A proposal last week by the N.C. Healthcare Association to the North Carolina General Assembly to modify certificate-of-need laws was more of a twig than an olive branch, according to Senate Leader Phil Berger, R-Rockingham, who spoke at a press conference Tuesday.
“As far as the hospitals’ press initiative from the other day, if you look at the substance of their proposal and the way it was released, it looked to me like it was more to deal with public relations than a substantive or serious proposal to get something worked out,” he said.
Disagreements involving CON have helped block a deal for Medicaid expansion.
The NCHA extended a proposal to lawmakers, saying they could agree to modifications of CON laws in ambulatory surgery centers, something the group estimates would cost hospitals $700 million in annual revenue. The proposal also indicates that they would support lawmakers repealing CON laws for psychiatric inpatient and chemical dependency beds.
As a condition of its cooperation, NCHA proposed that the General Assembly pass expansion legislation that includes participating in the Healthcare Access and Stabilization Program or HASP.
Berger said he hasn’t had a chance to talk to his colleagues in the House about the offer, but in his opinion, it needs more work.
“If you look at their proposal on ambulatory surgical centers, the only actors in healthcare would be in a position to open such a surgical center are the hospitals,” he said. “It looks to me like it like it’s more designed to further entrench the monopolies that hospitals have. Ambulatory surgical centers in other states are, in many respects, orthopedic centers, or ears, nose, and throat centers, or eye centers.”
He said the proposal would require three specialties to be in an ambulatory surgical center, and which isn’t a serious proposal.
When asked what he thought about Democrat Gov. Roy Cooper saying the Senate should present a counteroffer, Berger replied that the governor, hospitals, and the House know the Senate’s position on CON, and he wasn’t going to go back and forth in the press about the specifics.
Berger said his position on CON hasn’t changed from the bill the Senate passed and presented to the House earlier this year, including several alternatives which he wouldn’t specifically discuss.
He did remind reporters that the Senate is the only body that passed Medicaid expansion in North Carolina.
“The House has passed a bill promising to have a vote on expansion,” he said. “We have actually passed expansion and have said over and over again, if we are going to do that, we need to increase access to care by making sure there are more facilities available for (thousands) of people. We already have folks who have to wait days and weeks to get an MRI, appointment for a surgeon or medical provider.”
While Berger agrees that the sooner, the better in getting Medicaid expansion passed he said, “that sooner needs to be the result of the right bill and not just any bill.”
He still sees Medicaid expansion as a priority for himself and Senate Republicans for the next legislative session.
As a side note, Berger said there continue to be conversations on the SAVE Act, which allows nurses to practice at the top of their training without a doctor present. However, there isn’t any movement on the medical side.
“I continue to believe that it is part of the overall solution to some of the access problems we are having,” he said.
In terms of North Carolina’s Office of Recovery and Resiliency’s poor response to hurricane recovery efforts for homeowners affected by Hurricanes Florence and Matthew, Berger said they are looking at ways to improve the process.
“One of the reasons we made the modifications that we made to the Gov Ops committee is to enable the legislative branch to do a deep dive to conduct the kind of oversight that can really help the executive branch and provide the people of North Carolina with the kind of follow-through that they need in connection with the appropriations that take place and in connection with the policies that are adopted,” he said. “I do think there will be some things that we will be able to do, but I am not in a position at this point to talk specifics. I think it’s fair to say that North Carolina is the best state in the nation 48 hours before and 72 hours after a hurricane, but we are in woeful shape as far as the follow-through. Terrible.”
Berger also said he doesn’t see any reason for the state to give tax exemption on student loan forgiveness.
“It’s a federal policy that does not have supporting federal law from everything that I can see,” he said. “If we are going to make that change in our tax policy and tax laws for that kind of debt forgiveness, it would be totally unfair for folks who had credit card compromises where those are taxable and mortgage compromises that are taxable. I think it is something, in my opinion, that we do not need to address in that way.”
When asked if the state could give tax forgiveness on PPP loans, why not on student loans, Berger was adamant that it was a completely different situation.
“PPP loans were taken out as a result of the federal government and the state government shutting down the economy,” he said. “Those loans were provided for by federal law passed by Congress, which called for the non-taxability of that. In this case, what we got is basically an edict from the President and probably is not consistent with federal law.”
Berger questions whether President Biden had the actual authority to forgive student loans, and said anyone who compares them to PPP loans is not paying attention to the specifics.