounted service to low income people, schools and libraries, and that help keep the prices of rural service comparable to prices in urban and suburban markets.

      I doubt hospitals really want utility regulation unless they are money losers, as many costs incurred by hospitals are likely unnecessary and excessive, such as administrator’s compensation and duplicative expensive equipment. Back to CON.

      I think this is a worthwhile discussion.

      • re: ” There is nothing about a public utility that suggests it should give away free service. If you want electricity, you need to pay your bill.”

        that”s true but that’s not how EMTALA works. You get free service.

        “I doubt hospitals really want utility regulation unless they are money losers, as many costs incurred by hospitals are likely unnecessary and excessive, such as administrator’s compensation and duplicative expensive equipment. Back to CON.”

        Well, it’s not what hospitals “want”.

        Many would love to be rid of EMTALA and not have to cost-shift to people with insurance.

        that’s why I say – for the folks who really are opposed to govt-taxpayer-funded charity care – that it’s EMTALA they should be seeking to repeal.

        So the advice is – If that’s what folks and politicians – really believe – then man up and advocate it’s repeal. Otherwise it’s just a corrupt game of hide and seek hypocrisy.

  3. The GA voted to end the COPN process 15 years ago but it remains in place. What was the thinking about indigent care when the GA voted to repeal the COPN process?

    From Jim’ original article, “For example, CON states have about 13 percent fewer hospital beds per 100,000 persons than non-CON states.” So, it doesn’t seem (analytically speaking) that the Certificate of Need process adds to the gross level of health care available (as measured by hospital beds per capita).

    • re: ” What was the thinking about indigent care when the GA voted to repeal the COPN process?”

      the same as now – that uninsured/indigent use of ERs is less costly than if they actually had the ability to see primary care physicians and get treated before they need to go to an ER.. then get admitted to the hospital to receive hundreds of thousands of dollars of treatment of advanced disease… not detected earlier.

      as I’ve been saying and I think is in agreement with Don – the GOP in Virginia says one thing to gullible voters and does something else for legislation.

      • LarryG – The theory of the CON is that government forces scarcity by limiting the number of high priced medical devices that hospitals can buy. This scarcity (lack of supply) causes prices to rise. The higher prices raise profits which hospitals can use to fund indigent care.

        If it’s the Certificate of Need process that generates the extra margin to pay for unreimbursed indigent care then what happens if there is no Certificate of Need process?

        Other states have eliminated the CON process. Are all the hospitals going broke because of lower prices, lower profits and continuing indigent care? The General Assembly voted to eliminate Virginia’s CON process. How was indigent care going to be funded once the prices for equipment – intensive procedures fell (and hospital profits along with those prices)?

        • re: ” LarryG – The theory of the CON is that government forces scarcity by limiting the number of high priced medical devices that hospitals can buy. This scarcity (lack of supply) causes prices to rise. The higher prices raise profits which hospitals can use to fund indigent care.”

          in a true free-market – where there are no insurance companies or Medicare paying – that would be true.

          “If it’s the Certificate of Need process that generates the extra margin to pay for unreimbursed indigent care then what happens if there is no Certificate of Need process?”

          what happens ? the hospital charges as much as it can for as many different things – like aspirin – that Medicare and insurance will reimburse for. right? Cost shifting…

          “Other states have eliminated the CON process.”

          I see the map of the US. but I’m not sure how many states never had CON verses got rid of it – much less how many states started out without it and then incorporated it. In other words, it’s a snapshot.

          ” Are all the hospitals going broke because of lower prices, lower profits and continuing indigent care? The General Assembly voted to eliminate Virginia’s CON process. How was indigent care going to be funded once the prices for equipment – intensive procedures fell (and hospital profits along with those prices)?”

          This is the answer to indigent charity care? 😉

          you guys say “profits” . I see most hospitals as just trying to break even.

          but even in a world where SOME of the Hospitals – ARE for-profit – others are not – but say you have two in one area – one that is for-profit and one not. Do you think the MRI or appendectomy or whatever is reimbursed by Medicare and private insurance differently at the two hospitals or do you think they pay the same thing no matter which hospital?

          If you know for sure – that Medicare and private insurance actually do have different reimbursement rates depending on the hospital or hospitals in a given region – like NoVa – you might have a stronger argument.

          are you arguing that CON influences Medicare/private insurance reimbursement rates so that if CON introduces scarcity – that Medicare/private insurance will pay the higher rates?

          do we know this?

