The Oregonian: Oregon’s antiquated laws block needed health services
Health care shortages are a nationwide problem, but they are particularly concerning in Oregon – the state with the second fewest hospital beds and second fewest rehabilitation beds per capita. This problem didn’t pop up overnight. Instead, Oregon’s “certificate of need” laws have been restricting growth for decades, leaving Oregonians without access to much needed health care services.
Consider Eugene. Since December 2023 when PeaceHealth closed its hospital near the University of Oregon, the city has lacked an emergency room. Without an ER, residents suffering strokes, heart attacks or other urgent medical situations are forced to travel another six miles to the nearest facility in Springfield. This delay significantly raises the risk of severe complications or even death in situations where every second matters.
Recently, McKenzie-Willamette Medical Center announced it wanted to fill the void and open a new emergency room in Eugene. While this was welcome news, there’s no telling at this point when it will open or even break ground. All the project leaders could offer was that they planned to begin the lengthy and challenging certificate of need application process.
For those who may not know, laws like this serve a gatekeeping function, requiring health care providers to prove to the government that a new health care facility or service is “needed.” Oftentimes, competitors will protest issuing more permits saying the city does not “need” more competition.
Ultimately, these laws do nothing to ensure safety, for either patients or employees. Instead, certificate of need laws impede access to care by delaying or completely prohibiting new facilities from opening. Sadly, Oregon restricts access to care in many areas, maintaining over 40 different CON requirements.
It is nearly impossible to understand how government employees in Salem could understand community health needs better than the on-the-ground healthcare providers. Worse still, the time and costs associated with CON applications often cause providers to change their plans or avoid the Oregon market altogether.
For example, Post Acute Medical is a rehabilitation provider that sought to open a state-of-the-art rehabilitation center for patients recovering from head injuries and strokes. Oregon was a good target for expansion, because there are so few facilities offering this type of care. Instead, as Willamette Week reported earlier this year, patients suffering from traumatic brain injuries typically must leave the state for rehabilitation treatment.
In 2018, the business filed an application for a certificate of need. It had to wait four years for a decision from the Oregon Health Authority. During that time, it was forced to fight with the incumbent providers to prove that Oregonians needed its services. Its perseverance paid off and in 2022 OHA finally granted Post Acute Medical’s application.
The battle, however, was not over. Post Acute Medical’s competitors sued, forcing it into litigation. After four years fighting for its certificate of need, the business was spent; it didn’t have the resource to continue a second years-long legal battle and alerted the state in July 2023 that it would no longer pursue the project. The existing competitors won; Oregonians lost. “The dogged self-interest of PAM’s opponents (who sought delay at every turn and plainly have no concern about the patients who would benefit from PAM’s services) shows no signs of abating, and the Oregon appellate courts promise to give those opponents years of further delay at the very best,” wrote the company’s attorney, according to a Willamette Week story.
Allowing existing providers to block new or innovative services from the market is why big, entrenched businesses support these certificate of need – often referred to as “CON” – laws. Large health care systems are skilled at using them to protect their turf. The real losers are Oregonians who cannot access needed therapies.
CON laws were sold to the public with the hope that centralized health care planning would create greater access to care and lower health care costs. But a survey of the academic research on certificate of need laws shows they do exactly the opposite, resulting in higher costs, fewer choices, and lower quality.
CON laws don’t make sense in any market, but they’re especially absurd in health care. Eugene needs emergency services now. The McKenzie-Willamette Medical Center is ready to provide that service, but what happens if its application is delayed for five years? The last thing the state should be doing is creating barriers to necessary health care – doing so could be deadly.
This op-ed originally appeared in The Oregonian on December 11, 2024.