  4. As professor Gruber admitted it’s impossible to give away health care without taking something from others. But as we a seeing, most people are willing to pay much to cover others. See the irate complaints from the Harvard University faculty about paying more for healthcare. http://www.cnbc.com/id/102310408#. Even though many of them championed the ACA, they want someone else to subsidize the poor and near poor. Just what I’ve been arguing for months.

    • TMT – your argument would have merit if it were true that you’re not paying for the indigent already.

      Gruber was 100% correct but he said it in an arrogant and condescending way.

      People refuse to believe they are already paying but they are.

      the question is not whether or not you want to pay – but do you want to pay in a cost-effective manner?

      we pay twice as much for healthcare because of govt subsidies and cost-shifting – which basically opens up the process to profit-seeking companies who can charge more for drugs (especially when Congress will not let Medicare negotiate), more for medical appliances, more for CAT/MRIs – about 5-10 times what they cost in Europe and Asia.

      the intent of ObamaCare and the expansion was to get more people to pay part of the costs – i.e. insurance vs no insurance for those that could pay – and access to primary care for the indigent.

      but folks insist on being willfully ignorant on these issues – in part because the right has been very successful at demonizing …

      you get rid of ObamaCare and what are you back to – as long as EMTALA is not repealed?

      you”ll end up with even more folks going to the ERs – waiting until they have advanced diseases then getting exceptionally expensive after-the-fact too-late – care.

      finally – the opponents like you – have all the options in the world to offer something better and what have you done – other than defend the status quo?

    • Mark my words, the next shoe is preparing to drop. Employers are going to start providing employees with an allowance for health care and telling the employees to spend it however they want. Look for growth in private insurance portals. Of course, the employers will only escalate the allowance as far as they must in order to attract employees. In other words, health care costs will grow faster than the allowance is increased and employees will increasingly be squeezed. They won’t be able to take less coverage because … you can’t really keep you plan even if you like it. So, they will have to pay more out of their own pockets. This will slowly ignite a crisis where people are ready for something much more radical and … voila … single payer to the rescue.

      • employees are ALREADY squeezed. The increasing costs of health care have, in effect, eaten up any higher salaries for productivity. Increased productivity is going to pay for increased health care costs so salaries are stagnant.

        in terms of allowances.. maybe.. that’s exactly what Paul Ryan is talking about with Medicare – a voucher – but how would your “allowance” idea be any different from an annual deductible? Isn’t that already a reality?

        but you ALSO miss some of the biggest issues with employer-provided – and issues that the average person including those who actually have employer-provided are pretty much clueless about. All they care about is if their insurance “covers”.

        the first is – you pay the same rate as others no matter your own health or claims…

        the second is – you are pretty much guaranteed they can’t dump you

        finally – you can’t take the money instead and go out into the open market and buy what suits your needs – better than the employer-provided.

        people want to blame all of this on ObamaCare but the truth is – and has been for a while that the way we do insurance in this country – is a CF that has absolutely no resemblance to a market-based environment – and people USE their insurance to the limits they can .

      • Here’s something else I do not understand.

        In Virginia – teachers and their employers pay into a state-run VRS system.

        without getting into it’s solvency or unfunded stuff – consider for a moment how school systems do health insurance – and why we do not have a state-wide insurance pool for school employees – also – just like we have VRS?

        Our school system down here now “self-insures” (and I thought Fairfax does also). But down here with 3000 members – one person with a very expensive illness can cause a premium increase for everyone else.

        but here’s the real point – about employer provided. You pay for others.

        you pay for things they need that you do not and you also pay for their medical expenses if they have big ones…

        that’s the essential nature of – insurance – and that also tells you why indigent charity care at the hospitals is actually in a weird sort of way – insurance for the indigent – it’s just collected from others..

        if we had a state-wide health insurance plan – it could include the indigent and their “premiums” would be paid for by the Medicaid Expansion… instead of cost-shifting…

        • I agree with your description of the purpose of insurance. However, with 3000 subscribers, a single high-priced hospitalization isn’t going to have much of an effect on rates.

          That’s for two reasons – first, it’s spread over 3000 people, so even a million dollar claim will have a modest effect – and second, typically companies buy reinsurance for very large claims.

          Reinsurance takes the fact that claims over a certain dollar amount are rare, and basically insures the risk for claims over that amount for a set monthly fee per subscriber. It does not add much to the monthly cost of insurance – because the threshold is set to where claims are rare – and it reduces the volatility of rates.

          • Virginiagal2 – but it HAS had an effect.

            Premiums went up last year – remember the “fund” is the school not the insurance company – and the reason given was that 3 employees had very expensive medical costs over that year.

            the reinsurance sounds like a good idea – and not sure if school system has done that ..

            but if 3000 are good why not 50,000? even better, right?

            I thought it curious – i.e. don’t understand – why the insurance company gave the option to the schools to have more control over the premiums and deductions, co-pays, etc. and it appears to me that what the insurance company is doing right now – is providing administrative services ….

            you sound like you know more than I so if you want to extend and expand your response, I’d certainly benefit and suspect others would.

  5. Larry, how many times do I have to say this. I support expanding Medicaid: 1) if it can be shown that the added costs (Medicaid) exceed the amount of the costs for caring for indigent that are passed along to taxpayers and insurance premium payers in Virginia; and 2) if the law guarantees those cost savings will be passed along to taxpayers and premium payers. No such showing has been made. Do you think we should be forced to pay for Medicaid expansion if it cannot be shown to be cheaper than the status quo? My approach deals with all of the costs and benefits. You seem to want to hide in words.

    A number of us got a similar song and dance from Fairfax County about paying for non-rail transportation improvements for Tysons. Guess what? The Fairfax County DOT and Finance Department prepared a 20-year plus spreadsheet that listed each project and the likely years the project would be active (planning, RoW acquisition and utility relocation, and construction). And for each project and its component steps, the costs and sources of funding were listed. Costs and revenues were adjusted for future inflation. The staff answered citizen questions for two and one half hours. And the questions from citizens who were attorneys, engineers, economists and accountants were deep and probing.

    Shouldn’t we get the same analysis for expanding Medicaid? The analysis should take account of other states’ experiences, both good and bad. The supporters should be subjected to several hours of questioning.

    If McAuliffe says we are going to save $400 million over X period of time, his experts should be cross-examined. And then I want to see statutory language that gives the $400 million back to taxpayers and premium payers. Is that too much to ask? Either that or McAuliffe should say “We now think Medicaid expansion is going to cost you more than you are paying today for indigent care in your taxes and insurance premiums.”

    And “NO,” the idea behind Obamacare was not “to get more people to pay part of the costs.” Obama said over and over again that, if you like your present insurance policy, you can keep your present insurance policy.” Gruber fessed up that this was a lie to fool the people into supporting or not opposing Obamacare.

    As I’ve said a number of times, EMTALA should be phased out over a reasonable number of years. This will push people into buying insurance. Grandfather everyone’s existing insurance. Let those who want to buy insurance on an exchange do so. Give people who do so a tax deduction. There’s my plan, and it’s a lot better than the ACA, which is lies held together with falsehoods.

    • “Larry, how many times do I have to say this. I support expanding Medicaid: 1) if it can be shown that the added costs (Medicaid) exceed the amount of the costs for caring for indigent that are passed along to taxpayers and insurance premium payers in Virginia; and 2) if the law guarantees those cost savings will be passed along to taxpayers and premium payers. No such showing has been made. Do you think we should be forced to pay for Medicaid expansion if it cannot be shown to be cheaper than the status quo? ”

      TMT – how honest is your offer? how would you know ahead of time? If someone did such a “paper” study – would you believe it?

      “My approach deals with all of the costs and benefits. You seem to want to hide in words.”

      no – because you do not acknowledge the costs beyond the ER visits..

      “A number of us got a similar song and dance from Fairfax County about paying for non-rail transportation improvements for Tysons. Guess what? The Fairfax County DOT and Finance Department prepared a 20-year plus spreadsheet that listed each project and the likely years the project would be active (planning, RoW acquisition and utility relocation, and construction). And for each project and its component steps, the costs and sources of funding were listed. Costs and revenues were adjusted for future inflation. The staff answered citizen questions for two and one half hours. And the questions from citizens who were attorneys, engineers, economists and accountants were deep and probing.”

      what does that have to do with anything TMT ?

      “Shouldn’t we get the same analysis for expanding Medicaid? The analysis should take account of other states’ experiences, both good and bad. The supporters should be subjected to several hours of questioning.”

      there ARE analyses guy – they DO say that if people do visit primary care more often – that it detects disease earlier and cheaper …

      “If McAuliffe says we are going to save $400 million over X period of time, his experts should be cross-examined. And then I want to see statutory language that gives the $400 million back to taxpayers and premium payers. Is that too much to ask? Either that or McAuliffe should say “We now think Medicaid expansion is going to cost you more than you are paying today for indigent care in your taxes and insurance premiums.”

      that’s totally bogus guy. do you use that standard for ANYTHING – ahead of time?

      “And “NO,” the idea behind Obamacare was not “to get more people to pay part of the costs.” Obama said over and over again that, if you like your present insurance policy, you can keep your present insurance policy.” Gruber fessed up that this was a lie to fool the people into supporting or not opposing Obamacare.”

      Guber said people do not understand health care – he is correct.

      “As I’ve said a number of times, EMTALA should be phased out over a reasonable number of years. This will push people into buying insurance. Grandfather everyone’s existing insurance. Let those who want to buy insurance on an exchange do so. Give people who do so a tax deduction. There’s my plan, and it’s a lot better than the ACA, which is lies held together with falsehoods.”

      how many of your elected that you talk to – support repeal of EMTALA?

      how will people buy insurance guy if the insurance companies won’t sell it to them or they cannot afford the price the insurance companies put on it?

      what do you do with the folks who cannot get or afford insurance?

      are you advocating forcing insurance companies to sell insurance to anyone and sell it at a cost they can afford?

      if not – what is your plan?

  6. TMT – the CBO and other Congressional research services pretty much said that ObamaCare would save money – longer term.. but it would take time because people’s habits are ingrained.

    People who don’t normally go to a primary care doctor won’t start doing that even if it costs them less .. or even nothing…

    people who have spent their lives never going to a doctor – and always showing up at the ER – won’t change – unless the ER – can legitimately refer them to a primary care doctor who will schedule them.

    that’s going to take some regional clinics to be stood up – and staffed with doctors – that can and will see the indigent.

    that was part of the ObamaCare approach – to cut subsidies to ERs – but to allow them to refer the indigent. That part went south when Virginia decided to not go with the expansion – even though the expansion is already paid for out of medical appliance taxes and cuts to tax deductions for medical ( going from 7.5% to 10% of itemized, etc).

    so there is no chance that the funding sources for the MedicAid expansion are going to go away -unless Congress specifically cuts/undos these provisions.

    turning down the expansion – pretty much doomed the idea that hospitals could refer the indigent to clinics and primary care physicians – some of whom would come straight out of medical school in exchange for paying some of their education costs.

    but your idea of demanding to know ahead of time – is just not realistic. Even if someone showed you a study that “proved” it – you’d not believe them right?

    so are you really being honest here about your demand for “proof” before you will agree?

    My view is that you try it – you do a pilot.. you find out what is working or not and you fix what you can – and if at the end of the day -it’s not working – then you do drop it.

    that’s the only way we ever really know if something will actually work.

    and when I see the most vociferous opponents of ObamaCare get up and advocate repeal of EMTALA – say they are going to vote on it and send it to Obama – then I MIGHT believe you.. but until then I think I know of not a single elected person who publicly says we should repeal EMTALA.

    this is the problem with the opponents .. I’d be fine if they had a real competitive alternative. I might not like their plan as much as I like other plans but at least – they would be honestly offering a solution with integrity.

    failing that – the opponents are hypocrites because if they truly believe we should not be paying for the indigent – they never get up and admit it.

    that takes them out of the game as far as I am concerned.

    they’re not serious people.

    it’s easy to be against something. It’s harder to actually offer solutions and these folks are not the adults in the room.. how and why they get themselves elected when they offer nothing as an alternative – is a testament to Grubers view of citizens – and the horrible truth is that the elected themselves do not truly understand health care – either.

    Our politics is driven by willful ignorance.

  7. In the back and forth over health care – and the “certificate of need” for hospitals and medical facilities – we may have overlooked the fact that “CPCN” – stands for not just a certificate of need CON – but a Certificate of Public Necessity and Need – that applies to way more than just medical facilities.

    And it’s not a modern-day “power grab” by those nasty govt bureaucrats – nope, it’s a concept to goes back to 1870 and before!

    Perhaps Jim could entice Mr. Connaughton or someone at the Sorensen Institute to write an article about the origins of the concept of CPCN and especially so the justification of the govt to determine “need” for a wide variety of business-provided services – long, long before medical services.

    Now days – with the advent of “libertarian” types – like Dave Brat, Rand Paul, and others including John Stossel of FOX news and many who hail from the Conservative side of the political realm – would surely find the concept of the Govt deciding anything at all in terms of “business need” – an Anathema.

    But the reality is that it’s not only common in many states – there is no identified effort by any group political to repeal or dispense with any/all such laws.

    In fact, like a lot of issues – the average person – including the folks who have glommed on to the anti-govt bandwagon – most of us have if not, no clue, precious little knowledge of the basis for the concept and law and that is illustrated in part by treating the issue as more or less unique to the siting of Medical facilities – when then attempted to claim that basic idea of CON itself was created to help hospitals make a “profit” to pay for the indigent.

    NOT TRUE! Totally not true! COPN has a much bigger and older issue that has nothing what-so-ever to do with hospital profits and the indigent!

    The medical facility aspect is but one of many that are subject to the law and it’s not one of the original ones that led to the creation of the laws to start with!

    For instance, power line controversy on the James river – the Certificate of Public Convenience and Need is at issue.

    ” On Tuesday, January 6, 2015, the appeal of the State Corporation Commission’s grant of a certificate of public convenience and necessity for two powerlines and a switching station was heard by the Virginia Supreme Court. Significant issues included to what extent minimization of impacts on historic sites is mandated to the SCC in a certificate case, and whether local government zoning was preempted on a 51-acre switching station site by the SCC’s grant of the certificate.

    Andrew R. McRoberts, shareholder with Sands Anderson PC, argued the case against the certificate on behalf of firm clients James City County, the James River Association and the Save the James Alliance Trust. An opinion is expected at the end of February.”

    Now on the part of those who oppose the power line – at that location – the challenge to the Certificate may be a legal Hail Mary – we’ll see but the essential point is that Dominion had to seek permission of the Govt – often referred to an incompetent bureaucrats by the right these days, to 1. build their powerline and 2. – in a particular location.

    So the Government actually decides if Dominion “needs” the powerline and second, must have it at THAT particular location.

    I’ve done a little searching and found this at JSTOR

    ” Origins of the Certificate of Public Convenience and Necessity: Developments in the States, 1870 – 1920″

    I also went to the Va Code and Waldo Joquith’s Virginia Decoded but at this point I seem to have reached the legislative version of a rabbit warren.

    So that’s why I’m appealing to Jim or Mr. Connaughton to perhaps find more/better resources and/or knowledgeable folks to write an informative article about the entire concept of CPCN – in Virginia… for a LOT of service industries.

    How about it?

  8. The problem with health and free market advocates is that when it comes to health care, the market is just fine and dandy in well-populated areas. This is less so in rural parts. There really isn’t a strong profit motive to set up health care in an a area with low population densities.

    It’s like cable and internet companies cherry picking rich suburbs at the expense of the inner city and rural areas.

    Connaughton alludes to health care centers as utilities and in many ways they are.

    What bugs me about conservative market types is they try to overlay something as tremendously important as health care over the same template as entertainment like cable television. It just doesn’t work.

  9. What companies do now is change their traditional health care plans to an exchange program. Then they give employees a few hundred bucks as employer contribution. You can pick whichever plan you want, but you pay the rest. Most plans have increased monthly payments with gigantic deductibles compared to what was available the year before the change over. Just another lost benefit without proper compensation.

    • I thought it was pretty typical that the employer would kick in a certain amount and the employee – and if premiums went up – the employee would have to pay more.

      that’s the way it works in the local school system and that’s the way it works for Federal employees.

      Every January – Federal employees – find out – if their increase in pay beats the increase in their health insurance premium. Govt workers are, by far, luckier than a lot of non-Federal workers – even schools – that don’t give annual increases any more and often see – as Darrell points out – increased premiums or they ding you on the deductibles, co-pays, etc.

      this has been going on for a while – not new with ObamaCare – and if ObamaCare “works” the impact on non Obama-cARe insurance costs wont be immediate – it will lag – because what ObamaCare sought to do was reduce the costs to hospitals for uncompensated charity care – coming from people who use the ERs and other hospital services.

      it will take some time for this to change.. and it will take even longer if we don’t have the MedicAid Expansion – those folks will continue to rely on the ERs for their health care.

      Like I said before – if someone REALLY wants to deal with the uncompensated charity care in terms of NOT subsidizing people with ObamaCare or the MedicAid Expansion – they need to advocate getting rid of EMTALA – because it’s EMTALA that requires hospitals to give free care to people to don’t or can’t pay – and there is no way to fix that unless you either repeal EMTALA or find some other way like ObamaCare… to enable people to go to Primary Care rather than ERs.

      there are no easy answers. We have a messed up system.. and it started with the govt getting involved in employer-provided insurance and then passing EMTALA. Basically those with insurance – pay for those who don’t have it. The only real question is whether you want it to be in a cost-effective way or not…

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